Patellar Tendonopathy

Posted Posted by Usamah in Sports Injuries     Comments Comments Off on Patellar Tendonopathy

Case Study Patellar tendonopathy
A 42 year old male cyclist, director of a PR company, participating in triathlons since the age of 19, presented with a two weeks history of significant anterior knee pain related to pedalling and other knee extension activities. Three months earlier, during a wet training session, he fell onto the knee. After a five day break from training, he resumed his training schedule in preparation for a forthcoming event. During training, the pain developed early in the session, decreased well into the training schedule and then returned towards the end. It was initially relieved by rest. As a result, he stopped cycling and running altogether but continued with swimming training sessions. The history, clinical findings and Diagnostic Ultrasound confirmed the diagnosis of patellar tendonosis. He was treated with relative tendon unloading, eccentric drills and two guided injections of autologous blood into the tendon. After making some adjustments to the bike, he returned to competing eight weeks after starting treatment.

Tendinosis results from irritation of the tendon occurring with overuse and repetitive motion injury. It is most likely caused by excess angular traction on the tendon. Frequently, cyclists develop overuse conditions in the early season due to a rapid increase in distance. There are three areas of bike fit that could predispose to patellar tendonosis: the crank arms (too long), the cleats (improperly aligned), and the saddle (too far forward).

Relative tendon unloading is critical for treatment success and may be accomplished by correcting anatomic, functional, or equipment related errors. The key to the rationale behind eccentric drills is that they are the best way of promoting tendon remodeling. A loss of eccentric control of the patellar tendon may lead to increased strain through the tendon and damage. It is crucial to assess the level of hip mobility (tight extensors), pelvic control, and quadriceps stretch. Controlled lunging and step-down tests may give an indication of the eccentric control on the tendon. Weak quadriceps muscles in comparison with hamstring strength and control would increase the shear forces on the patellar tendon. Lower back problems (stiffness at the L3-L4 level) could also affect neural firing to the quadriceps and might increase shear forces through the tendon.

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