Knee overuse injuries Flashcards
Patellar tendonitis quadriceps tendonitis semiimembranosus tendonitis prepatellar bursitis ( housemaid's knee) Iliotibial band friction syndrome
1
Q
What is patella tendonitis?
A
- Activity related knee pain associated with focal patellar-tendon tenderness
- aka jumper’s knee
- 20% of jumping atheletes
- more common in adolescents/young adults
- quadriceps tendinopathy > older adults
- risk factors
- poor quadriceps and hamstring flexibility
2
Q
What is the mechanism and histology of patella tendonitis?
A
- Mechanism
- Repetitive, forceful, eccentric ( lengthen as tehy contract) contraction of the extensor mechanism
- Histology
- Degenerative, rather than inflammatory
- micro-tear of tendinous tissue are commonly seen
3
Q
Describe the classification of patella tendonitis?
A
- Blazina
- phase 1= pain after activity only
- Phase 2= pain during and after activity
- Phase 3= persistent pain w or woout activities
- deterioration of performance
4
Q
What is the presentation of patella tendonitis?
A
Symptoms
- insidious onset of anterior knee pain at Inferior border of patella
- inital phase= pain following activity
- late phase= pain during activity
- pain w prolonged flexion
O/E
- swelling over the tendon
- tenderness inferior border of patella
-
Basset’s sign
- tenderness to palpation at distal pole of patella in full extension
- no tenderness to palpation at distal pole of patella in full flexion
5
Q
What is seen on imaging of patella tendonitis?
A
- Xray
- maybe inferior traction spur- Enthesophyte
- USS
- thickening of tendon
- hypoechoic areas
- MRI
- chronic cases
- tendon thickening
- increase signal on T1 & t2
6
Q
What is the tx of patella tendonitis?
A
Non operative
-
Ice, rest, activity modification, physio
- most pts
- stretching of quads/hamstrings
- eccentric exercise programe
- taping or chopat’s strap can reduce tension across patella tendon
- ** corticosteriods CI due to risk of patella tendon rupture**
Operative
-
Surgical excision and suture repair as needed- open vs arthroscopic
- for Blazina stage 3 disease
- partial tears & chronic pain/dysfunction
- resect angiofibroblastic and mucoid degenerative area
- follow w bone abrasion at tendon insertion/ suture repair/anchors as needed
-
Post op
- inital immobilisation in extension
- progressive rom & mobilisation exercises as tolerated
- Wb as tolerated
7
Q
What are the oucomes of surgery for patella tendonitis?
A
- return to activites is achieved by 80%-90% of athletes
- there may be activity related aching for 4-6 months post surgery
8
Q
Describe quadriceps tendonitis?
A
- Inflammation of the suprapatellar tendon of the quadriceps muscle
- M>F : 8:1
- more common in adult athletes
- risk factors
- jumping sports: basketball, volleyball, athletics
9
Q
What is the aetiology of quadriceps tendonitis?
A
- Mechanism of injury
- occurs as the result of repititive eccentric contractions of the extensor mechanism
- Pathology
- microtears of the tendon most commonly at the bone-tendon interface
10
Q
What are the associated conditions of quadriceps tendonitis?
A
- Jumper’s knee
- patella tendonitis
- Quadriceps tendinossi
- chronic tendon degeneration with no inflammation
11
Q
Describe the anatomy of quadriceps ?
A
-
Quadriceps muscles
- rectus femoris
- vastus medialis
- vastus lateralis
- vastus intermedius
-
Quadriceps tendons
- anterior layer= rectus femoris
- middle layer= vastus medialis, vastus lateralis
- deep layer= vastus intermedius
-
blood supply
- medial, lateral and peripatellar arcades
-
innervation
- Muscular branch of femoral n L2, L3 L4
12
Q
What is the presentation of quadriceps tendonitis?
A
- hx
- overuse
- increase in athletic demands
- Symptoms
- Pain localised to superior border of patella
- worse w activity
- assoc w swelling
- O/E
- knee alignment
- swelling
- tenderness to deep palpation at quads tednon insertion at the patella
- palpable gap would suggest a quads tendon tear
- Able to actively extend the knee against gravity
13
Q
What is seen on xrays with quadriceps tendonitis?
A
- Usually normal
- tendon calcinosis in chronic degeneration
- elavuate knee alignment for varus/valgus
- evaluate patellar height ( alta vs baja) - quads rupture
-
Install- Salvati method
- normal between 0.8- 1.2
- <0.8 = patella alta
-
Install- Salvati method
14
Q
What is the most sensitive imaging modality?
A
-
MRI
- dx of intrasubstance signal and thickening of tendon
- USS - operator and user dependent to detect and localising tendon rupture
15
Q
What is the tx of quads tendonitis?
A
Non operative
-
Activity modification, nsaids, physio
- mainstay of tx
- rest until pain is improved
- physio to start with rom and progress to eccentric exercises
- cortisone injections CI due to risk of quads tendon rupture
Operative
- quads tendon debridment
- v rarely required
16
Q
Describe Semimembranosus tendonitis?
A
- Most common in male athletes
- pt in 30yrs
- report of increase in endurance activites
- Pain in posteromedial knee
- may radiate to thigh/distal medial calf
- maybe exacerbated by down stairs/deep flexion
- tenderness to palpation at tibial insertion
- passive deep flexion of knee/ internal rotation of tibia at 90o may increase pain
- MRI helpful for dx
30
Q
What is the tx of iliotibial band syndrome?
A
- Non operative
-
rest, ice, nsaids, corticosteriod injections
- intial tx to reduce pain/swelling
-
Physio & training modification
- stretch ITB, lateral fascia and gluteal muscles
- deep transverse friciton message
- change shoes every 300-500 miles
-
rest, ice, nsaids, corticosteriod injections
- Operative
-
Excision of cyst, bursa or lateral synovail recess
- failed non op mx
- soft tissue pathology
- arthroscopic vs open
-
Elipitical surgical excision of ITB
- failed non op with chronic pain
- open technique
- lateral femoral incision
- expose post portion of ITB over lateral femoral condyle
- incise 2x4cm ellipse of band tissue
-
Z plasty of ITB
- in refractiry cases
-
Excision of cyst, bursa or lateral synovail recess
