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1

What is knee tendonitis?

Extensor mechanism tendinitis is an overuse injury involving either
the:
quadriceps tendon
or
patella tendon

(Above or below)

2

Who is prone to knee tendonitis?

Adults < 40 yrs who do jumping or kicking sports

“jumpers knee”

Adults >40 yrs after change in exercise level or substantial weight gain

3

Hallmark of knee tendonitis?

Anterior knee pain

4

Describe the pain for knee tendonitis

Anterior knee pain
Immediately after exercise
Pain with:
- Prolonged sitting
- squatting
- kneeling

Climbing stairs, running, squatting or jumping makes it worse

5

PE for knee tendonitis will show?

TTP at quad or patellar tendon

Mild infrapatella bursa swelling

Loss of ROM secondary to pain (can be forced)

Quadriceps atrophy (chronic)

6

Diagnostic tests for knee tendonitis?

Radiograph: normal except:
- some chronic findings
- or w Osgood-schlatter disease

MRI reserved for recalcitrant cases

7

What will radiographs show with chronic tendonitis?

Small osteophytes

Heterotropic ossification at the upper or lower pole of patella

8

What will show on x ray with a PMH of Osgood-Schlatter disease for tendonitis pts?

Large ossicle from an unhealed tibial tuberosity apophysis

(Maybe)

9

Treatment for knee tendonitis?

Phased approach
1. Control inflammation
2. Achieve full ROM
3. strength conditioning back to 90%
4. Agility drills/RTD

10

He really liked PRICES, what does it mean?

Some guy wanted to get known for something but didnt have anything good so he added protection/pain meds and support,strength/stretching to bookend RICE

11

What are some treatment adjuncts for knee tendonitis?

Braces
PRP
Surgical debridement
Excision of nonunited tibial tuberosity ossicle
Unicorn tears

12

What tendonitis pts get referred?

Possible rupture of extensor mechanism (refer ASAP)

Cases recalcitrant to non-operative management

13

What is patellofemoral pain?

Constellation of problems characterized by a diffuse aching anterior knee pain

14

What makes patellofemoral pain better and worse?

Worse:
Increase in activity that places additional loads across patellofemoral joint

Running
Stairs
Kneeling
Squatting

better:
Not doing those things

15

Patellofemoral pain is secondary to?

Overuse syndrome

16

Though it causes anterior knee pain ____ is not considered patellofemoral pain.

Misalignment (bad Q angle)

17

Chondromalacia patella is not the same as patellofemoral pain. Why?

Chondromalacia indicats that pathologic changes are present in the articular surface of patella
Not always the case here

18

Chondromalacia patella is aka?

Runners knee

19

Clinical symptoms of patellofemoral pain?

Diffuse aching anterior knee pain

Worse after:
- prolonged sitting (theater sign)
- stairs
- jumping
- squatting

Maybe instability of retropatellar catching sensation

20

Does patellofemoral pain knee swell?

Nope

21

How should i examine my patellofemoral pain pts?

Weight-bearing stance

Watch them walk

Look at Alignment (genu valgum foot pronation (flat foot))

22

What if the patient’s patella point toward eachother while walking?

Increased femoral anterversion

May increase patellofemoral pain

23

What is patellar apprehension sign?

Indicates patellar instability

With the knee extended translate the patella laterally and then flex the knee 30%

Discomfort or “apprehension” is instability

Palpate patella for crepitus in ROM

Slide 22

24

X rays of the sunrise view of patella is diagnostic for patellofemoral pain if?

The patella is not in the femoral grove

Fancy words are:
Patellar subluxation

25

Treatment for patellofemoral pain

Activity mod
Strengthening and flexibility
Modified quadricep exercises to avoid causing knee pain

NSAIDS
Patellar pad or knee sleeve to isolate patella
Steroids (maybe)
Surgery (maybe)

26

Which way does the patella typically dislocate?

Commonly lateral dislocation

27

Predisposing factors for patellar instability

Patella alta
Shallow trochlear groove
Ligamentous laxity
Muscular imbalance (VMO)

28

Patellar instability can cause dislocations

What 2 ways do patellar dislocations present?

Obvious dislocation

Transient dislocation (w spontaneous reduction)

29

How does patellar instability present?

Patellar dislocation
Sever pain
Audible pop
Acute hemarthrosis
Loss of motion
(Mimics ACL injuries)

30

Primary symptoms of patellar instability?

Malalignment
Retropatellar pain
Exacerbated w
- stairs (descending)
- Movie theater sign
- Squatting