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Author Topic: Patellar Tendon Problems (Left Knee)  (Read 581 times)

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Offline Baez

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Patellar Tendon Problems (Left Knee)
« on: May 19, 2016, 08:57:52 PM »
Long post, TL;DR at bottom!

This probably started about 4 years ago playing soccer. I broke my right tibia (hairline fracture) and probably started playing again too soon afterwards. Because of this, I favoured my left leg the first season back far more than I should have. Maybe 6 months later, I started getting a pain right below my patella. I ignored it for the first while but it started getting painful enough that I had to wear a patellar strap.

Fast forward a year (about 2.5 years ago) and it's bad enough that even when taking a month off it stays painful. I go to physio and they try electro-acupuncture and shockwave therapy for a few months, with no significant improvement. After that had failed I had pretty much come to terms that this was a problem I would have to live with.

Then about a year ago I was seeing another physiotherapist for a separate issue. I mentioned to him my patellar tendon problems and he recommended an ultrasound (first time anyone recommended this). Turns out I have a 1.5cm (3/4in) tear. The doctor and technician couldn't tell how it happened but suspected it could only have been from blunt-force trauma. I only remember it getting progressively worse, not in an instant. They were surprised it hadn't ruptured.

6 months ago I received my first PRP injection (which no one told me would be so excruciating!) and 3 weeks later a second injection. I took about 6 weeks off after that to allow it to heal. I go to get a second follow-up ultrasound, nervous that I just spent $1500 for no reason. Ultrasound came back and the tear had completely healed! No sign of any opening. Awesome. I start playing again and it feels amazing, I couldn't remember a time without the pain by then.

Then, about 2 months ago it starts to hurt again and I get worried, but still far less pain than before. Until it gets warmer 3 weeks ago and I go for a bike ride. Knee feels okay during, but the morning after it's so stiff and painful. Since that ride it's been getting worse and now is even more stiff and painful than it ever has been. Soccer hasn't been painful since the PRP and now that's just as bad.

Does this sound like a potential case of a patellar bone spur or something else going on? I'm not sure what to do going forward and I don't want to waste my time and another doctor's time for something that's not there.



TL;DR Have patellar tear, get PRP, heals perfectly and feels great, 2 months ago gets worse again and now even more painful.

Offline Leena20

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Re: Patellar Tendon Problems (Left Knee)
« Reply #1 on: May 20, 2016, 08:21:17 PM »
To me it sounds like your patella tendonitis may have returned. Usually after the PRP injections you should have a physio programme so you progressively load the tendon more, and return to sports slowly. I would go to a doctor and see if you can get an MRI. It should be possible to diagnose what is going on from that and sort out a treatment programme - you're definitely not wasting anyones time if you're in pain!   

Offline Clarkey

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Re: Patellar Tendon Problems (Left Knee)
« Reply #2 on: May 24, 2016, 05:33:02 PM »
Hi Baez,

I am also having on-going problems with my right knee with patella tendonitis, it has been a problem since having a 2nd surgery of anterior interval release surgery (AIR) in July 2014. My 1st surgery was medial plica excision and fat pad trimming.

There a lot of discussions amongst OS's if PRP injections does relief patella tendonitis? I have so far had PT and 3 cortisone injections last year, it has not made any difference. I have not been able to run since January 2013, I can only walk at a slow pace! If I try to increase then I straight away get intense anterior knee pain right at the bottom of the tibia. 

I have yet to try out ESWT that I see has not really benefited your patella tendonitis, I think here in the UK the OS’s are over rating it too much as a miracle cure for ‘chronic patella tendonitis’ that I yet to try out. I will have 3 sessions of ESWT in September to please my OS and the Sports Physician. I know it is more than just patella tendonitis, I have asked my OS for to go ahead with a diagnostic arthroscopy. He reluctant to go ahead in the fear of forming excessive scarring and patella baja as he states on my MRI scan report.

Paragraph of my latest MRI scan that was done in December 2015.

The MRI showed change of signal of the fat pad underneath the patella. Otherwise there were no pathological findings on it. On further evaluation of the MRI one may appreciate a slightly bigger distal pole of the patella with a bone spur which may be affecting the fat pad, however the signal of the tendon is normal. In addition Professor Snow was a little concerned about developing of patella Baja after surgery.

A useful link and information about how to treat patella tendonitis by a British OS that been through the knee condition himself with personal experiences of patella tendonitis.


Mr Charles Willis-Owen a UK based OS located south of London has done extensive research on PRP injections for inflammation of the patella tendon saying the following quote.

PRP (platelet-rich-plasma) injections have been shown in large metastudies to be of no benefit for patellar tendinitis.

http://www.kneeguru.co.uk/KNEEnotes/specialists/knee-surgeon/dr-mr-charles-willis-owen

There are other way to try and resolve patella tendonitis by trying out all the conservative methods of treatment.

1.   Physiotherapy
2.   Cortisone injections
3.   PRP Injection (does not work)
4.   Extracorporeal shock wave therapy (ESWT)
5.   Surgery

Link below is NHS based that mentions ESWT so assuming it is available that I could possibly try out before resorting to surgical intervention.

http://www.nhs.uk/Conditions/Tendonitis/Pages/Treatment.aspx

Surgery

Surgery may be an option for some tendon injuries, but this is often only considered as a last resort because it's not always effective and carries a risk of complications such as wound infections, scarring and rupturing of the affected tendon.

Surgery can be used to:

•remove the damaged section of tendon

•remove lumps or deposits that have formed on the tendon

•encourage the tendon to heal

•repair ruptured tendons


Good luck with your patella tendonitis and any other problems that get picked up on by your OS. Hopefully it will only be a short term acute knee injury rather than a chronic knee condition injury.

[email protected]
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming