Treatment Options for Patella Tendonitis

[Clarkey]

As a long term suffer of patella tendonitis I can share my own experiences of a condition that not only physically demanding it also a mentally stressful as there no permanent straight forward fix. I have been battling on to try and resolve my chronic form of patella tendonitis that hard to get right again. It can end a professional athletic career when I spoke to my OS about having the condition and can only ease the pain and discomfort with physio exercises.

My chronic tendinitis started after two arthroscopies on my right knee. Scope #1 was a diagnostic arthroscopy and had medial plica excision and fat pad trimming in November 2009. it took 18 months to fully recover from the surgery. I was able to run at a competitive level long distances until I slipped on ice in January 2013 and not been able to run since. I had scope #2 in July 2014 that looked on my MRI scan that I would require microfracture surgery only to wake up having Anterior release surgery.

Scope #1 caused excessive build up of scar tissue with lots of scar tissue removed around the patella tendon. Since scope #2 it putting strain once again on my patella tendon, I have recently been diagnosed with right hip impingement. It might have been a long term pre existing condition problem that had been speeded up walking with a limp putting strain onto my right hip.

Treatment options that are currently available should be conservative treatment methods, never resort to surgery unless it absolutely essential. Most OS’s will try none invasive ways to hopefully fix or ease the pain and discomfort around the patella tendon.

The most obvious way to try and ease or if you are lucky fix the patella tendonitis is finding a Sport Physiotherapist that I find are better at sorting out knee injuries than standard physiotherapist. Increasing the quadricep muscles that is also helpful if you have maltracking problems. Making the muscles stronger will lift the kneecap slightly so you feel less anterior knee pain and discomfort.

If that does not work cortisone injections can help some patients with patella tendonitis and not for others that increases the risk of rupturing of the patella tendon. I had 3 injections in one year, I found it did not benefit my patella tendonitis.

Platelet-rich plasma therapy, sometimes called PPR is not an option to consider if you have patella tendonitis that many OS are totally against!  It increases problems rather than ease patella tendinitis. It can increase scar tissue build up after reading OS’s online articles about treatment methods for patella tendonitis.

Mr Willis Owen has had personal experiences of patella tendonitis. He thinks highly of using ESWT that may or may not improve patella tendonitis with some useful information on his link below.

http://www.sportsorthopaedicspecialist.co.uk/sports-injuries/patellar-tendonitis-jumpers-knee

http://www.sportsorthopaedicspecialist.co.uk/treatments/shockwave-therapy

http://www.kneeguru.co.uk/KNEEnotes/courses/lower-limb-overuse-injury-series-charles-willis-owen-frcs/tendinitis/patellar-tendinitis

Mr John Hardy is the OS that came up with this procedure called ‘Arthroscopic Confluence Coblation Surgery’ that should not be mixed up with Arthroscopic Infrapatella Pole Surgery that is likely to make the knee worse rather than better. This type of surgical procedure is less invasive with a high success rate in the healing of chronic cases of patella tendonitis.

Quote from Mr John Hardy web link.

http://www.johnhardy.co.uk/Publish/information/patella_tendonitis.pdf

Mr Johnson an OS based in Bristol OS has operated on professional sports men and women that have chronic patella tendonitis by performing patella decompression surgery. My OS says he will perform patella decompression surgery if PT and ESWT does not fix my patella tendonitis, this is now looking likely to happen at some point in 2017 that is a high risk and big gamble!

http://www.kneeandsportsinjuryclinic.co.uk/patient-information/knee-surgery/patellar-tendonitis/

Hope my links and sharing my own personal experiences will be useful informative information about patella tendonitis or Patellar tendinopathy / Jumpers knee There have been an increase in postings from members with patella tendonitis so now is a good time to share with everyone that are suffering from patella tendonitis.

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[Kasix]

Dear Clarkey,

Recently I have been diagnosed with patellar tendinopathy. My case is quite atypical because the main cause of my condition is a tibial IM nailing surgery which I had 6 months ago due to severe farcture of both tibia and fibula. IM nail is placed inside tibia through knee, patellar tendon is cut along and then sutured. It's been 2 months since my symptoms started. 

First I tried doing some excercises because my leg muscles are weak, then I took NSAIDs which helped but in a short run.

My OS recommened 5-6 sessions of ESWT over next 5-6 weeks, which I start tomorrow, and limit physical activity to walking only to let my tendon heal. He himself had ESWT therpay for tennis elbow and speaks highly of results.

Did you have your ESWT treatment? How was it? Any improvement?

I will share my experience.

[Kasix]

I already had 3 out of 5 ESWT treatments for patellar tendonitis and want to share my experiences.

Parameters of my treatment: 2,2-2,5 Bar, 9-10 MHz, 2000 shocks per treatment.

It is a bit painful, especially when close to the bone but absolutely bearable. The knee area was sore for about 24h afterwards.

I felt improvement after the second treatment. The knee was less stiff and my pain decreased (I could do a full squat, very slowly with just a little discomfort that was not possible before). After third it is even better!

My plan is to start light strenghtening excercises 10 days after the last, 5th treatment. Will see it the pain comes back.

[Clarkey]

Hi Kasix,

Sorry for the late reply to your post, glad that the ESWT has worked out ok for you and are seeing some improvements. My three treatment pressure bar were;

1st session 1.8 @1500 pulses with a frequency of 10.
2nd session 1.8 @2000 pulses with a frequency of 15
3rd session 1.8 @200 pulses with a frequency of 15

Three cortisone injections and physiotherapy have all failed to improve my right knee patella tendoniti, scheduled for patella decompression surgery sometime in October. Will be 2 years post-op next week Tuesday 18th July, have not made any progress since the AIR surgery.

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[Clarkey]

After over 3 years post-op I will be scheduled for what I hope will be my 3rd and final surgery for a long time period until my right knee has worn and need a TKR hopefully well into my retirement. Patella decompression surgery is not a common surgical procedure with a mixed reviews of a successful surgery. I am hoping that my OS finds other problems while doing a diagnostic arthroscopy increasing the success rate.

Has anyone had a successful patella decompression surgery getting back to physical activities at a none competitive level. Playing football with your children or nephews and nieces as an example, if I could do short distance running before feeling pain and discomfort I would be satisfied. Right now restricted in my new job as an autism support worker not being allowed to key work a service user that's suddenly run off. Happened this week at the summer club I am working in north east Birmingham. If i could run a ok pace in the sports hall would be a big bonus after surgery in autumn 2017.

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[Christine10S]

Hi Clarkey-
what do you feel are the best exercises for patellar tendinitis?  You seem to have a great deal of experience with this terrible injury.  Im sorry you aren't 100% yet, I hope your recovery is coming along.

[Clarkey]

Hi Clarkey-
what do you feel are the best exercises for patellar tendinitis?  You seem to have a great deal of experience with this terrible injury.  Im sorry you aren't 100% yet, I hope your recovery is coming along.

Hi Chris,

Isometric contraction muscle exercises puts less strain on the patella tendon building up the muscles with less strain onto the knee joint. I had 3 sessions Extracorporeal shock wave therapy (ESWT) followed by isometric holds. An x-ray guided cortisone injection close to the patella tendon effusion that did not improve the pain that was mainly around the bottom of the tibia feeling knotting if I rubbed my finger across the tibia.

Links might be helpful.
 
https://nydnrehab.com/blog/how-isometric-exercises-can-reduce-tendon-pain/

http://blogs.bmj.com/bjsm/2013/07/23/tendinopathy-rehab-progression-part-1/

I was dealing with a lateral meniscus tear that did not show up on the MRI that could have been torn from the excessive scar tissue having anterior release surgery twice in succession. Be cautious towards cortisone injection close to the patella tendon that can weaken tendon making it more likely to snap/rupture. ESWT and isometric holds were advised by the sports medicine doctor I saw before my 3rd scope who was the team doctor for England Cricket team and London 2012 Summer Olympics.

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