This 17-year-old male football player presented with a three-month history of highly localised anterior knee pain. The pain was provoked by activity but typically warmed-up during exercise allowing him to continue. He reported it aching following activity.
The player had a normal knee examination with the exception of localised tenderness about the proximal pole of the patella tendon. The pain was provoked by single leg squatting.
There is fusiform thickening within the proximal 20-25 mm of the left patellar tendon. Within the deep aspect of the proximal tendon there is an elongated region of reduced echogenicity with dimensions of 20 x 9 x 6 mm. Power Doppler displays prominent abnormal vascularity within the hypoechoic tissue. The tendon is normal further distally. An x-ray image of the left knee is normal.
The player was successfully managed with a graded strengthening programme. This started with an isometric strengthening programme followed by a progressive eccentric exercises. He had good initial relief from a taping soft tissue release and analgesics. His symptoms progressively improved over a four-month period. He was able to continue training and playing during this time.
A strengthening programme is the mainstay of treatment for patella tendinopathy. Isometric exercise is generally useful in the acute setting. It has been shown to produce a short-term analgesic effect. Eccentric loading (often using a decline board) or a gym based “HSR” (heavy slow resistance programme) have shown promise in more refractory cases. Knee taping can be effective. Surgery is rarely needed however it can be considered after the failure of a comprehensive rehabilitation programme. About 60-80% of athletes return to their previous level of sport.
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