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PAIN BELOW KNEECAP / JUMPER'S KNEE / PATELLAR TENDON RUPTURE

    JUMPER'S KNEE / PATELLAR TENDINOSIS / PATELLAR TENDONITIS / PATELLAR TENDINOPATHY

    • Tendinosis differs from its cousin tendonitis in a few important ways. 
    • Tendinosis can indeed produce pain, stiffness and swelling in a tendon. However, it usually develops gradually as a result of long-term overuse. 
    • Probably many, many microtears over a long period of time rather than a more acute injury. It isn't inflammation like tendonitis, it's degeneration. 
    • As such, the greater the extent of cellular changes in the tendon, the longer and more difficult the healing process. 
    • Since tendinosis is a chronic condition, this doesn't have one root cause. It's a common knee injury seen in athletes. 
    • Patellar tendon starts degenerating due to it's overuse and poor conditioning. 
    • Small tears in the tendon can make it difficult to walk. A large or complete tear of the patellar tendon is a serious disabling injury (Torn Patellar Tendon). 
    • Torn Tendon usually requires surgery and physical therapy to regain full knee function. Jumpers Knee is relatively common with about 14% of athletes currently affected. 

    PATELLAR TENDON
    It actually is a ligament (thick band of tissue) connecting patella (knee cap) to the tibia bone. Patellar tendon plays major role in Extension of knee joint (straightening of leg) with help of quadricep muscle group.

    Severity of JUMPER'S KNEE

    In severe cases it can cause Patellar tendon to tear and torn tendon will lead to difficulty while walking and weakness of Quadricep muscles.

    Stage 1 – Pain only after activity, without functional impairment

    Stage 2 – Pain during and after activity, although the person is still able to perform satisfactorily in his or her sport

    Stage 3 – Prolonged pain during and after activity, with increasing difficulty in performing at a satisfactory level

    Stage 4 – Complete tendon tear requiring surgical repair

    Symptoms of JUMPER'S KNEE

    • Pain and swelling over that knee region.
    • Indentation is felt/observed where the patellar tendon ruptures.
    • Tearing or Popping sensation when if ruptures.
    • Kneecap moves up a bit because it is no longer anchored to your shinbone.

    Diagnose JUMPER'S KNEE

    • Physical test are very important to diagnose it.
    • Patellar Tendon is palpated to look for tenderness(pain) around that region.
    • A gap is felt in the patellar tendon just below the kneecap.
    • Straight leg raise test is negative that is patient won't be able to raise his leg above knee joint. Unable to perform active straight leg raise or maintain passively extended knee.
    • Knee's range of motion decreases (and difficulty bearing weight).

    X-Ray and MRI of Patellar Tendon Tear

    • An X-ray is obtained, to exclude patellar fracture as it produces similar symptoms.
    • On the X-ray, patella usually shifted upwards as compared to the opposite knee because quadriceps pulls up the kneecap, and torn or week Patellar tendon is unable to holds it down in its normal position.
    • MRI may be used to confirm the diagnosis but its more significant for analyzing surrounding tissue damage. MRI is used to 
    1. differentiate between partial and complete tendon rupture 
    2. find site of disruption
    3. degeneration in tendon
    4. soft tissue injury in that region

    • Ultrasound indicates acute and chronic injuries. 
    • USG is very effective at detecting and localizing disruption in the tendon.

    TREATMENT

    Initial treatment typically involves rest, physical therapy and other conservative measures all aimed at allowing the body's healing mechanism to catch up with the damage. Small tear in the tendon get easily recovered with rest and conservative therapy but a completely torn patellar tendon does not heal well on its own, and left untreated will lead to weakness of the quadriceps muscle and difficulty with routine activities, including walking.

    Surgical Approach

    • Surgery to repair the ruptured patellar tendon is relatively straight forward in concept but can be difficult to perform.
    • The torn ends of the tendon need to be sewn together. 
    • The difficulty lies in the fact that it is important to restore proper tension to the tendon, not making it too tight or too loose.
    • Also, it can be difficult to get a good repair, especially if the tendon has torn directly off the bone. 
    • The sutures used to repair the tendon have to be attached directly through the bone.
    Conservative Approach
    • Conservative Treatment is given to those with minute tear or moderate injury to the Patellar tendon.
    • Patellar Tendon is allowed to heal by itself with adequate rest to the tendon.
    • Knee Brace And Tapes are used for this purpose.
    • Physical therapy plays a major role in complete rehabilitation of Torn Patellar tendon.
    • Physical therapy should begin as soon as the pain has diminished. 
    • Program must consist manual techniques, and therapeutic exercises to control pain, reduce inflammation, and increase strength, flexibility, and muscle endurance of the injured area. 
    • Must Consult a Doctor If
      Stretching and strengthening the leg (quadriceps) muscle is a key to successful rehabilitation of Jumper's Knee.

    • Symptoms Continue or worsen even after rest 
    • Pain is unbearable and doesn't subside with time
    • Pain Interferes with your ability to perform routine daily activities

    Recovery and Prognosis

    • Recovering from a torn patellar tendon is difficult and takes time but pain due to Jumper's knee recovers within a month.
    • One of the most important prognostic factors for recovery is the time to surgery, and surgery delayed beyond a few weeks can limit recovery ability.
    • It is known that early mobility after surgery, protected strengthening, and preventing excessive stress on the repair will speed overall recovery. 
    • Even with these steps, there is a minimum of three months until the return of normal daily activities, and four to six months until sports should be resumed.
    • While most people heal completely from a patellar tendon surgery, there can be long-term weakness even with a successful repair.
    • Athletes who are attempting to return to competitive sports may take a year or longer to return to their preinjury level of function. 

    Prevention of re-rupture

    • After a person has recovered from patellar tendonitis, they can take steps to try and prevent future injuries.
    • Anyone who plays a sport in which jumping and hard landings are common, they can take the same steps to avoid getting injured in the first place.

    ways to strengthen patellar tendon

    • warming up and stretching before exercise
    • cooling down and stretching after exercise
    • wearing knee support when playing sports
    • doing exercises to strengthen the leg muscles and support the knees
    • avoiding jumping and landing on very hard surfaces, such as concrete.
    Cristiano Ronaldo's Patellar Tendinosis
    Cristiano Ronaldo took his Real Madrid  squad to the Champions League title, but it came with a cost. The speedy winger fought a sore knee for much of the season, spending long hours with the Real Madrid medical staff. The condition had complicated, though, with reports said that Ronaldo was now dealing with tendinosis, not tendonitis. He worked with his own therapists and doctors as he prepared to play for Portugal in the World Cup. This is one of the reasons that he wasn't taking part in many Portugal games or workouts. Much of the therapy he did was simply rest and trying to let his body rebuild and recharge. There was significant rehab, including some fairly advanced techniques designed to help slow any degeneration in the knee.


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