Patella tendonitis. Tendinopathy of the patellar tendon. Reasons for the development of the disease

Anatomy of the knee joint and injuries that cause inflammation of the ligaments (tendonitis), ruptured ligaments, menisci, fractures, inflammation of the joints, etc. can be found in the “” section.

What is “Tendinitis”?

This is inflammation of the tendon. In this case, the tendon connecting the patella and the main bone of the lower leg (tibia) becomes inflamed. This tendon plays a key role in the straightening movements of the lower leg. The movements of the lower leg performed when hitting a ball, riding a bicycle and jumping high are carried out by the thigh muscles with the help of this tendon.

Causes

There are many reasons leading to inflammation of the ligament, among which injuries and their constant impact are of paramount importance. This is why patellar tendonitis occurs in athletes and in people engaged in intense physical activity involving the work of a group of muscles of the knee joint. A number of scientists imply the development of this pathological process as a complication of degenerative changes that are more typical in old age.

Symptoms

Like many other inflammatory processes in our body, the leading place in clinical symptoms is pain, taking into account varying intensity and duration. In the first stages, patients are bothered by barely noticeable pain, which often appears in the evening hours after excessive exercise. Gradually the pain intensifies and occurs in the midst of “complete well-being”, at rest. The temperature during tendonitis practically does not rise; most often this occurs when the inflammatory process generalizes and involves neighboring anatomical structures. It should be noted that a common and, unfortunately, very dangerous complication for the patient is

Read more about treating tendinitis

Patellar tendinitis does not immediately and unambiguously lead to rupture of the ligament, but the gradual inevitable progression of inflammation implies a weakening of those structures that were involved in the inflammation.

Conservative treatment.

Treatment for patellar tendinitis depends on the stage of the disease. The first and second stages, as a rule, respond well to conservative treatment, i.e. non-surgical treatment. It includes:

Surgery.

If patellar tendonitis persists and pain persists despite adequate treatment, surgery may be required.

The essence of the operation:

Many surgeons, when operating for chronic tendinitis, always prefer to resect, i.e. shorten the lower pole of the patella, assuming that there is always impingement (pinching) of the patellar ligament with tendinitis. In general, there is no need to be afraid of open knee surgery, although such treatment for patellar tendonitis is delayed and causes more noticeable discomfort for the patient. Again, if the situation is inevitable and clinical therapy is ineffective, it is necessary to prevent complications, namely, which will inevitably require surgical intervention. Based on this, it is much more rational to prevent consequences than to treat them at the height of the disease.

Rehabilitation exercises you can look at the knee joint on our website in the “Rehabilitation - Knee Joint” section.

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

When conducting laboratory tests, no changes are observed, except in cases where the disease is associated with infection or a rheumatoid process.

As a result of constant stress, including frequent impact on the surface of the lower extremities (when running), tendinitis can develop in the upper thigh. It affects the rectus femoris tendon (basis and quadriceps tendonitis), the iliopsoas tendon (hip flexor tendonitis), and the adductor longus tendon (groin tendonitis). The main manifestations of hip tendinitis are:

• changes in gait and lameness;
• slow increase in symptoms;
• pain decreases after initial activity and returns with greater force during subsequent activities;
• cracking in the upper thigh.

Gluteal tendonitis

Tibialis posterior tendinitis

Shockwave therapy for calcific tendinitis of the shoulder - video

Tendinitis

Tendinitis (tendinitis; tendin- + -itis) is degeneration of tendon tissue, accompanied by phenomena of secondary (reactive) inflammation; usually combined with tenosynovitis.

Tendinitis- this is inflammation of the ligament. The term is derived from the Latin word tendo (tendon) and the ending itis, which means inflammation. From a philological point of view, inflammation of the patellar ligament should be called ligamentite(from the Latin word ligamentum - ligament), and not tendonitis. Currently, both the terms tendonitis and ligamentitis can be found in the literature, and they occur with approximately the same frequency.

Causes

There are two types of patellar tendinitis. The first type occurs in athletes or young physically active people. In this case, this disease is called "jumper's knee" or illness Blazina named after the surgeon who coined the term "jumper's knee" in 1973. However, of course, they knew about patellar tendinitis even earlier, Blazina just suggested a good name for the disease. For example, in 1963, Maurizio described the association of patellar tendon inflammation with jumping sports. Initially, “jumper’s knee” meant inflammation of the patellar ligament only at the site of its attachment to the patella, but, although less frequently, inflammation can also occur in the lower part of the ligament - at the site of its attachment to the tibial tuberosity. Let us remember that during movements, the attachment points experience the greatest stress and deformation, and not the middle part of the ligament, which explains the occurrence of inflammation in these places. In 1978, Mariani and Roels suggested that inflammation not only in the upper but also in the lower part of the ligament be called “jumper's knee”, since these conditions are very similar in their causes, principles of development and treatment, and differ only in the location of inflammation.

In 1986, Ferretti explained the causes of jumper's knee. The inflammation is based on repeated trauma to the ligament during stress, which is more common in jumping sports (running, volleyball, basketball, boxing), cycling and contact martial arts, where there are kicks. The disease occurs between the ages of 16 and 40 years, and is slightly more common in men. Flat feet with pronation of the foot can contribute to the occurrence of inflammation, (Pronation (pronatio: lat. prono, pronatum tilt forward) is a term meaning the rotation of a human limb around its long axis so that its front surface is turned towards the midline of the body. Pronation of the foot is that its dorsum rotates inwards, and the sole is outward.)

since in this condition the tibia twists a little and the tension of the ligament increases. Patellar position, Q-angle, femoral and tibial rotation, and knee stability have been hypothesized to contribute to the condition (you can read about these conditions in the article on patellar tilt and subluxation), but scientific research has shown that there is no significant connection between these factors. factors and tendinitis no. It is believed that patellar tendonitis may be caused by problems with the quadriceps muscle and hamstring muscles (posterior muscle group) hips (so-called muscle stiffness (Rigidity (from the Latin rigidus - hard, hard) in physiology, the functional state of skeletal muscles, characterized by a sharp increase in their tone and resistance to deforming forces. Muscle rigidity arises as a result of changes in the nature of the nervous influences constantly experienced by the central and peripheral nervous system .) or tightness).

A sharp increase in duration, intensity and changes in training methods can contribute to the occurrence of tendinitis in athletes.

In addition, patellar tendon inflammation may be caused by the covering. where training or sports take place. Thus, about more than half of the cases of the disease occur in people involved in sports or training on hard surfaces. Of course, excessively long training contributes to the development of the disease. The angle of flexion in the knee joint is important, at which the load occurs: the ligament is most tense in flexion amplitude from 30 to 60 degrees. Thus, all sports where frequent jumping and landing, acceleration and braking occur are at risk.

In the mid-1990s, Johnson suggested that when flexed at an angle of 60 degrees, the ligament could be pinched by the lower pole of the patella, proving his theory with several examples. However, this theory was not widely and generally accepted, and it was even found that in athletes with a long, low pole of the patella, the location of this bone pathology did not always correspond to the site of inflammation of the ligament. However, when surgically treating chronic tendinitis, many surgeons prefer to resect, i.e. shorten the lower pole of the patella.

Patellar tendonitis may occur as a complication after anterior cruciate ligament reconstruction with a BTB graft. (bone-tendon-bone (bone-tendon-bone) .

Chronic stress or even overload of the patellar ligament can lead to micro-tears, inflammation and, accordingly, pain.

Sometimes patellar tendonitis or “jumper's knee” is called Sinding-Larsen-Johansson-Smillie disease, but this is not entirely true. In fact, Sinding-Larsen-Johansson-Smillie disease occurs only in adolescents and is associated with bony immaturity of the lower pole of the patella. It is very similar in nature to Osgood-Schlatter disease. .

The second type of patellar tendinitis occurs not in athletes, but in ordinary people, usually over the age of 40. With age, degenerative changes accumulate in the tendon (the ligament “gets old”) and it can no longer withstand stress as successfully as before. Accordingly, micro tears and inflammation occur.

Histological studies (Human histology is a branch of medicine that studies the structure of human tissues) showed that with tendinitis there are classic signs of overload syndrome, consisting in the presence of two interrelated processes: degeneration (the process of “weakening”, “aging” of the ligament, manifested by mucoid (Mucoid swelling is a superficial and reversible disorganization of connective tissue) and myxomatous restructuring, fibrinoid necrosis necrosis (local death), accompanied by impregnation of the affected tissues with fibrin (Fibrin (from the Latin fibra - fiber) is a high-molecular, non-globular protein formed from fibrinogen in blood plasma in the liver under the action of the enzyme thrombin; has the form of smooth or cross-striated fibers, clots of which form the basis thrombus during blood clotting.) and the formation of pseudocysts) and regeneration (the process of “restoring” the ligament, manifested by the germination of new blood vessels, increased cellularity and angiofibroblastosis). There are no signs of acute inflammation in the ligament. These changes occur in both types of tendinitis: jumper's knee and degenerative tendinitis.

Typically, patellar tendinitis occurs in only one leg., usually pushing, but there are cases of bilateral tendonitis. The occurrence of tendonitis is facilitated by systemic diseases that weaken connective tissue (for example, rheumatoid arthritis, diabetes mellitus, chronic renal failure, systemic lupus erythematosus, etc.) and long-term use of glucocorticoids (Glucocorticoids, or glucocorticosteroids, is the general collective name for a subclass of adrenal hormones that have a stronger effect on carbohydrate than on water-salt metabolism, and their synthetic analogues) .

Classification

1 stage: pain occurs only after sports activity;

2 stage: pain and/or discomfort occurs before and after sports activity;

3 stage: pain occurs during and after exercise;

4 stage: rupture of the patellar ligament.

Of course, inflammatory changes in the ligament are accompanied by a decrease in its mechanical strength, which can lead to complete or partial rupture of the patellar ligament.

Symptoms

Typically, patients complain of pain in the area of ​​the lower part of the patella, that is, at the site of attachment of the ligament. In addition, pain can also occur at the site of fixation of the ligament to the tibial tuberosity, although this symptom is less common. In the early stages, pain after physical activity is typical. As the disease progresses or becomes chronic, pain may occur during and before exercise. Usually the pain is dull, localized along the ligament or slightly to the sides of it. With progressive tendinitis, attacks of more intense pain may occur during exercise.

In addition to pain, the disease can manifest itself as stiffness, tension, or weakness of extension in the knee joint.

An examination by a doctor plays an important role in diagnosis. The superficial location of the patellar ligament, including its attachments to the patella and tibia, simplifies inspection. With a thorough examination, it is usually easy to detect typical symptoms. Pain is typical when palpated in the area where the ligament attaches to the patella. Often the process is localized in the deep parts of the ligament adjacent to the joint; in such cases, pain occurs when deep pressure is applied to the ligament. In some cases, pain and swelling are noted along the entire ligament, which indicates peritendinitis or tendovaginitis, i.e. a condition in which inflammation is concentrated not only in the ligament, but also in its membranes.

The pain intensifies when the knee joint is extended with resistance and when pressure is applied to the patella. A similar pattern of pain can occur with partial or complete ruptures of the quadriceps tendon and patellar ligament. In young athletes, osteochondropathy should also be excluded. (Osteochondropathies are diseases inherent in children aged 3 to 16 years. This osteochondral disease occurs when blood circulation is disrupted in a certain area of ​​the bone and, as a result, necrosis of the area of ​​bone tissue occurs, which causes pain and discomfort) the lower part of the patella (Sinding-Larsen-Johansson-Smillie disease) and the tibial tuberosity (Osgood-Schlatter disease). (Osgood-Schlatter disease - necrosis of the tibial tuberosity)

Anterior knee pain may not only occur with patellar tendonitis, so your doctor should rule out other causes of knee pain.

To clarify the diagnosis, in addition to the examination, the doctor may prescribe radiographs in frontal and lateral projections. Radiographs will help identify possible stress or avulsion fractures, as well as possible calcification (ossification) within the ligament. If patellar ligament calcification is detected or other bone problems are detected, a CT scan may be required.

Sometimes, to rule out other causes of knee pain, such as pain from injuries and tears of the menisci, especially in the anterior parts, magnetic resonance imaging (MRI) can be useful, which allows you to see soft tissues (menisci, ligaments, tendons, cartilage , muscles, etc.). In patients with patellar tendonitis, MRI often shows increased signal at the inferior pole of the patella and in the ligament itself, but the signal intensity does not always correspond to the severity of symptoms. In some cases, with tendonitis, the ligament may be thickened on MRI.

Magnetic resonance imaging for patellar tendonitis. The ligament itself (the dark cord from the patella to the tibial tuberosity) at the site of attachment to the patella has an area of ​​increased signal (marked by a red arrow). The ligament itself is thickened.

Due to its superficial location, the patellar ligament is accessible for ultrasound. An experienced physician can detect ligament thickening, degenerative changes, and partial and complete tears. During the regeneration stage, an increase in blood flow can be recorded on ultrasound with Doppler sensors.

Treatment

Conservative treatment. Treatment for patellar tendinitis depends on the stage of the disease. The first and second stages, as a rule, respond well to conservative treatment, i.e. non-surgical treatment. This includes changes to your training regimen, ice packs, and a short course of anti-inflammatory drugs (indomethacin, ortofen, etc.) that relieve symptoms, but there is no evidence that these drugs affect the development of tendonitis. Anti-inflammatory drugs should be used with caution in elderly patients and should not be used in patients with concomitant diseases of the gastrointestinal tract.

Local injections of glucocorticoids (kenalog, diprospan, hydrocortisone) for patellar tendonitis are not recommended due to possible atrophy of the ligament and its subsequent rupture.

An important role in the treatment of tendinitis of the first and second stages is played by physical exercise, aimed at strengthening and stretching the quadriceps muscle, allowing a gradual return to sports activities, but this may take from several weeks to several months.

In addition to exercise can be very effective taping - gluing special tapes to the knee that relieve the load on the patellar ligament. Taping is a special branch of sports traumatology. The essence of taping comes down to the fact that a special sports tape is glued - tape, which relieves the load on the patellar ligament. If tape is not available, then a wide adhesive plaster, for example from Hartmann, can be used.

Unloading the patellar ligament with tape can be done by sticking the tape across the ligament, on the sides of it, crosswise with fixing the long ends of the tape at the top or bottom. The tape can also be applied along the ligament with the tape being fixed below the normal attachment point of the ligament to the tibial tuberosity. Of course, combinations of taping methods are also possible.

1- Transverse taping is the easiest way to relieve the patellar ligament. The tape is glued with moderate force. 2- taping on the sides using a specially shaped tape. 3- combined taping. There are transverse, cross-shaped and longitudinal tapes. Notice the band running down along the anterior edge of the tibia. 4- The classic version of combined taping, combining transverse and cross-shaped tapes.
Similar to taping is the treatment of patellar tendinitis using orthosis, which is tightened across the ligament (and not across the patella). The brace relieves stress on the ligament and helps relieve the symptoms of tendinitis. There are many manufacturers of such orthoses, but we consider preferable those orthoses that have a silicone pad on their inner surface in contact with the skin covering the patellar ligament.

In any case, fast sudden movements and jumps should be avoided. At the third stage, treatment begins in the same way as in earlier stages. If the ligament ruptures (stage 4 tendonitis), of course, surgery is required.

Surgery.

If patellar tendonitis persists and pain persists despite adequate treatment, surgery may be required. Arthroscopic (through 1-2 centimeter punctures) or open (through a traditional incision) removal of chronically altered tissue is performed, usually in the area of ​​the apex of the patella. The choice of arthroscopic or traditional open surgery depends on which parts of the ligament are damaged. If there is a bone growth on the patella that leads to impingement (pinching of the ligament), then it can be removed arthroscopically. If cysts or other volumetric changes have formed in the ligament itself, then they can only be corrected with open surgery. In addition to removing the altered areas of the ligament, in most cases, during surgery, curettage (scraping) of the lower part of the patella is performed to cause tissue repair (restoration process) through inflammation. Sometimes, additionally, partial excision of the ligament, wide excision with re-fixation of the remnants of the ligament, and multiple longitudinal tenotomies (incisions on the ligament) are performed. However, any of these operations is fraught with rupture of the ligament in the future. At stage 4, timely surgical reconstruction of the ligament allows you to restore quadriceps strength and range of motion and return to the previous level of activity, and a delay of several weeks significantly reduces the strength of the quadriceps femoris muscle.

Many surgeons, when operating for chronic tendinitis, always prefer to resect, i.e. shorten the lower pole of the patella, assuming that there is always impingement (pinching) of the patellar ligament with tendinitis.

Elements of the operation may include partial resection (removal) of the Hoffa fatty body, transfer of the attachment site of the patellar ligament if the axis is violated,

Forecast

Regardless of treatment method, rehabilitation is fundamental to returning to sport and preventing relapse. After resting and changing your training regimen, you should gradually increase the tone of the quadriceps muscle. The four-step program includes static stretching of the hamstrings, quadriceps, and eccentric stretching exercises with icing after stretching. Sport-specific exercises are introduced gradually as quadriceps strength and flexibility increase. Return to previous loads is allowed after restoration of range of motion, increase in the strength of static contraction of the quadriceps muscle to at least 90% of the original and in the absence of pain or discomfort during exercise.

Complications

Patellar tendonitis usually has a favorable prognosis with adequate treatment and rehabilitation. If treatment rules are not followed, the already mentioned rupture of the patellar ligament is possible, which requires prompt surgery.

A rare complication such as calcification(ossification) inside the patellar ligament against the background of chronic inflammation in it. This condition may also require surgery to remove calcified areas of the ligament with plastic (strengthening) with synthetic or other materials (tendons from other parts of the body, etc.).

Ossification of the patellar ligament - areas of ossification of the patellar ligament are marked with red arrows (clinical observations by H. Matsumoto, M. Kawakubo, T. Otani, K. Fujikawa. In this case, ossification occurred after injury.

Used materials from an article by Andrey Petrovich Sereda, Candidate of Medical Sciences

Panni AS et al: Patellar tendinopathy in athletes: outcome of operative and nonoperative management. Am J Sports Med 2000;28:392.

Peers KH et al: Cross-sectional outcome analysis of athletes with chronic patellar tendinopathy treated surgically and by extracorporeal shock wave therapy. Clin J Sport Med 2003; 13:79.

Warden SJ, Brukner P: Patellar tendinopathy. Clin J Sport Med 2003;22(4):743.

Matsumoto, M. Kawakubo, T. Otani, K. Fujikawa. Extensive post-traumatic ossification of thepatellar tendonA REPORT OF TWO CASES. From Keio University and the National Defense Medical College, Tokyo, Japan

Smetanin Sergey Mikhailovich

traumatologist - orthopedist, doctor of medical sciences

Moscow, st. Bolshaya Pirogovskaya, 6., bldg. 1, metro station Sportivnaya. Registration strictly by phone!!!

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Education and professional activities

Education:

In 2007 he graduated with honors from the Northern State Medical University in Arkhangelsk.

From 2007 to 2009, he completed clinical residency and correspondence postgraduate studies at the Department of Traumatology, Orthopedics and Military Surgery of the Yaroslavl State Medical Academy on the basis of the Emergency Hospital named after. N.V. Solovyova.

In 2010, he defended his dissertation for the degree of Candidate of Medical Sciences on the topic "Therapeutic immobilization of open fractures of the femur" . Scientific supervisor - Doctor of Medical Sciences, Professor V.V. Klyuchevsky.

Professional activity:

From 2010 to 2011 he worked as a traumatologist-orthopedist at the Federal State Institution "2nd Central Military Clinical Hospital named after P.V. Mandryk".

Since 2011, he has been working in the clinic of traumatology, orthopedics and joint pathology of the First Moscow State Medical University. THEM. Sechenov (Sechenov University), being an associate professor at the Department of Traumatology, Orthopedics and Disaster Surgery.

Conducts active scientific work.

Internships:

April 15-16, 2008 JSC course "AO Symposium Pelvic Fractures" .

April 28-29, 2011 - 6th educational course "Problems in the treatment of common fractures of the bones of the lower extremities" , Moscow, State University of Monika named after. M.F. Vladimirsky.

October 6, 2012 - Atromost 2012 "Modern technologies in arthroscopy, sports traumatology and orthopedics" .

2012 - training course on knee replacement, prof. Dr. Henrik Schroeder-Boersch (Germany), Kuropatkin G.V. (Samara), Yekaterinburg.

February 24-25, 2013 - training course “Principles of total hip replacement”

February 26-27, 2013 - training course "Basics of total hip replacement" , FSBI "RNIITO im. R.R. Harmful" of the Ministry of Health of Russia, St. Petersburg.

February 18, 2014 - workshop on orthopedic surgery "Endoprosthetics of the knee and hip joints" ,Dr. Patrick Mouret, Klinikum Frankfurt Hoechst, Germany.

November 28-29, 2014 - training course on knee replacement. Professor Kornilov N.N. (RNIITO named after R.R. Vreden, St. Petersburg), Kuropatkin G.V., Sedova O.N. (Samara), Kaminsky A.V. (Kurgan). Subject "Course on ligament balance in primary knee replacement" , Morphological Center, Yekaterinburg.

November 28, 2015 - Artromost 2015 "Modern technologies in arthroscopy, sports traumatology, orthopedics and rehabilitation" .

May 23-24, 2016 - congress "Emergency medicine. Modern technologies in traumatology and orthopedics, education and training of doctors" .

May 19, 2017 - II Congress “Emergency Medicine. Modern technologies in traumatology and orthopedics.”

May 24-25, 2018 - III Congress “Emergency Medicine. Modern technologies in traumatology and orthopedics.”

Annual scientific and practical conference with international participation “Vredenov Readings - 2017” (September 21 - 23, 2017).

Annual scientific and practical conference with international participation “Vredenov Readings - 2018” (September 27-29, 2018).

November 2-3, 2018 in Moscow (Crocus Expo, 3rd pavilion, 4th floor, 20th hall) conference"TRAUMA 2018: A multidisciplinary approach."

Associate member of the InternationalNational Society of Orthopedic Surgery and Traumatology (SICOT - French Société Internationale de Chirurgie Orthopédique et de Traumatologie; English - International Society of Orthopedic Surgery and Traumatology). The society was founded in 1929.

In 2015, he was awarded the gratitude of the rector for personal contribution to the development of the university .

From 2015 to 2018 was an applicant at the Department of Traumatology, Orthopedics and Disaster Surgery of the Medical Faculty of Sechenov University, where he studied the problem of knee replacement. The topic of the dissertation for the degree of Doctor of Medical Sciences: "Biomechanical substantiation of knee arthroplasty for structural and functional disorders" (scientific consultant, doctor of medical sciences, professor Kavalersky G.M.)

Protection dissertation work took place September 17, 2018 V dissertation council D.208.040.11 (Federal State Autonomous Educational Institution of Higher Education First Moscow State Medical University named after I.M. Sechenov of the Ministry of Health of Russia (Sechenov University), 119991, Moscow, Trubetskaya St., 8, building 2). Official opponents: doctor of medical sciences, professors Korolev A.V.,Brizhan L.K., Lazishvili G.D.

He is a doctor of the highest qualification category.

Scientific and practical interests: endoprosthetics of large joints, arthroscopy of large joints, conservative and surgical treatment of musculoskeletal injuries.

Anatomy of the patellar ligament

The patellar ligament is anatomically a strong cord that runs from the lower pole of the patella to the tibial tuberosity. The ligament plays a key role in the biomechanics of the knee joint. The patellar ligament, also known as its own ligament, is a continuation of the extensor apparatus, formed first by the quadriceps femoris muscle, then by the patella and the patellar ligament itself.

1- femur

2 - quadriceps tendon

3 - superior inversion of the knee joint

4 - patella

5 and 6 - fatty bodies of the knee joint

7 - anterior cruciate ligament

8 - posterior cruciate ligament

9 - patellar ligament

10 - tibia

When the quadriceps muscle is tense, the patella moves upward, and behind the patellar ligament itself, extension occurs in the knee joint, raising the straightened leg. The points of attachment of the ligament experience the greatest stress and deformation, and not its middle part, therefore there are more separations of this ligament than ruptures. The patellar ligament is very strong, and the damaged ligament usually ruptures or is torn off. Typically, the rupture of the patellar ligament is preceded by its tendonitis, that is, aseptic inflammation.

Symptoms of a torn patellar ligament

Typical mechanism of injury to the intrinsic ligament:

• powerful contraction of the quadriceps muscle when pushing, lifting,
• sometimes you can hear a crunching, crackling sound,
• there is a sharp pain,
• movement in the knee joint becomes impossible.

With these complaints, you should urgently consult a doctor.

The traumatologist will look at the knee joints, palpate the knee joint, and can determine hemarthrosis, that is, blood in the knee joint. When the ligament is completely ruptured, the patella moves upward due to the traction of the thigh muscles, and extension in the knee joint becomes impossible. In some cases, you can palpate the hole in the place where the patellar ligament should be.

Diagnosis of patellar ligament injuries

X-rays of the knee joint are helpful in diagnosing rupture and damage to the patellar ligament, which can rule out other injuries, especially fractures. On the lateral view, the patella is higher than on the healthy leg. This is a 100% diagnosis of patellar ligament rupture. Sometimes the ligament comes off with a piece of bone - either the lower pole of the patella or the tibial tuberosity. Ultrasound of the knee joint or MRI is also useful for diagnosis.

X-ray of the knee joint, lateral projection - the patellar ligament is intact, the patella is in a typical place

Avulsion of the patellar ligament with upward displacement of the patella due to traction of the quadriceps femoris muscle

Treatment of patellar ligament rupture

To fully restore your own ligaments, surgery is necessary.

Conservative treatment of patellar ligaments does not bring results. Moreover, it is advisable to perform the operation as early as possible, this will lead to a better result. During operations, the traumatologist finds the ends of the torn patellar ligament and stitches them together. Sometimes the ligament is additionally strengthened with absorbable or synthetic materials. There are a huge number of techniques, but their point is to stitch the ligament, restore its length and strengthen it.

After kneecap surgery, the leg is immobilized in a straight position with a cast or orthosis. An orthosis is preferred because it is possible to adjust the angle of flexion in the knee joint and to carry out early development of movement in the knee joint, since active development has been proven to accelerate the fusion of the ligament.

The prognosis is usually favorable. The main thing is to perform surgery as early as possible.

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The knee joint is one of the most important and largest joints in the body, and this is not surprising, because it can withstand the strongest loads. The knee moves with a large amplitude, and it must support the weight of the entire human body. As a result of such loads, injuries to the joint and adjacent tendons often occur, followed by their inflammation.

Tendinitis of the knee joint is an inflammatory pathology that affects the tendons. The disease is common among athletes, as well as people doing heavy physical work. This condition is accompanied by pain and dysfunction of the knee, and requires timely consultation with a doctor.

Tendinitis of the pes anserine of the knee joint

Anserine tendinitis is a fairly common condition. It is an inflammation of the attachment site of the semitendinosus, sartorius and gracilis muscles. Their tendons form a triangle, resembling a crow's foot in appearance. Such a close plexus of tendons leads to the fact that inflammation easily passes from one of them to another.

Tendinitis can also affect the quadriceps tendon and the patellar ligament. Depending on the location of the inflammatory process, pain will occur in different parts of the joint.

So, with pes anserine tendinitis, the pain is localized under the knee on the back of the leg. If you press on the crow's foot area, the discomfort will intensify. When the quadriceps tendon is damaged, the front of the knee hurts from above, and the unpleasant symptom radiates to the thigh. Patellar tendonitis causes pain under the knee in the front.

Any tendonitis of the knee joint develops gradually. The disease is associated with microtraumas and degenerative processes in the tendon, which is why athletes are more susceptible to the disease.

During heavy physical activity, or as a result of poor warm-up, the tendon is torn. If after such an injury the patient undergoes a course of therapy, the knee will recover completely. But most often, athletes do not pay attention to the aching pain and continue to train, which leads to further injury to the tendon and its inflammation.

Knee tendonitis is accompanied by the following symptoms:

• Aching pain in the knee, which manifests itself during physical activity.
• Impaired joint function, the knee is difficult to bend and straighten, and perform rotational movements.
• In the acute form, swelling may be visible in the area of ​​the affected tendon.
• The skin around the inflammatory process feels hot to the touch.
• The knee crunches when flexed or extended.

The symptoms of knee tendinitis may vary, depending on the form of the pathology. If an infection gets into the affected area, for example, through a wound on the knee, or through the bloodstream, then purulent tendonitis will occur. With this pathology, the symptoms are very pronounced:

• the pain is constant;
• the knee swells, turns red, and becomes hot to the touch;
• signs of intoxication appear, body temperature rises.

If acute tendinitis poses a danger mainly only to the knee itself, then the purulent form of the disease can lead to sepsis. Therefore, infectious tendinitis requires immediate hospitalization.

Causes of knee tendonitis

The cause of tendon inflammation lies in its injury. This formation is a dense, non-elastic band that connects muscles to bones and bones to each other. The tendons of the knee joint provide its stability, as well as the correct trajectory of movement.

During active physical activity, the tendon becomes fatigued, that is, microcracks appear inside it. They are not dangerous in themselves, but the body needs some time to heal.

If a person follows a work-rest regime, that is, after active loads, the knee rests for at least two days, then the tendons are completely restored. But if the load continues, new microcracks appear, and as a result, fatigue injury and inflammation.

This is why professional athletes and bodybuilders do not train the same muscle group every day. Firstly, it will not help build muscle mass, and secondly, it will lead to a fatigue injury. You should always take breaks to give your muscles and tendons time to regenerate.

Tendonitis of the knee joint can also occur due to a tendon rupture. If the load is too active, incommensurate with the physical condition of the person, or neglect of warm-up, it can cause serious injury.

Tendons are quite tight formations. If you do not warm up the knee joints before active work, when lifting heavy weights, the tendon may simply not withstand the load and tear. This condition is accompanied by severe pain and requires long-term therapy, often not without surgical intervention.

Tendonitis of the pes anserine tendons of the knee joint can also be caused by the following negative factors:

• passive lifestyle or prolonged immobilization of the leg;
• poor nutrition;
• weak immunity;
• joint diseases, degenerative and inflammatory, rheumatic pathologies;
• hereditary predisposition;
• congenital pathologies of muscle tissue and tendons;
• mature age of the patient;
• knee injury;
• poor posture and flat feet, as a result of which the load on the joints is poorly distributed;
• wearing low-quality and incorrectly selected shoes.

Chronic tendonitis of the knee joint

Knee tendonitis can be acute or chronic. Chronic tendinitis occurs due to repeated injury, or due to poor treatment of the primary inflammatory process in the tendon. It can be fibrous and ossifying.

Fibrous tendinitis of the knee joint is a chronic inflammatory disease in which the area of ​​tendon tear is overgrown with fibrous connective tissue. As a result, scars form on the tendon, and the surrounding healthy tissue begins to atrophy. This leads to thickening of the tendon, it becomes completely inelastic and does not perform its functions well.

Ossifying tendonitis is a chronic form of the disease in which lime salts accumulate in the area of ​​tendon tear. This condition occurs after severe injuries, for example, fractures, wounds.

Chronic tendonitis is characterized by the appearance of aching pain at the end of the working day. The knee gets tired and begins to bother, but after rest the symptom goes away. Periodically, the disease can worsen, then swelling occurs and the range of motion of the knee decreases.

It is worth noting that chronic tendinitis is very difficult to treat. Therefore, doctors recommend that if you have any pain in the knee, you should immediately undergo an ultrasound and an examination by an orthopedic traumatologist. If a pathology is identified, it is better to treat it immediately. Neglected injuries often cause disability.

Calcific tendinitis of the knee

Calcific tendonitis is a condition in which calcium salts accumulate in the tendon. Calcific tendonitis of the knee is rare and usually affects the shoulder joint.

Why calcium deposits occur in the tendon has not yet been established. Doctors associate this process with age-related changes and hereditary predisposition. The disease also more often affects people with a history of rheumatic pathologies.

Calcific tendonitis manifests itself as aching pain, which intensifies over time. A very advanced form of the pathology brings severe discomfort to the patient; due to severe pain, joint movement is impaired, and the patient suffers from insomnia.

Calcifications can only be removed surgically; arthroscopic surgery is usually performed. If the pathology does not cause severe inconvenience, then only symptomatic therapy is prescribed.

Treatment of knee tendinitis

Any form of knee joint requires long-term and competent treatment. It will depend on the cause of the disease, the form of the pathology, and the neglect of the case.

If tendonitis occurs against the background of a fatigue injury, for example, when carrying heavy objects, against the background of active squats in the gym, then immobilization and anti-inflammatory therapy, in particular NSAIDs, are prescribed:

If the patient consults a doctor immediately, it will be enough to use an ointment or gel with such active ingredients. After pain and inflammation are relieved, you will need to slowly and carefully develop the tendons. You cannot immediately return to previous loads; there is a high risk of provoking a re-injury. Then the treatment will drag on for several months.

A tendon rupture often requires surgery to heal properly. If the tendon is not repaired, it forms a large scar, and as a result, fibrous tendinitis. After surgery, antibiotics and anti-inflammatory drugs are prescribed.

If inflammation in the tendon is associated with rheumatic pathology, then specific therapy will be required.

Treatment of knee tendinitis should always be completed with exercise therapy and physiotherapy. Such therapies will help improve blood circulation and repair the tendon faster, as well as develop tissue to prevent further injury.

Exercises for knee tendonitis

Acute tendinitis is a contraindication to exercise; at this time, immobilization with an elastic bandage or orthosis is prescribed. After the acute condition has resolved, the patient is advised to undergo daily physical therapy, but it is forbidden to put too much stress on the sore knee. You need to exercise only with the permission of a doctor.

Exercises:

• You need to perform slow rotational movements in the knee.
• You need to lie on your side and slowly lift your straight leg up.
• Sit on the floor, press your back against the wall. Place a gymnastic ball between your knees. Squeeze and unclench the ball with your knees.
• Stand up, leaning on the back of a chair, bend your affected leg at the knee and grab it by the shin. Gently pull towards the buttock.
• Grab the back of the chair with both hands and straighten your back. Perform slow swings of your legs backwards.

You shouldn’t immediately perform a large number of repetitions; you need to exercise wisely, increasing the load slowly. If you have tendinitis, you should not run, squat or lunge, especially with weights, as this will most likely lead to re-injury.

Prevention

In most cases, tendonitis is caused by the person himself. To avoid this unpleasant disease, you must follow the following recommendations:

• It is always good to warm up before physical activity, be it training in the gym, carrying furniture when moving, or active jogging. Any load should begin with joint exercises, then the risk of injury will be minimal.
• You need to train taking into account your physical condition. If a person has never played sports, he should not lift heavy weights or perform circuit training on the first day in 4 sets of 30 repetitions.
• The load should be distributed evenly. If a person trains in the gym, he needs to load different muscle groups every day. If you put a lot of stress on your knees every day, a fatigue injury will occur.
• It is recommended to lead a healthy lifestyle, that is, eat a balanced diet, do exercises every day, and give up alcohol and smoking.
• For any knee injuries, especially during physical activity, you should contact a traumatologist and undergo an ultrasound for prevention. And treatment after an injury must be complete; it cannot be interrupted when the pain disappears.

Only the right attitude towards your body will help you maintain health and avoid knee tendonitis, as well as many other inflammatory and degenerative diseases of the musculoskeletal system.