Knee tendinitis is an inflammation and degeneration of the tendons located in the knee area. The main cause of tendinitis is constant overstrain and microtraumatization of tendons. This pathology is often detected in athletes. It is manifested by pain at first only during active exercise, and then at rest, sometimes hyperemia, local edema and restriction of movements are detected. The diagnosis is made on the basis of complaints, anamnesis, clinical symptoms, MRI and ultrasound. To exclude other diseases, radiography is prescribed. Treatment is usually conservative.
ICD 10
M76.5 Patellar tendinitis
Meaning
Knee tendinitis is an inflammatory and degenerative process in the tendons of the knee joint. The disease, as a rule, affects its own patellar ligament (“jumper’s knee”), the focus of inflammation is usually localized in the area of attachment of the tendon to the bone, although it can occur on any other part of the tendon. Pathology is treated by orthopedic traumatologists.
Knee tendinitis causes
Knee tendinitis is detected in athletes, it is often considered as an occupational disease of volleyball players, basketball players, tennis players, football players and track and field athletes. According to researchers in the field of sports medicine, orthopedics and traumatology, the disease develops more often in men with a large weight. The provoking factor is the constant jumping on the hard surface. Predisposing circumstances include:
- an ill-conceived training regime;
- wearing uncomfortable shoes;
- joint injuries;
- prolonged use of antibiotics;
- pathology of the feet (flat feet, hallux valgus installation of the feet);
- posture disorders;
- pathological changes of the spine (usually acquired).
In some cases, secondary tendinitis develops in rheumatic, parasitic and infectious diseases, endocrine diseases and metabolic disorders. The probability of a secondary inflammatory process in patients with chronic pathologies increases with an increase in the level of physical activity.
Pathogenesis
With excessive loads, micro-injuries develop in the tendon tissue. Small hemorrhages appear in the area of damage, around which foci of aseptic inflammation form. Collagen fibers in the areas of hemorrhages are destroyed with the formation of necrosis sites, which are subsequently replaced by scar tissue. Due to a decrease in the strength of the tendon and damage to the surrounding fibers by harder fibrous tissue, new myco-injuries appear, inflammation progresses.
Classification
Knee tendinitis is classified taking into account several signs:
- By mechanism: primary and secondary.
- In form: acute and chronic.
- Due to development: traumatic, infectious, metabolic, autoimmune, parasitic.
- According to the type of inflammation: acute tendinitis can be serous or purulent, chronic – fibrous or ossifying.
Knee tendinitis symptoms
Primary inflammation of the patellar ligament usually develops for a long time and proceeds chronically. There are four clinical stages of tendinitis. At the first stage, pain on the anterior surface of the knee joint occurs only at the peak of intense physical activity. At rest and under normal loads (including during training), there is no pain syndrome.
In the second stage, dull, sometimes paroxysmal pains and discomfort appear at standard loads and persist for some time after training. At the third stage, the pain syndrome increases even more, discomfort and pain do not disappear even after 4-8 hours of complete rest. At the fourth stage, due to extensive degenerative changes, the tendon becomes less durable, tears appear in its tissue, a complete rupture is possible.
Along with the pain syndrome that occurs during exercise, and then at rest, a characteristic sign of tendinitis is pain during palpation and pressure on the tendon. With a “jumper’s knee”, there may be pain when feeling the tuberosity of the tibia and pressing on the patella. In some cases, a small local edema and hyperemia of the affected area are detected. There may be a slight restriction of movement. Sometimes, when moving at a distance or using a phonendoscope, you can listen to unusual sounds – creaking or crunching.
Secondary tendinitis can develop acutely. In this case, the pain increases rapidly within a few days, the swelling is more pronounced than in chronic processes. Hyperemia is found in the tendon area, sometimes hyperthermia of the skin. The phenomena of general intoxication are uncharacteristic, observed only with purulent inflammation.
Complications
With a prolonged course, inflammatory processes are replaced by degenerative ones, tendinosis of the patellar ligament develops. The weakening of collagen fibers as a result of inflammation and degeneration increases the likelihood of tendon tears and ruptures. Tendinitis entails a decrease in resistance to physical exertion, prevents sports activities and can cause withdrawal from big-time sports.
Diagnostics
The diagnosis is made on the basis of anamnesis, characteristic clinical manifestations and data from additional studies. Instrumental and laboratory methods in most cases are not informative enough, they are prescribed for differential diagnosis, exclusion of complications, detection of secondary, long-term or ossifying tendinitis. The examination program may include the following procedures:
- Knee joint x-ray. Usually unchanged, sometimes a slight thickening of soft tissues is noticeable in the pictures. During ossification, calcification foci are found in the tendon tissue.
- Other visualization methods. CT of the knee joint, MRI and ultrasound of the knee joint are indicative only in the presence of pronounced pathological changes. A violation of the structure, foci of degeneration and tears of tendon tissue are determined.
- Laboratory tests. Changes in the tests are detected only in secondary symptomatic tendinitis. In the presence of infection in the blood, signs of inflammation are detected, in rheumatic diseases, anticyrulin antibodies and rheumatoid factor are determined, with metabolic disorders, the level of creatinine and uric acid increases.
Tendinitis is differentiated with traumatic, rheumatic and degenerative lesions of the knee joint, in the process of differential diagnosis, the data of X-ray examination are crucial.
Knee tendinitis treatment
Treatment is usually conservative, carried out on an outpatient basis. Operations are rarely performed, they are indicated when conservative measures are ineffective and ruptures of the altered tendon.
Conservative therapy
Completely stop training, conduct complex therapy, which includes:
- Protective mode. Patients are recommended to rest, if necessary, immobilization is carried out with a plaster or plastic splint.
- Medicinal products. Analgesics and anti-inflammatory drugs (naproxen, ibuprofen) are prescribed.
- Physiotherapy. After eliminating the phenomena of acute inflammation, patients are referred to physical therapy, massage, electrophoresis with novocaine, ionophoresis, UHF and magnetotherapy.
With severe edema, intense pain syndrome and fibrous changes, X-ray therapy is sometimes used or blockades with corticosteroid drugs are performed. The introduction of hormonal agents is carried out in short courses with an interval of at least six months, since frequent use of medications of this group can accelerate the degeneration of the tendon. Shock wave therapy is an effective method of treating tendinitis and tendinosis.
Increase the load on the joint should be smoothly, gradually. During remission, patients are advised to unload the affected ligament using special tapes (tapes) or fixing the knee joint with an orthosis. In some cases, a good result is provided by aiming work with the technique and height of jumps (it has been found that tendinitis develops more often in athletes using a rigid landing strategy, making higher jumps and landing with a deeper squat).
Surgical treatment
Indications for surgical intervention are tears and ruptures of the tendon, as well as the absence of a positive effect from conservative therapy for 1.5-3 months. The operation is carried out as planned in the conditions of an orthopedic or traumatology department. The skin above the lesion area is dissected, the ligamentous canal is opened, and pathologically altered tissues are removed.
Sometimes, to stimulate the recovery process, they resort to scraping the lower part of the patella or perform multiple incisions on the tendon using traditional or minimally invasive endoscopic access. Cystic formations are excised in an open way. In case of major tears and ruptures, surgical reconstruction of the patellar ligament is performed.
In the postoperative period, antibiotics, analgesics, physical therapy, physiotherapy and massage are prescribed. They are allowed to start training only after the completion of rehabilitation measures.
Forecast
With an early start of treatment and timely adjustment of the level of physical activity, the prognosis is favorable. Inflammatory phenomena disappear without a significant decrease in the strength of the tendon. With a prolonged course, there is a degeneration of tendon tissue, fraught with a decrease in resistance to stress and an increased likelihood of tendon injuries. There is a tendency to relapse with knee overloads.
Prevention
Measures to prevent tendinitis include a gradual increase in the intensity of physical exertion, a well-thought-out training regime, wearing comfortable shoes, preventing traumatic joint injuries, normalizing body weight. Patients with a history of injuries and diseases of the knee joint are recommended to use orthoses when doing sports.
