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A 17-year-old basketball player has been referred to physical therapy by his family physician for evaluation and treatment of anterior knee pain. His pain had been intermittent over the past summer. However, since the start of the fall high school sport season, his pain has increased in severity and become constant. Pain is now limiting his ability to practice and play, as well as his ability to ascend and descend stairs, and stand after long periods of sitting. His coach told him that he has "jumper's knee" and that he should "get a knee strap and he should be fine." Plain film images revealed no bony abnormalities, though his tibial and femoral epiphyseal plates are almost completely ossified. Otherwise the patient's medical history is unremarkable. Signs and symptoms are consistent with patellar tendinopathy. The patient hopes to finish his season and be ready to compete in an all-star game in the spring.

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Based on the patient's symptoms and history, what are the most appropriate examination tests to help confirm the diagnosis of patellar tendinopathy?

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What are the most appropriate physical therapy interventions?

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What is his rehabilitation prognosis?

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APOPTOSIS: Programmed cell death in response to specific stimuli

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ECCENTRIC CONTRACTION: Controlled lengthening of a muscle as it responds to an external force greater than the contractile force it is exerting

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MUCOID DEGENERATION: Deterioration of collagen fibers into a nonfunctional gelatinous or mucus-like substance

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NEOVASCULARIZATION: Formation of functional new microvascular networks in tissue that does not normally contain blood vessels, or blood vessels of a different type within a tissue

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PROTEOGLYCANS: Mucopolysaccharides bound to protein chains in the extracellular matrix of connective tissue

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TENDINITIS: Acute inflammation of a tendon, typically affecting its insertion; a type of tendinopathy1

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TENDINOPATHY: Clinical term that encompasses all overuse conditions that affect a tendon (proximally, distally, or midsubstance) in the presence or absence of an inflammatory response; includes tendinosis2

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TENDINOSIS: Chronic degeneration and a failed healing response within a tendon, but without the presence of characteristic inflammatory markers; a type of tendinopathy3

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  1. Explain the distinctions between tendinitis, tendinosis, and tendinopathy.

  2. Describe the pathophysiology that contributes to the development of patellar tendinosis.

  3. Describe the differential diagnoses for patellar tendinopathy.

  4. Prescribe the most appropriate strengthening interventions for patellar tendinopathy based on examination findings.

  5. Describe additional treatment options for patients with patellar tendinopathy that have failed conservative management.

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PT considerations during management of the individual with a diagnosis of patellar tendinopathy:

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  • General physical therapy plan of care/goals: Decrease pain and increase function; increase lower extremity strength; prevent or minimize loss of aerobic fitness capacity
  • Physical therapy interventions: Patient education regarding functional anatomy and pathophysiology; modalities and manual therapy to decrease pain; ...

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