10/28 - Patellar Tendinopathy Flashcards
what structure is a hallmark for tendinopathy
lose highly striated, tightly packed, organized structure
- becomes highly degenerated
what are 6 signs of a failed healing response
- hypercellularity
- microtearing (w/i tissue)
- loss of tightly bundled collagen
- inc proteoglycan content
- neovascularization
- absent / minimal inflammation
what are 4 intrinsic factors that contribute to tendinopathy
age
body composition
ROM
strength (possibly)
how is age an intrinsic factor for tendinopathy
prevalence inc w age
predisposition rather than cause
- inc stiffness & limited tolerance to load
—-> dec proteoglycans
—-> inc cross-links
how is body composition an intrinsic factor for tendinopathy
inc waist circumference linked to patellar tendinopathy (and also achilles)
tendinopathy inc w inc adipose tissue
how is ROM an intrinsic factor for tendinopathy
dec amt of DF
- inc amt & rate of loading
leading to both patellar and achilles tendinopathy
how is strength an intrinsic factor for tendinopathy
literature mixed as to if there is a positive or negative association of tendinopathy with weakness
what are 5 extrinsic factors for patellar tendinopathy
- corticosteroids
- training errors
- distance, intensity, technique - training surface
- uneven, incline, rigid - environment
- cold, wet climate - footwear / equipment
- esp if direct pressure
what sports have a higher incidence of patellar tendinopathy and why
volleyball - inc GRF in take-off
basketball
running
jumping and landing sports, higher incidence d/t GRF
what are anatomical factors that contribute to the epidemiology of patellar tendinopathy (2)
dec quad and hamstring flexibility
patellar maltracking
what is the enthesis
part of tendon that attaches to bone
what are 3 locations of patellar tendinopathy pathology
- enthesis site
- inferior pole of patella (post)
- infrapatellar fat pad highly innervated
what is a technique utilized with other pathologies that might not be useful in patellar tendinopathy
palpation - depends on patient
may be able to differentiate things within tendon or the fat pad if come off laterally
during the exam what are hx questions we want to ask (3)
prior hx of patellar tendinopathy
prior hx of tendinopathy in other locations and where
pain w loading (jumping, stairs)
what are 4 things to assess in the exam
- strength - gluts, quads
- ms length
- limited quad and hamstring
- (+) thomas, ely, SLR, 90-90 - ROM - dec DF
- palpation
- inferior pole of patella
- enthesis
what is an outcome measure for determining patellar tendinopathy
VISA-P
what are 5 differential dx for patellar tendinopathy and why are these probable
- PFPS
- osgood-schlatter’s dz
- bursitis
- ant meniscal tear
- Hoffa’s dz
all present w ant knee pain
prox weakness or distal ROM/weakness can contribute to knee pain/dysfunction
what imaging is appropriate for patellar tendinopathy and why
radiographs
- r/o osgood schlatter
CT - not often used bc radiation exposure
MRI** best sensitivity/specificity
- expensive and inc scan time
US - inc utilization
- highly operator dependent
what imaging is the most commonly used to patellar tendinopathy and how is it utilized
US
assess for hypoechoic region
- disruption of collagen arrangement
what is a risk factor for developing sx patellar tendinopathy and what is the significance of US in screening for this
asymptomatic hypoechoic regions of patellar tendon
doppler is able to pick up the neovascularity
what are 4 interventions for patellar tendinopathy
- relative rest / reduce tendon load
- flexibility - quads, hammies
- cross friction massage
- eccentric exercise
what does relative rest mean
immobilization is contraindicated
trying to just reduce tendon load
why is cross friction massage utilized
break up degenerative tissue to incite normal inflammatory process and inc fibroblastic activity -> create healing environment w normal collagen alignment
why is eccentric loading the primary exercise we want
helps to realign and restructure the collagen
- should be uncomfortable to disrupt the scar tissue
- we are using loading to remodel the tissue
what anatomical changes were seen as a result of eccentric activity
inc type 1 collagen
inc tendon stiffness
dec neovascularity -> thus dec pain
what is the main eccentric activity that should be introduced as soon as possible bc it is just chefs kiss
decline squat
- whether both legs or unilateral
why do we love decline squats in this population
inc patellar tendon force
inc patellar tendon strain and quad EMG
what did research show ab the duration of eccentric and tissue loading exercises
likely doesn’t matter the duration as long as tissue is loaded
what is PRP, what does the evidence say and how has this been utilized to treat patellar tendinopathy
taking platelet rich plasma (PRP) adn spinning in centrifuge and then injecting back into same site to stim healing
mixed literature - depends on body part and patient
combo w PT is important
what are the 2 main predisposing factors to consider
flexibility
training errors
what is the typical duration of most protocols
10-12wks
what should interventions address and be biased toward
address faulty biomechanics w bias toward eccentric strengthening
