The SPECIALIST'S OFFICE => Overuse problems of the knee (except Osgood Schlatter's) => Topic started by: Matt99 on January 07, 2006, 07:13:03 AM

Title: Help and advice needed for patellar tendinopathy
Post by: Matt99 on January 07, 2006, 07:13:03 AM
If you have a few minutes, I would very much appreciate anyone with experience in overuse patellar tendinopathy to read my story and give some feedback. It's a bit lengthy but I thought I should be thorough. Anyway here goes....

Fall 2002, a very physically active time for me at work (forestry) and play (downhill mountain biking, moutaineering, ultimate frisbee, some running)... I injured left knee, and mis-diagnosed for 3 months before being told by an excellent PT that I have patellar tendinosis. Conservative therapy for many months through 2003, including an MRI (didn't show much), and I have a noticeable recovery after 6 months from diagnosis, and by 2004 I'm playing and working again but still making sure I allow myself to recover and not overload. I'm out of therapy by spring 2004. Through summer 2004 I'm starting to bike ride again, work semi-regularly in the field, and lovin' life.

THEN... by the end of the summer, over the course of about 7 bike rides and a month of time, I re-injured the knee. Following this, after basically doing nothing but walking to get around and swimming with legs holding a float for about 6 months, I decided I needed to get serious about physio again as things were getting worse. In late spring of 2005 I started with the eccentric leg squats, weekly physio visits, and a new sport (ww kayaking) to take my mind off the blues, I started improving again. I was even able to go for the odd little hike (less than 5km on easy ground). I was careful to not overdo things in terms of repitition or loading. This continued but it seemed I never got more than a 15-20% improvement in condition. I did notice the psychological effect of doing something fun like kayaking - it seemed to improve things probably just because it was a "lift" for the spirits and took my mind off things. With the end of paddling season and the 2005/2006 winter blues setting in, with the advice of my physio I'd thought I'd try some VERY mellow hockey (pick-up on a pond so amateur and egoless). I wasn't doing the eccentric leg squats anymore as I thought why bother if I'm walking and skating. After skating I would ice and stretch and ice and mostly rest. I played a mellow game for about 1 hour once per week and I thought it was okay, with some short mellow walks in between. Then slowly after about a month of this, I started to notice some very slight degeneration, so I backed off the skating. Home for holidays I went for a few walks, stretched and iced, did some eccentrics here and there, then towards the end of my Xmas, I went on a 8 km cross-country ski (classic -- not skate). It wasn't a quick or aggressive ski. I even rested for a good while after 4 km. This was about one week ago now (New Years eve).

Since this time, my knee has degenerated further, and it feels like it's where it was a year ago. As far as activity goes since xc skiing, I haven't done anything other than walk to get around, and ice. I saw my physiotherapist and he's now suggesting I see an orthopedic surgeon, as a year and 4 months of conservative therapy does not seem to be working. I made the referral yesterday, but it will take sometime to get in. He's reportedly a very talented surgeon who helps a lot of athletic types. I should also say that my physio had patellar tendinosis too, and got surgery, and took about 2 years to get back to full recovery or activity. Oh yeah, and I am 35 years old.

If you have any advice or insights into my situation that would be great. My concern is that, looking at this site and others, surgery does not at all guarantee an improvement, and in some cases can make things worse. Does anyone have any experience with APROTININ? What would you do in my situation. I do notice when I do nothing it gets worse, when I do too much (which my base level is already very low as you can tell), it gets worse too. A fine balance indeed.

Thanks for you time!!!
Title: Re: Help and advice needed for patellar tendinopathy
Post by: IanT on January 07, 2006, 09:24:25 AM

Your story sounds just like mine. Have you read this post -

Tendinopathy = Tendinosis, a condition very different to Tendinitis.

PM me with a 'phone number if you'd like to discuss my treatment and ongoing rehab experience.

Title: Re: Help and advice needed for patellar tendinopathy
Post by: Wojt on January 10, 2006, 10:33:09 PM
I have been  low back sufferer and knee problems having (not very well diagnosed, but looks like patella bursitis). Since many years I suffer to different degree daily. Let me tell you: emotional state affects terribly any injury or weak spot. Then it builds into the nervous system and no matter what you do, you feel the symptoms any time you get "mental". It is based on my experience, many years, I write diary every day. Try to control your mental state. I used to be sporty a lot, not anymore. It used to upset me horribly, inability to exercise. This did the damage on its own.
Take a rest, do not be active. Think positive about your break from activities. Give yourself a chance. Than you will start deeling better. In summary: Stay mentally positive (mind over body) and let you joints heal.
Best of luck,
Title: Re: Help and advice needed for patellar tendinopathy
Post by: australia on January 11, 2006, 06:28:11 PM
Given that:

1.) Your MRI "didn't show much"

2.) You had seen a lot of improvement after your original diagnosis, and seemed to feel normal for a number of months, until re-injury.

I would be very reluctant to under-go any surgery if I were you.

I also was diagnosed with patellar tendinitis, with minimal showing on an MRI.  I also improved -- although not in a straight line at all -- over the past two years w/ physical therapy.  My doctor, a well-regarded orthopedic surgeon in Boston, MA, said to me: "In my wildest dreams, I would not imagine any surgery for you."  He highly discouraged me from surgery.
Title: Re: Help and advice needed for patellar tendinopathy
Post by: old_runner on January 12, 2006, 01:59:14 AM
I'll chime in because I’m one of the "sad chronic tendonosis" out there.  My knee pain came 18 months ago after 25 years of distance running.  Running was a lifestyle thing for me, so it was about as natural as eating.  Anyhow, the OD I saw recommended a conservative approach and was pretty clear that surgery was not the correct path.  After 6 months and a couple failed attempts to return to running (at the level I expected), I got a referral from a friend that had a Petallar Debridemnt procedure done by a local OD.  After the MRI showed some minor damage to my left patellar he suggested surgery as an option.  Of course at that point I had already convinced myself that surgery was the way to go.  Well, 1 year later I am clearly worse off and in addition my other knee has started to show signs of degeneration as well.   I had been so frustrated that I went and saw a third OD who took another MRI and said the tendon still had a cyst on it.  He said he could "go back in" with 70% chance of success, to which I quickly said no thanks.

After 3 ODs and 3 PTs I am currently doing my own thing and trying to strengthen the knee with eccentric exercise and stretching.  At this point I have given up competitive running and would be happy to some day be able to jog five miles without my knees killing me.  Anyhow, as you may have gathered I would try to do just about anything before having surgery. If you do decide on surgery make sure your OD and PT have a very clear and structured rehab program.  Coming back too quickly probably did me in.

Good luck.
Title: Re: Help and advice needed for patellar tendinopathy
Post by: Matt99 on January 22, 2006, 07:38:53 PM
Thanks for all the feedback. There's a few things I've taken from here, the first being to only consider surgery as a last resort. Also, there are a few techniques I've never heard of that I'm wondering if people can link me to some sites that explain them a little better, and maybe their success. These are:

- aprotonin
- autologous blood injections
- galpapentin

My physio has never heard of these.

Thanks!! And by the way, I'm doing a little better (5%) than I was when I wrote this (2+ weeks ago), just from resting. :D
Title: Re: Help and advice needed for patellar tendinopathy
Post by: australia on January 23, 2006, 06:11:06 PM
I checked Medline to see if there was much written in medical journals about the first two items you mentioned.  Unfortunately, there wasn't anything I found helpful.  Hence, these treatments are likely to be new and unproven at this point.  Few, if any, double-blind, controlled experiments have likely been done by multiple researchers to say these things really work.  Given that there have been a lot of failed "cures and treatments" for patellar tendinitis, I'd be skeptical at this point.

The third item, Gabapentin (also known as Neurontin) is a drug that can relieve nerve pain associated w/ tendinitis and other conditions.  It may or may not be helpful for you.  It can be very helpful for some.  It does not treat your tendinitis, only the nerve symptoms you may have resulting from the tendinitis.  It must be prescribed by an M.D. 

Title: Re: Help and advice needed for patellar tendinopathy
Post by: racquetman on August 05, 2008, 05:57:14 PM
Have just been prescribed ABI for a tendinopathy including a small tear in the right patellar tendon.  Main sport is squash.  Will suspend thatfor the time being.  Probably important to mention that I ruptured the left almost 4 years ago playing squash. 

Have been gleaning options from the threads here, but interested in any views or pointers to research so I can make an informed decision after seeing the specialist next Monday!

Many thanks in advance.
Title: Re: Help and advice needed for patellar tendinopathy
Post by: shipitin on August 06, 2008, 12:41:28 AM
Racquetman you will spot that the rest of these contributions are quite old.  This is the only topic that I have been watching but have not contributed until now.

I developed a right knee Patellar Tendonopathy (PT ) in October 2005.  Until I put it to a real test, (which I am reluctant to do!) I get the impression that my knee has “fully” recovered.  I think the last time I was reminded of the problem may have been while skiing earlier this year.  However I do avoid sport and exercise that is likely to aggravate it. At  age 47 I am no longer that fit and am coming to terms with a changing lifestyle!  However, I now am happy to; go to the gym, play 18 holes of golf, play a few sets of tennis and most importantly, go ski touring off-piste and ski in deep powder.

History:   Previously adequately fit; running twice a week etc, lapsed for a month due to minor illness and probably caused tendonopathy whilst out running when trying to get fit again.  Perhaps underestimated problem and went on previously booked skiing holiday Dec 05 and kept  problem at bay with lots of Brufen anti-inflammatories.  Tried rest and denial until private orthopaedic knee surgeon No1 in May 06 recommended arthroscopy procedure.  MRI scan, report as follows: 
“Moderately severe tendonopathy and a small deep surface partial thickness tear of the proximal third of the patellar tendon.  Less marked tendonopathy in the medial fibres of the mid and distal thirds  of patellar tendon.  Associated adjacent inflammation.  Mild chondromalacia on medial facet of patella.  No menisular tear.  Mild subluxation of patella.”

Only for about the first year was I continually aware of the problem or worse limping with pain, following that I have been aware of it less and less.  But generally the condition has allowed me to walk reasonable distance and do such things as cycle gently.  It has only been a problem when ‘loaded’ and going up or down (hill or stairs) or given acute shock pressure (i.e. jumping down from height).  Life was tolerable but keeping adequately fit is very difficult and sports such as tennis and skiing was out of the question until a couple of yeas had passed.

I decided not to have the arthroscopy operation, but tried Physio, (mostly ITB stretching and patellar realignment) and Orthotic shoe in-plants.  Still no resolution so tried private orthopaedic knee surgeon No2 in Sept 06, who did not recommend operating for PT, (‘No evidence that it works’), but suggested KneeGuru and Autologous Blood Injections, (ABI).  I had two ABI procedures Nov & Dec 06 at Wimbledon with same chap mentioned above(?).   Unfortunately I did not follow up with the physio immediately as I should have done but did, three months later.  The physio was much the same as before but there was suggestion to address bad ‘core body strength’ which has knock-on effects around the body.

I don’t think that the ABI procedure on its own worked for me, and its probably imperative to do the physio.  I totally understand and accept the principle at play but still wonder if it really works at all!  What influence has the placebo effect or even the renewed discipline on physio on success stories elsewhere? 

It does seem as if a lot of people have the problem for a long time.  They seem to get better at some stage and sometimes coincidentally after doing work on it.  I wonder if rest and time are not the most effective.  I have wondered what age other patients are and if age affects the speed and possibility of recovery?
Title: Re: Help and advice needed for patellar tendinopathy
Post by: paulad on August 15, 2008, 08:50:28 PM
Hi everybody,
Today i just got diagnosed with patellar tendinotitis ,am just wondering will it ever go away or do i have this for life, i am very upset by this as i have knee problems all my life  but in the past 6 years i have had no problems with them and it's been great . Will i always have this will it get worse is their a cure for it? :'( :(