Patellar tendonitis treatment. Patellar tendonitis (jumper's knee): symptoms and treatment. Surgical treatment of the disease

Knee movement and stability are possible thanks to the well-coordinated work of its five ligaments:

two cruciform,
two lateral,
own patellar ligament.

In addition to unpleasant situations associated with direct injury to the knee (ligament rupture, dislocation or fracture), there is another danger - knee tendonitis (inflammation of the tendons and ligaments). The most commonly diagnosed tendonitis of the patellar ligament itself.

Patellar Ligament Anatomy

The proper ligament extends the tendon of the quadriceps femoris and attaches it in front of the tubercle tibia located below the kneecap.

Such an original structure makes the knee joint unique: it provides not only motor functions, but also works on the principle of a lever-block mechanism, multiplying the efficiency of the quadriceps muscle:

Causes of Knee Tendinitis

Knee tendinitis is caused by either mechanical or degenerative causes.

Mechanical tendonitis

The first type (mechanical) is associated with sports or professional activities:

Constant training or load leads to microtrauma of the ligament and the occurrence of an inflammatory process in it.
Patellar tendonitis is most often diagnosed in athletes involved in jumping sports, which is why this pathology has received a very accurate name - the jumper's knee.

The greatest tension always appears at the place of attachment of the ligament, and, therefore, tendonitis develops mainly in the place of its fixation to the patella or tubercle of the tibial muscle (the former is more common). Thus, it is more expedient to consider it not tendonitis, but enthesitis.

The provoking factors of tendonitis are:

flat feet with its collapse inward (pronation);
the anatomical position of the patella, in which the ligament is pinched by it when the knee is bent above 60 °;
impaired knee stability with rotation of the femur and tibia;
hamstring syndrome - injuries caused by constant loads of the muscles of the back of the thigh.

Degenerative tendinitis

The second type of tendonitis is age-related and is associated with aging of the ligaments and degenerative changes in them:

mucoid process or fibrosis predominates;
pseudocysts appear.

Ligament degeneration can be facilitated by:

rheumatoid arthritis;
infectious arthritis;
diabetes;
long-term use of glucocorticosteroids and other reasons.

In the weakened ligament, the process of regeneration is also underway - the restoration of degeneratively altered areas:

the recovered areas are denser and larger;
angiofibroblastosis is possible in them;
ossification (ossification) and calcification of the ligaments can be observed - this property is observed in both types of tendonitis.

Stages of knee tendonitis

Knee tendinitis goes through four stages:

First, the symptoms of pain discomfort occur only after exercise or exertion.
Second, the above symptoms are possible both before and after the load.
The third is pain symptoms during the exercise itself and after it.
The fourth is a ligament rupture.

The gap comes naturally: chronic inflammation in a bundle lead to its structural changes, reducing the mechanical strength. If the rupture is not due to an ordinary injury, but due to tendonitis, then it is considered a complication of tendonitis.

Symptoms of Knee Ligament Tendinitis

Tendinitis of the own patellar ligament begins at first with mild dull pain in the lower part of the patella or in the area of the tibial tubercle.
On the early stage pain occurs mainly after exertion.
There is also a feeling of tension or stiffness, and knee extension can be difficult.
As the progress progresses, the pain becomes more intense until it begins to accompany all flexion and extension movements.
If tendinitis affects the deep layers, then with strong and deep pressure on the area between the patella and the tubercle of the tibia, pain occurs.
A symptom of a partial or complete rupture of the ligament is pain when extending with resistance.

Diagnostics

To clarify the diagnosis, an X-ray of the knee is done: frontal and lateral projections.

X-ray allows you to identify fatigue microtrauma, areas of ossification and calcification.

It should be noted that knee pain can be for many reasons:

damage and rupture of the meniscus;
osteochondropathy of the patella;
an enlarged tubercle of the tibia.

For a closer examination of local areas of the ligaments or menisci, an accurate examination using computed tomography or magnetic resonance imaging may be required.

Knee Tendonitis: Treatment Methods

In the first two stages, conservative treatment is used:

Facilitate training and stress regimes, reducing the intensity of training or work.
Put on ice compresses.
To reduce pain, use oral or intramuscular non-steroidal anti-inflammatory drugs (ibuprofen, indomethacin, naproxen)

It is better not to use intra-articular local injections of NSAIDs or glucocorticosteroids for knee tendinitis, as they contribute to the development of ligament atrophy.

All of these drugs have a temporary effect and have many side effects, especially for the digestive tract.

The main method of treating knee tendonitis is exercise therapy with exercises for hyperextension and strengthening of the quadriceps muscle of the thigh and the posterior muscle group.

You need to do them for a long time (sometimes several months), but the effect of the exercises is very good - they allow you to cure tendonitis and resume training or work in full mode.

Another type of conservative non-drug treatment is taping.

Taping for knee tendonitis

The point of taping is to use special tapes that unload the bundle.

There is different kinds taping:

the tape is glued across the bundle;
crosswise with attachment at the top or bottom;
along the ligament with fixation below the tibial tubercle, to which the patella's own ligament is attached;
combined taping (for example, cruciform and longitudinal, cruciform and transverse).

As well as taping, wearing orthoses helps to relieve the knee's own ligament, only it is not worn directly on patella, and a little lower.

Surgery

Third to fourth degree tendinitis of the knee joint is difficult to correct conservatively, and then surgical treatment may be required.

They often resort to arthroscopy - a method in which an instrument is inserted through small punctures under the supervision of a microscopic video camera and the damaged areas are removed. In this way it is possible to delete:

slight damage to the ligaments;
growths on the patella, if they pinch the ligaments.

Cysts and other formations require open surgery.

Types of open transactions:

excision of the ligament;
scraping the bottom of the patella;
multiple tenotomies on the ligaments (notches).

But these methods can lead to weakening and rupture of the ligament in the future. In the fourth stage, the preferred operation is plastic reconstruction.

Sometimes surgeons resort to other kinds of operations:

resection of the lower pole of the patella, if it is considered the culprit of chronic knee tendonitis;
removal of the fatty body (Goffa) located under the patella.

Exercise therapy: examples of exercises for knee tendonitis

These exercises are very effective for knee tendonitis:

Quadriceps Stretching Exercises:

Turning our back to the table or pedestal and holding the back of the chair, we put our right foot on the table. We maintain balance for 45 - 60 seconds, feeling tension on the front of the thigh. We repeat the exercise with the left leg.
You can slightly modify the exercise without placing it on the table, but holding the back with your hand on the foot.
Sitting on the floor, bend over backwards, leaning back on your elbows. We bend one leg at the knee, and raise the other straightened one and hold it for a while. Then change the position of the legs and repeat the lift.
Isometric exercise (for severe pain):
- Sit on the floor, legs straightened, hands rest on the back of the floor.
- Tighten the leg muscle by pulling the kneecap towards you (the leg remains motionless).
- Fix this position for a few seconds, then relax and repeat with the other leg.
- Perform 20 times in several approaches.
Resistance exercises (performed with a rubber cord or elastic band):
- The leg bent at the knee is fixed with a tape. We extend the knee, overcoming resistance.
- Other options: abduction of the leg with resistance back, to the side, swinging the leg.

Exercises for the thigh muscles of the posterior group:

In a standing position in front of a table (gymnastic ladder), put your foot on a surface or a crossbar and reach with your hands to the foot without bending the other leg.
In a sitting position on the floor, bend over alternately to the feet of the spread legs.

Video: Self-healing knee tendonitis.

A fairly common disease characterized by damage to the tendon of the knee joint at its junction with the bone, and later on by the development of inflammation, is called knee tendinitis. Absolutely any person, regardless of gender and age, can face this pathology.

What Happens With Tendinitis

In terms of incidence, tendonitis is equated to. The knee has two menisci: lateral and medial. It is the medial meniscus that is more susceptible to trauma, because it is less mobile and it is more associated with the knee ligament. People who are actively involved in sports, adolescents and people over 40 are more susceptible to the development of tendonitis of the knee joint. Knee tendinitis is acute and chronic.

Ignoring the symptoms of the disease is fraught with a decrease in the strength of the patellar ligaments, and in the future - their rupture. It is necessary to treat tendonitis on time - this is the only way you can avoid serious complications.

Otherwise, the disease is called "jumper's knee." This is due to the fact that most often it affects people involved in cycling, basketball, volleyball and other "jumping" sports. The pathology is characterized by damage to the patellar ligament, which is attached to the tibia and is a continuation of the quadriceps femoral ligament. She is responsible for extending the knee and raising the limb in an extended form.

In most cases, there is a lesion of the knee joint of the pushing leg, but damage to both joints is not uncommon. A large number of microscopic injuries occur due to high intense loads. With normal rest, the restoration of damaged tissues is observed. If there is no rest, as such, microtraumas lead to degenerative changes in the knee, in particular, the tendons, which provokes the development of tendonitis.

X-ray diagnosis.

The disease begins, as a rule, with inflammation of the tendon bursa or tendon sheath. It is often mistaken for a common sprain of ligaments and tendons. Only a qualified specialist can identify pathology. Only he can appoint correct treatment... The sooner you seek help from a doctor, the sooner recovery will come and the lower the risk of complications.

The reasons for the development of pathology

The causes of knee tendonitis abound. may be due to:

prolonged and intense stress on the joint;
various injuries, in particular subluxations, meniscus injuries;
fungal infections;
bacterial infection;
an allergic reaction to medications;
anatomical features (flat feet, different leg lengths);
a decrease in the body's defenses;
age-related changes in tendons;
increased joint mobility.

Factors provoking the development of inflammation include long-term use, the presence and diabetes mellitus, renal failure. Tendinitis can be infectious and non-infectious.

To distinguish tendon problems from other knee pains, see this video:

Symptoms

Symptoms of tendinitis do not appear immediately. Moreover, a person after an injury to the knee joint (dislocation or subluxation) may not even be aware of or the development of tendonitis. Symptoms of the pathology can be confused with tendobursitis of the crow's feet tendons, characterized by intense pain.

Bursitis of the crow's feet can develop as a result of trauma (subluxation, dislocation of the joint, rupture of the meniscus, blows). The bursa of the crow's feet is localized between the medial collateral ligament and the tendons of the crow's feet. The diseases are similar, but require different treatment. Therefore, you should not self-medicate and guess that this is a rupture or damage to the meniscus, subluxation. If appears, seek medical attention. Only he, on the basis of complaints, examination and a number of additional studies, will be able to identify pathology.

Inflammation of the knee is accompanied by:

the unexpected appearance of pain in the affected area, radiating to nearby areas;
pain provoked by changes in atmospheric pressure;
deterioration of joint mobility;
redness;
swelling;
the appearance of a distinct squeak at the bone attachment points during movement;
increased sensitivity to palpation.

However, doctors do not advise taking such drugs for a long period, because this can lead to disastrous consequences from the gastrointestinal tract. NSAIDs are prescribed in two-week courses.

With severe inflammation, antibiotics are prescribed. Corticosteroid injections can help minimize pain. Remember: taking this or that drug can only be prescribed by a doctor. Overuse of corticosteroids can weaken the tendons and rupture them further.

Of the methods of physiotherapy for tendinitis, the use of UHF, magnetotherapy, electrophoresis and iontophoresis is prescribed.

In the treatment of knee tendonitis, massage and exercises aimed at stretching and strengthening the muscles and helping in the repair of the tendons after treatment are helpful.

Surgical intervention

The operation is performed at the last stage of tendonitis. Surgical intervention is aimed at removing the affected tissue in the patella area. Arthroscopy or open surgery is prescribed.

If there are calcium build-ups on the patella (calcifying tendinitis), leading to infringement of the ligaments, arthroscopy is prescribed. The growths are removed through small incisions.

When any other volumetric changes appear, an open operation is assigned. Quite often, in addition to excision, during surgery, curettage is performed in the lower part of the patella. This helps to activate the recovery process.

At the last stage, in order to restore the functions of the quadriceps muscle of the thigh, the ligaments are reconstructed. During surgery, it is not uncommon to completely or partially remove the Hoffa's fatty body and transfer the ligament attachment in the event of an axis violation.

In the case of a purulent adherence to the tendonitis of the knee joint, purulent contents are urgently pumped out of the tendon sheath. The duration of the postoperative period is three months.

The use of alternative medicine

Treatment of tendonitis should be prescribed exclusively by the attending physician. Means of informal medicine are effective and efficient, but do not forget that they are an addition to traditional medicine and that is why you should not replace medications with infusions and compresses.

For the treatment of tendinitis, it is recommended to use funds both for external use and for internal use. Herbal medicines help minimize inflammation, improve overall health, and strengthen the immune system. With their appropriate use, recovery will come many times faster.

Oral means:

Brew the chopped ginger rhizome in three hundred milliliters of boiled water. Leave to brew in a thermos. Drink 100 ml of the drink three times a day.
In order to minimize pain, curcumin is recommended as a condiment.
Fill in the partitions walnut in the amount of one glass of quality vodka - half a liter. It is necessary to insist the composition for three weeks. Consume twenty drops of the strained tincture twice a day.
Steam fresh berries of bird cherry - 20 g, or dried (50 grams) in two hundred milliliters of freshly boiled water. Heat the mixture over low heat for a quarter of an hour. Take 50 ml of the strained drink three to four times a day.

Means for external use:

It is recommended to massage the area with inflammation every day with a small piece of ice. The duration of the massage is a quarter of an hour.
Take a few leaves of aloe, wash them and place them in the refrigerator for a day. Grind the raw materials, squeeze the juice out of it. Soak a gauze cloth in freshly squeezed juice and apply to the affected joint for three hours. Secure with a bandage. Change the dressings on the first day five times a day, and then apply compresses once a day before going to bed.
Combine chopped arnica with melted lard. Heat the mixture over low heat for a quarter of an hour. Use the cooled ointment to rub the affected joint twice a day. The remedy will help in eliminating the symptoms of tendonitis, in particular, inflammation and swelling.

Application physiotherapy exercises

Lie on your side. Try to raise both legs as much as possible. Repeat the exercise five times. With each subsequent lesson, you can increase the intensity and number of repetitions.
Lie on your back. Raise your straight leg 90 degrees. Repeat five times. Do the same with the other leg.
Lean your back against the wall. Squeeze the ball at your knees.
Sit in a chair. Bend and straighten your knees.

Walking, extension and swinging of the leg with resistance are also used.

Prophylaxis

In order to prevent the development of such a common pathology as knee tendonitis, adhere to the following recommendations:

make it a rule to warm up your muscles before each workout;
avoid prolonged stress on one muscle group;
bend your legs when lifting weights;
get more rest;
avoid injury to the knee joint.

Following these simple guidelines can help prevent tendonitis. If symptoms of pathology appear, in no case do not hesitate to visit a specialist. It is necessary to treat the disease in a timely manner and only under the supervision of a doctor.

An internet user shared how to cure tendonitis on his own. You will learn about his method from the video:

Knee tendinitis is more common in athletes. These are inflammatory processes in the tendons of the patella and adjacent tissues, which are associated with mechanical trauma. But research shows that inflammation of the tendons can be associated with other causes, including infectious and rheumatic diseases, metabolic disorders and neuropathy that causes muscle disorders, with degenerative processes in the joints. The disease is fraught with complications, therefore it needs complex treatment, which is possible only after a comprehensive examination.

Symptoms

The disease can manifest itself in various ways. This partly depends on what causes it. One thing is injuries, flat feet, incorrect posture. But if arthritis or gout influenced the development of tendonitis, then signs of these diseases will be added to the pain in the tendon. If it is caused by infections, then symptoms of general intoxication of the body may be observed - headache, weakness, decreased appetite, low-grade fever. The classic symptoms of tendonitis itself are as follows:

1. Pain (sometimes moderate, in advanced cases - burning) in the tendon itself and in the areas adjacent to it. Sometimes the pain gradually increases, sometimes it appears suddenly. If calcium deposits are present, it will be especially sharp.
2. Decreased joint mobility.
3. Puffiness, which is complemented by inflammation and redness, but this is not always the case.

Sometimes nodules that do not move to the side become noticeable, which surround the joint. If tendovaginitis (inflammation of the synovial membrane of the articular sheath) develops, then chronic fibrosis is observed.

With tendinitis, pain is noticeable on palpation of the tendon. But it usually intensifies either during movement, or immediately after it. Painful sensations can appear when the weather conditions change (when it is damp, windy, there are drops in atmospheric pressure). There is an increased stiffness of the tendons and joints due to tension. Moreover, this symptom may appear the next day after the injury.

Tendinitis of the patellar tendonitis is more common in athletes who are involved in jumping and athletics. It is sometimes even called the "jumper's knee". In this case, the disease affects the patellar ligament, which extends down from the patella and is an extension of the quadriceps femoris muscle. It connects the latter to the head of the tibia. Its task is to provide knee extension. It also helps to lift the extended leg. This type of disease in athletes often affects the knee of the jogging leg. That is, tendinitis of the right or left knee is observed. In rare cases, the disease affects both limbs.

The disease is usually caused by repeated injury to the ligaments under loads typical for running, basketball, volleyball, cycling, boxing, and for some types of contact martial arts. It develops more often in men aged 16-40 years. A risk factor is flat feet, due to which the tension of the ligament increases.

Not only athletes are at risk. But people over 40 are more likely to develop other forms of knee tendinitis (both right and left). It all starts with inflammation of the tendon bursa - tendobursitis or even tendovaginitis. These conditions are often confused with sprains, but they have different causes and consequences and are treated differently.

Types and stages

Although often referred to as "knee tendonitis," the disease affects the tendons. Modern diagnostics(CT, MRI, ultrasound) helps to determine where exactly the inflammation occurs. According to its results, we can say that this is, for example, tendonitis of the internal lateral ligament, and even specify the stage of the disease.

There are such forms of tendonitis as acute (it can be purulent or aseptic) and chronic (subdivided into fibrous and ossifying type caused by the deposition of salts).

There are four stages of this disease. On them its symptoms are manifested in different ways. They can be described as follows:

1. 1st stage - due to numerous minor injuries, mild pain or discomfort occurs after intense training and increased physical activity.
2. 2nd stage - there is a paroxysmal dull pain, and even as a result of a weak load.
3. 3rd stage - quite severe pain can appear even at rest.
4. 4th stage is the rupture of the ligament. Moreover, it does not always come at once. In the presence of chronic inflammation of the ligament, certain structural changes gradually occur, and its mechanical strength decreases.

The treatment strategy depends on the stage of the disease and the accompanying pathologies.

Treatment principles

Treatment for tendinitis should be comprehensive. This means that pain and swelling must be eliminated - this is done with the help of analgesics and other non-steroidal anti-inflammatory drugs. An equally important step is to eliminate the cause of the development of the disease.

In general, conservative methods are used in the treatment. Providing complete rest is important to relieve pain. This will help prevent further damage to the tendon. At the first time after the injury, you need to apply cold to the damaged area (you cannot leave ice directly on the skin, put a cloth or towel under it). Cold slows down blood circulation and helps prevent tissue swelling. It also partially eliminates pain. Experts recommend fixing the injured knee with elastic bandages. Additionally, the limb must be raised to a height.

Complete immobilization of the joint is not always necessary. Sometimes it is enough to simply reduce the stress on the knee. For this, while moving, crutches or a cane are used. While to immobilize the knee, you will have to wear a splint (in severe cases, plastering is performed at all). In modern conditions, methods such as taping and wearing an orthosis are used. The first option involves attaching a special tape (tapes) to the knee. Exist different types taping, the specific option is chosen by the doctor. In the second case, we are talking about wearing a specially designed knee pad. Such orthoses can be used even for prophylaxis during intensive sports activities, hard physical work (including in the garden).

In the future, to eliminate pain and inflammation, they use ointments based on diclofenac and ibuprofen. Such drugs are produced both in the form of tablets and in the form of solutions for injection. Long-term oral use of non-steroidal drugs is not recommended due to the fact that they all have rather severe side effects on the gastrointestinal tract. It is believed that they can be drunk within two weeks. But with local use, they do not affect the mucous membranes of the stomach, so the duration of the course can be much longer. In severe cases, it is recommended to use these injectables.

If these medications do not work, your doctor may prescribe injections of corticosteroids directly into the affected joint. These medications should not be taken for a long time, as they weaken the tendon in large doses. Platelet-rich plasma is also used. Such drugs can relieve pain and inflammation, but if there is an underlying pathology that caused tendonitis (arthritis or infection), then it is necessary to eliminate it. Therefore, in parallel, drugs are taken to treat this disorder.

Various physiotherapy methods are used. These are electrophoresis, magnetotherapy, UHF, iontophoresis. In the case of a chronic form of the disease, it is recommended to do a therapeutic massage. At acute form tendinitis, if there are no complications, then the pain can be relieved within literally a few days. A full recovery will take a month and a half.

To treat the first two stages of tendonitis, conservative therapies are used. Surgical intervention is indicated only in advanced stages of the disease. Operations are performed with stenosing tendonitis, which is accompanied by a narrowing of the blood vessels. If the underlying pathology turns into purulent tendovaginitis, urgent surgical intervention is necessary with pumping out pus. The recovery period after surgery will be 2-3 months. During this time, you can apply medications and some types of physical therapy.

Modern technologies make it possible to make surgical intervention minimally traumatic. If earlier operations included a conventional incision, today methods of endoscopic surgery are used (in this case, it is called arthroscopy, with its help, minor irregularities are corrected and growths on the patella are removed). Open surgery is used only when cysts or other serious changes appear in the ligament that cannot be corrected by other means. The strategy is chosen only by the doctor based on clinical picture and data obtained using MRI and CT. These diagnostic methods are today considered more informative than X-rays and ultrasounds, which only allow differentiating tendonitis from other diseases with similar symptoms.

Traditional methods

Some people prefer treatment folk remedies... With tendinitis, such recipes do not help to eliminate the cause, but can bring significant relief, especially if the disease is at an early stage or has become chronic. But before you start using such methods, you need to consult your doctor.

At home, you can use various tinctures and herbal teas. For oral administration, it is advised to use an infusion of walnut partitions. But such a remedy must be prepared in advance, since it must be infused for 18 days. Therefore, it is rarely used for acute tendonitis. But with chronic course diseases, you can take this tincture on vodka for 1 tbsp. l. three times a day. This remedy is contraindicated for those who drive a car.

Traditional healers suggest drinking tea from dried bird cherry berries. This drink is a decoction that is prepared in a water bath. For 1 glass of boiling water, you need to take 1 tbsp. l berries.

For the period of treatment of the disease, you can use more seasonings such as turmeric. Its active ingredient is curcumin. It helps relieve pain and inflammation.

Treatment with folk remedies is mainly local procedures in which active substances enter the body directly through the skin. You can make a compress from aloe juice. It is squeezed out of the cut leaves of the plant, which have been in the refrigerator for a day. On the first day after the injury, you need to make 5-6 such compresses, and then one is enough for the night.

You can make an arnica ointment based on any nourishing cream. This will help relieve inflammation and swelling. This cream is applied three times a day. The pharmacy also has ready-made ointments based on this plant.

A good result is given by lotions from crushed ginger root (for 2 tablespoons of vegetable raw materials, take 2 cups of boiling water and insist for half an hour). Such lotions are put three times a day for 10 minutes.

Compresses and contrast procedures help well, but they can only be used if there is no reddening of the skin and an increase in body temperature over the affected joint. Such procedures consist in the fact that you need to alternate a light massage with ice cubes with warming up with the help of millet groats heated in a pan (it is poured into a linen bag or sock). These manipulations help improve blood circulation and tissue repair.

Physical exercise

In the treatment of tendonitis, exercise therapy plays an important role. It is used only for the 1st and 2nd stages of the disease, and only after the pain has been relieved. A set of exercises is selected by a doctor, and the first exercise therapy classes should be supervised by a health worker. The course of physiotherapy exercises can take several months, during which complete restoration of the ligaments is expected. Only after that it will be possible to play sports again.

All movements in physiotherapy exercises should be aimed at stretching the posterior groups of the femoral muscles and quadriceps, as well as gradually extending the knee with resistance. Professional athletes are encouraged to include squat squats ( inclined plane), and they can be performed both with and without weights. But they can also be carried out only after the pains disappear. At first, gymnastics will take literally 10-15 minutes, gradually both the duration and the load will increase. Some experts recommend doing yoga for several months after the end of the exercise therapy course. But this does not apply to professional athletes.

Prevention of tendonitis plays an important role. Before any workouts, first warm up all muscle groups, do not start classes abruptly. Doctors advise not to perform exercises for a long time on any one muscle group, so as not to cause overstrain.

If the work is associated with lifting weights, then you need to avoid sudden movements. When lifting such a load, you need to bend your knees so as not to put too much stress on them. With any physical work, you need to regularly take breaks for rest, and if there is such an opportunity, then change the type of stress. Monotonous movements and postures should be avoided during the working day.

Knee movement and stability are possible thanks to the well-coordinated work of its five ligaments:

two cruciform,
two lateral,
own patellar ligament.

Patellar Ligament Anatomy

The proper ligament extends the tendon of the quadriceps femoris and attaches it anteriorly to the tibial tubercle below the patella .

Causes of Knee Tendinitis

Knee tendinitis is caused by either mechanical or degenerative causes.

Mechanical tendonitis

The first type (mechanical) is associated with sports or professional activities:

Constant training or load leads to microtrauma of the ligament and the occurrence of an inflammatory process in it.
Patellar tendinitis is most often diagnosed in athletes involved in jumping sports, which is why this pathology has received a very accurate name - the jumper's knee.

The provoking factors of tendonitis are:

flat feet with its collapse inward (pronation);
the anatomical position of the patella, in which the ligament is pinched by it when the knee is bent above 60 °;
impaired knee stability with rotation of the femur and tibia;
hamstring syndrome - injuries caused by constant loads of the muscles of the back of the thigh.

Degenerative tendinitis

The second type of tendonitis is age-related and is associated with aging of the ligaments and degenerative changes in them:

mucoid process or fibrosis predominates;
pseudocysts appear.

Ligament degeneration can be facilitated by:

rheumatoid arthritis;
diabetes;
long-term use of glucocorticosteroids and other reasons.

In the weakened ligament, the process of regeneration is also underway - the restoration of degeneratively altered areas:

the recovered areas are denser and larger;
angiofibroblastosis is possible in them;
ossification (ossification) and calcification of the ligaments can be observed - this property is observed in both types of tendonitis.

Stages of knee tendonitis

Knee tendinitis goes through four stages:

First, the symptoms of pain discomfort occur only after exercise or exertion.
Second, the above symptoms are possible both before and after the load.
The third is pain symptoms during the exercise itself and after it.
The fourth is a ligament rupture.

The rupture occurs naturally: chronic inflammation in the ligament leads to its structural changes, reducing the mechanical strength. If the rupture is not due to an ordinary injury, but due to tendonitis, then it is considered a complication of tendonitis.

Symptoms of Knee Ligament Tendinitis

Tendinitis of the own patellar ligament begins at first with mild dull pain in the lower part of the patella or in the area of the tibial tubercle.
In the early stages, pain occurs mainly after exertion.
There is also a feeling of tension or stiffness, and knee extension can be difficult.
As the progress progresses, the pain becomes more intense until it begins to accompany all flexion and extension movements.
If tendinitis affects the deep layers, then with strong and deep pressure on the area between the patella and the tubercle of the tibia, pain occurs.
A symptom of a partial or complete rupture of the ligament is pain when extending with resistance.

Diagnostics

To clarify the diagnosis, an X-ray of the knee is done: frontal and lateral projections.

X-ray allows you to identify fatigue microtrauma, areas of ossification and calcification.

It should be noted that knee pain can be for many reasons:

damage and rupture of the meniscus;
osteochondropathy of the patella;
an enlarged tubercle of the tibia.

For a closer examination of local areas of the ligaments or menisci, an accurate examination using computed tomography or magnetic resonance imaging may be required.

Knee Tendonitis: Treatment Methods

In the first two stages, conservative treatment is used:

Facilitate training and stress regimes, reducing the intensity of training or work.
Put on ice compresses.
To reduce pain, use oral or intramuscular non-steroidal anti-inflammatory drugs (ibuprofen, indomethacin, naproxen)

It is better not to use intra-articular local injections of NSAIDs or glucocorticosteroids for knee tendinitis, as they contribute to the development of ligament atrophy.

All of these medications are temporary and have many side effects, especially on the gastrointestinal tract.

The main method of treating knee tendonitis is exercise therapy with exercises for hyperextension and strengthening of the quadriceps muscle of the thigh and the posterior muscle group.

You need to do them for a long time (sometimes several months), but the effect of the exercises is very good - they allow you to cure tendonitis and resume training or work in full mode.

Another type of conservative non-drug treatment is taping.

Taping for knee tendonitis

The point of taping is to use special tapes that unload the bundle.

There are different types of taping:

the tape is glued across the bundle;
crosswise with attachment at the top or bottom;
along the ligament with fixation below the tibial tubercle, to which the patella's own ligament is attached;
combined taping (for example, cruciform and longitudinal, cruciform and transverse).

As well as taping, wearing orthoses helps to relieve the knee's own ligament, only it is not worn directly on the kneecap, but slightly lower.

Surgery

Third to fourth degree tendinitis of the knee joint is difficult to correct conservatively, and then surgical treatment may be required.

slight damage to the ligaments;
growths on the patella, if they pinch the ligaments.

Cysts and other formations require open surgery.

Types of open transactions:

excision of the ligament;
scraping the bottom of the patella;
multiple tenotomies on the ligaments (notches).

But these methods can lead to weakening and rupture of the ligament in the future. In the fourth stage, the preferred operation is plastic reconstruction.

Sometimes surgeons resort to other kinds of operations:

resection of the lower pole of the patella, if it is considered the culprit of chronic knee tendonitis;
removal of the fatty body (Goffa) located under the patella.

Exercise therapy: examples of exercises for knee tendonitis

These exercises are very effective for knee tendonitis:

Quadriceps Stretching Exercises:

Turning our back to the table or pedestal and holding the back of the chair, we put our right foot on the table. We maintain balance for 45 - 60 seconds, feeling tension on the front of the thigh. We repeat the exercise with the left leg.
You can slightly modify the exercise without placing it on the table, but holding the back with your hand on the foot.
Sitting on the floor, bend over backwards, leaning back on your elbows. We bend one leg at the knee, and raise the other straightened one and hold it for a while. Then change the position of the legs and repeat the lift.
Isometric exercise (for severe pain):
- Sit on the floor, legs straightened, hands rest on the back of the floor.
- Tighten the leg muscle by pulling the kneecap towards you (the leg remains motionless).
- Fix this position for a few seconds, then relax and repeat with the other leg.
- Perform 20 times in several approaches.
Resistance exercises (performed with a rubber cord or elastic band):
- The leg bent at the knee is fixed with a tape. We extend the knee, overcoming resistance.
- Other options: abduction of the leg with resistance back, to the side, swinging the leg.

Exercises for the thigh muscles of the posterior group.

The disease affects people of all ages, but each of them has its own causes of the disease. Inflammation of the tendons and surrounding tissues or their mechanical damage is called tendinitis.

Most often, they suffer from the disease:

professional athletes... It is necessary to distinguish between people who go in for sports for the sake of health promotion and athletes for whom this is the only source of income. The first ones put personal well-being at the forefront and will never work for wear, the second agree to sacrifice their health for the sake of the next record. As a result of excessive loads on the knee joints, the tendons are constantly overloaded and injured, as a result - acute painful sensations, restriction of mobility. And in the case of severe injuries, loss of motor abilities and disability are possible;
people leading a sedentary lifestyle. Prolonged absence of stress causes the degradation of tendons and muscle tissues. In the future, even insignificant by the standards of a physically normally developed person, loads become the cause of tendonitis - the tissues are injured and inflamed;
persons who are constantly engaged in hard physical labor. Tissues wear out faster, tendons lose their elasticity and firmness;
children. High mobility and carelessness often cause injury. It should be borne in mind that most injuries do not go unnoticed for the tendons and necessarily make themselves felt in adulthood or old age.

The disease becomes the cause of a violation of the functionality of the patellar ligament of the quadriceps femoral muscle. Any overvoltage causes microdamage, if there is not enough time for their recovery, then they do not have time to self-destruct, painful sensations of varying degrees appear in the knee. In addition, even timely healed microtraumas form scars in the tissues, reducing their plasticity and extensibility. These changes, in turn, further increase the risks of mechanical damage and inflammation.

The disease can have an acute (purulent or aseptic) and chronic (ossifying or fibrious) phase of development, as a result of changes in the structure of tissues, their complete rupture often occurs.

The disease can occur due to:

significant stress on the joint. The impact can be short-term or long-term. Excessive loads often cause complex injuries that require immediate surgical intervention... The second consequence is microtraumas that cause inflammatory processes;
various diseases of the body. Most often, complications occur during the disease with some types of arthritis, but there are complications after viral or bacterial infections. Insufficient immunity also provokes the onset of the disease. Timely and competent treatment of diseases significantly reduces the risk of tendonitis;
disorders of the physical development of the human skeleton... Flat feet, poor posture, lameness, scoliosis, etc. cause increased stress on the tendons of the knee joint. Prolonged overloads cause premature loss of physiological characteristics.

Given the underlying cause, tendonitis can be infectious or non-infectious. Before prescribing a course of treatment, the attending physician must make an accurate diagnosis, the method and the success of the treatment of the disease depend on this.

What should be alarming

The sooner the disease is detected and its treatment begins, the more fully the functionality of the knee joint will be restored. What signs should i see a doctor?

Incomprehensible causeless pain in the knee joints. People call this pain "weather".
Joint mobility is limited, and an increase in amplitude causes pain. A creaking sound is heard while walking.
The skin on the knees became red and hot, and a swelling appeared. When probing the knee, unpleasant or painful sensations arise.
Attempts to get up suddenly from a chair are very painful, it is difficult to walk up stairs, the slightest exertion is accompanied by bouts of shooting pain.

Walking stairs causes pain and discomfort

The development of the disease can be gradual, at first the pain appears only after great physical exertion. In the future, already insignificant loads cause unpleasant sensations. The next phase - sometimes pain occurs during rest, the presence of loads does not matter.

Further development of pathological changes can cause a complete rupture of the ligaments - the consequences are very sad, they require, for the most part, a surgical operation. The diagnosis should be made not only because of the onset of the disease, but also taking into account the stage of its development. These factors must be taken into account when drawing up a medical plan.

It is not necessary to bring the development of tendonitis to a complete rupture of the ligaments.

Medical diagnostic methods

Diagnostic examinations allow you to accurately establish the diagnosis, which is a prerequisite for successful treatment. Laboratory tests are used in cases of tendinitis after viral or bacterial infectious diseases.

Magnetic resonance imaging and computed tomography are prescribed before surgery. Based on the data obtained, a plan of surgical intervention and methods for achieving the assigned tasks are developed.

With the help of an ultrasound examination, it becomes possible to see pathological changes not only tendons, but also nearby tissues.

X-rays are used in the last stages of the development of the disease, pictures of the knee joint make it possible to determine the pathologies that have occurred.

Methods for treating ailment

The choice of methods and specific drugs is carried out only after an accurate diagnosis of the disease, the causes of its occurrence and the stage of development.

Medical (conservative) method

The disease can be localized or completely cured at the 1st, 2nd and 3rd stages of development. During treatment, it is imperative to remove as much as possible or significantly limit the load on the diseased joint, to limit its mobility. For this purpose, crutches are used, the knee is covered with a plaster cast or a medical brace is worn.

Depending on the characteristics of the disease, the following treatment regimens can be used.

After immobilization pain different non-steroidal anti-inflammatory drugs.

They reduce the production of mediators by the patient's body that increase inflammatory processes - the preconditions of the processes are eliminated. At the same time, these drugs relieve pain. Medicines can be taken orally as tablets, in the form of ointments and creams, or injections.

Taking into account the patient's condition, the doctor determines the ways of treatment, as the state of health changes, the method can be adjusted. You need to know that drugs belong to the potent group, any duration of treatment with NSAIDs cannot exceed 14 days. In this regard, such treatment can be considered symptomatic and is aimed mainly at alleviating the critical condition of the patient. Long-term use of the medication is prohibited due to the risks of various complications.
If the nature of the disease is infectious, antibacterial agents are included in the course of treatment, in some cases antibiotics may be used.
A prerequisite for successful treatment is the performance of physiotherapy procedures. You can do it only after the acute phase has been removed; the complex of medical prescriptions includes microwave, ultrasound and UHF therapy.

Knee tendinitis is treated for quite a long time, in the later stages it will take at least 6 weeks. A complete rehabilitation after surgery can take six months or more.

In case of tendon ruptures or in the absence of positive reactions after long-term conservative treatment, doctors resort to surgical methods. Removal of pathologically altered tissues is performed through small punctures (arthroscopic) or an ordinary incision (open), the choice of method is tied to the degree and specific site of the lesion. Bone growths are eliminated only arthroscopically, and cysts on the ligaments can be removed only with open surgery.

In order to stimulate natural tissue repair (repair), curettage is done. The lower part of the patella is scraped off, these actions trigger the body's defenses, and accelerated restoration of damaged tissues occurs. For the same purposes, a partial excision of the tendon tissue with re-connection and multiple longitudinal incisions can be done.

In some cases, a positive effect of treatment can be achieved only after the operation is performed, such actions are shown in the difficult fourth stages of the development of the disease. In addition, due to surgical treatment, it is possible to restore the original functionality of the quadriceps femoris muscle. Before the operation, repeated complex or special examinations of the patient are done.

Folk remedies

Folk remedies can only be used as an adjunct to drug treatment. There are topical and oral medications.

For oral administration, you can use:

use turmeric as a seasoning for various dishes, the daily dose cannot exceed 0.5 g.;
a decoction of bird cherry berries, you can take both fresh and dry. Take 100 ml three times a day.

For external use, you can use compresses from aloe juice, ice massage, ginger lotions, arnica ointment, etc.

Contrast massage is effective, the procedure is performed in remission. The massage is done in two stages. First, the knee is warmed up by putting it in a cotton bag wheat groats and then massage with a piece of ice. The procedure is repeated 4-5 times. Contrast massage significantly improves the processes of blood supply to the affected tissues, accelerates their regeneration.

It is possible to remove the swelling and pain with a "plaster" bandage. Beat one protein with a blender chicken eggs, add a tablespoon of vodka and flour, stir until a thick porridge is obtained. Apply the mixture to an elastic bandage and fix the knee joint. Keep for several hours, repeat daily.

Treatment of the disease with onion preparations.

A tablespoon of sea salt is mixed with the same amount of chopped onion. The porridge is applied to the damaged area and wrapped in a warm cloth. Use a compress for 5-6 hours daily.
Grind 5 medium-sized onions with a blender, add a tablespoon of honey. Use the mixture as a compress on sore spots.

Good results are achieved after treating knee joints with oils.

Add two tablespoons of dry lavender to 200 gr. sunflower or olive oil, let it brew in a cool dark place for at least a week, drain. Lubricate sore areas several times a day.
In equal parts (a few drops each) mix fir and lavender oil, dilute with olive or sunflower oil. Rub the skin of the knee before going to bed, it is recommended to wrap it up for warming.

If the disease persists after a few days, then you should contact medical institutions.

Full restoration of the knee joint is impossible without physiotherapy exercises; it plays a significant role at all stages of the disease. It is especially important to exercise during the period of rehabilitation and recovery from surgery. Classes should be done until full recovery, in time it can take from several months to a year.

Standing position, back pressed against the wall. Clamp the ball between the knees, alternately increase / decrease the compression forces.
Lying on your side, in turn, raise your left and right legs up, over time, increase the amplitude of the rise.
Lying on your back, bend / unbend your knees, make movements with simultaneous static efforts.
In a standing position, perform swings with bent and straight legs, the number of repetitions is at least twenty.