Knee - Patella Tendonitis
Description
The patella tendon attaches the patella (aka-kneecap) to the tibia (shin bone). It is responsible for completing the transmission of force from the quadriceps muscle, resulting in the ability to extend the knee. Patella tendinitis is inflammation of the tendon and surrounding sheath.
What are the causes?
Patellar tendinitis results from overuse or from a direct blow to the front of the knee. Patellar tendinitis, also known as 'jumper's knee', frequently occurs in athletes who play sports such as basketball and volleyball because of the repetitive jumping involved.
What are the symptoms?
Patella tendinitis causes pain in the front of the knee just below the kneecap. The pain is activity related and is commonly associated with squatting, running or using stairs. There is sometimes swelling in the joint.
How is it diagnosed?
Dr. Liu will perform a thorough history and physical exam, which typically includes X-rays. Typically there is no bone abnormality and the area directly below the patella may be painful with pressure. Your surgeon will evaluate the motion and strength of the muscles around the knee. Some weakness and pain may be noted with resisted knee extension. X-rays are usually normal unless the inflammation is chronic, resulting in calcium formation within the tendon. MRI may be ordered if surgery is possible in the future.
Non-operative
Non-operative management of patella tendinitis is the first-line of treatment. Your surgeon may prescribe anti-inflammatory medication, physical therapy, cryotherapy and activity modification to avoid painful activities. Therapeutic high frequency ultrasound administered by your physical therapist has been used successfully to treat this condition. Your surgeon may offer you an injection. A strap worn over the patella tendon may reduce pain by taking stress off of the tendon's attachment site.
Platelet Rich Plasma (PRP) Injections is another non operative option. Blood is taken from your arm and is spun down to get the healthiest healing factors - platelets and serum. Once injected, the platelets degranulate and release activate growth factors and cytokines to promote healing. A one time leukocyte rich, concentrated PRP injection is recommended. One injection may be all you need, however, there are times where multiple injections may provide additional benefit. Not covered by insurance.
Mesenchymal Stem Cell Injections is another non operative option. Bone marrow is aspirated from your pelvis and centrifuged in a special kit to concentrate the stem cells, which are then reinjected into the tendon. The goals are to change the living microenvironment of the tendon, up regulating collagen formation, and promote tendon cell healing and reorganization. Not covered by insurance.
Operative
Operative treatment for patellar tendinitis is seldom indicated, as most patients will respond to non-operative treatment. If non-operative treatment fails and operation becomes necessary, the surgeon makes several longitudinal splits in the tendon and drills into the kneecap to encourage bleeding from the bone. The drill holes allows bone marrow to leak into the lesion bringing with it blood cells that are capable of healing the damaged tendon.
Coming Soon!
Can I shower after surgery?
If you have a bulky dry dressing you can remove it on postop day #3; you may then shower allowing water to run over steri-strips or sutures; towel pat dry and keep clean; NO soaking or submerging operative body part. If you have a waterproof dressing, please leave it on until you follow up in the office. You can shower over the dressing, no soaking or submerging the shoulder
How long do I need to wear the compression stockings?
Dr. Liu wants you to keep the compression stockings on for 3 weeks. Compression stockings are the best way to help the swelling to go down after surgery.
Should I use ice or heat?
Ice can provide analgesic effects and control swelling for the first 3-5 days; after that we recommend ice after exercises or PT.
How do I use an ice machine or CPM?
if either device is part of your recovery, treat this as an assistance to your recovery. Use either as directed, allowing only the machine to move or do the work. Remember, you should not be doing the work or moving the operative body part on your own.
How do I decrease my pain after surgery?
You may take your pain medication as prescribed; if pain continues, you may add ibuprofen or naproxen in between pain medication doses: (8am pain med, 10am ibuprofen 600-800mg or naproxen 500mg, 12p pain med).
Who schedules my first post operative appointment?
You are responsible for scheduling this appointment. This can be done prior to your surgery or within 1-3 days following. Please call the office, at 702-740-5327, provide your date of surgery, and you will be provided your appointment time and date.
When can I drive?
This depends on your surgery. Please wait until your first post op visit to discuss with your provider.
When can I go swimming?
Please wait at least 4 weeks until you submerge your incision into baths or pools. When your incision is submerged, it can open up and increase risk of infection. We ask that you wait 4 weeks when the incision is healed to soak in tubs or pools.
When do I start Physical Therapy?
Physical Therapy will be discussed at your first postoperative visit 10-14 days after surgery.
I have questions that have not been answered.
Please re-read your postoperative instructions handout. If questions remain, please contact the surgery line that has been provided to you on your post surgical handout.