Patellar Tendinitis/Quadriceps Tendinitis

Overview

The quadriceps tendon is located just above the kneecap (patella) and connects the quadriceps muscles in the front of the thigh to the top of the kneecap. The patellar tendon is located just below the kneecap. It connects the kneecap to the shinbone (tibia). The function of the quadriceps tendon and patellar tendon is to work with the muscles in the front of the thigh to straighten the knee. Therefore, both tendons are instrumental in allowing people to perform activities such as climbing stairs, walking, running, and jumping.  

Tendinopathy is a common overuse injury caused by repeated and prolonged stress on a tendon.  This repeated stress (micro-trauma) on the tendon can lead to the tendon becoming thickened and tiny tears developing in the tendon. The body attempts to repair these tiny tears, but if the rate of breakdown within the tendon exceeds the rate of repair, this can lead to pain and dysfunction.

Patellar tendinopathy is a common disorder in athletes who participate in sports that require jumping such as volleyball and basketball and has been labeled “jumper’s knee.” It is also commonly seen in athletes involved in sports such as track and field, gymnastics, and tennis. However, quadriceps and patellar tendinopathy can occur in any individual who is active, especially those who may have recently increased their physical activity.  

Patellar tendinopathy and quadriceps tendinopathy are characterized by:

  • Pain. The pain occurs in the anterior knee below the kneecap with patellar tendinopathy and in the anterior knee above the kneecap with quadriceps tendinopathy. The pain is often worse with activities such as running, jumping, walking up and down stairs, and squatting, and it can also occur with prolonged sitting.
  • Stiffness. The tendon can often feel stiff initially in the morning or after physical activity.
  • Swelling. The painful tendon may appear thickened or swollen compared to the non-affected side.

The initial treatment for quadriceps and patellar tendinopathy involves relative rest by decreasing the frequency of activity or avoiding the activities that put stress on the tendons such as running and jumping. Cross training activities that involve lower loads on the tendon such as cycling or swimming can typically be performed in order to maintain cardiovascular fitness while avoiding or decreasing the frequency of the activities that cause pain.  

Physical therapy is a very important component in the treatment of patellar and quadriceps tendinopathy. Performing specific strengthening exercises, such as eccentric exercises or heavy slow resistance training that is designed to gradually increase the load through the quadriceps and patellar tendons over time, allows the tendons to become stronger. This allows the tendons to better handle the high stresses placed on them with activities such as running and jumping. Stretching exercises can also be beneficial if there are tight muscles in the thigh. In addition, improving running technique and landing technique when jumping can be beneficial.  

If pain and dysfunction persist despite relative rest and physical therapy, other treatment options can be considered. These include extracorporeal shock wave therapy, which uses sound waves to stimulate healing. Regenerative medicine procedures such as a platelet-rich plasma (PRP) injection performed into the area of damage within the patellar or quadriceps tendon can stimulate the body’s natural healing process. A percutaneous ultrasonic tendon debridement can be performed. This is a minimally invasive procedure that involves using ultrasonic energy to break down and remove the damaged tissue within the tendon. Nonoperative treatment is successful in most patients with patellar and quadriceps tendinopathy, but open or arthroscopic surgery may be considered for patients with persistent pain and dysfunction.   

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