Tendinitis of the knee

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Learn more about tendons

The tendon is an anatomical formation, connecting muscles and bones.

The tendinitis may affect three parts

  • the tendon body,
  • the musculotendinous junction,
  • the osteotendinous junction.

The tendon, rich in water, has visco-elastic properties that provide it with tensile strength and the possibility to store energy and then restore it during movements. A tendon can stretch by 5% of its length without any damage if it is not already fibrous or damaged

Definition of tendinitis

A tendinitis is an inflammation of the tendon with no break, caused by overexertion, repetitive gestures, or inappropriate technique, for example after changing bikes 

The various types of tendinitis, also called tendinopathy or sports technopathy (athlopathy)

  • Caused by traction

Sports with impulsions, changes in the trajectory or sharp repetitive movements (jumps, team sports)

  • Caused by rubbing, with or without bursitis

Sports with repetitive gestures and abnormal slipping of the tendon in its sheath (cycling and others...)

  • Caused by direct shock or repeated micro-traumas

The initial lesion heals poorly and results in a fibrous area that becomes inflamed or in a small haematoma that encysts to form an intratendinous nodule (running and other sport...)

Note that a tendinitis may be associated with a micro-tear with a non visible internal bleeding that could lead to a small bruise.

The clinical sign indicative of a tendinitis: the pain+++

At rest or during exertion

The three characteristics of this pain

  • Pain on pressure
  • Pain when stretched,
  • Pain when contracted against resistance

With total or partial functional impotence, i.e. a pain that prevents the sports movement, such as pedalling

The various causes of tendinitises

Medical causes

Overweight

Inflammatory conditions, including rheumatism

Poor dental health

Use of certain drugs, including antibiotics

Sport-related causes

Over-training and repetition of a gesture

New equipment such as a new bike or a new racket

Wrong equipment or wrong adjustments

Frequent change in the running surface

Worn out shoes

Technical flaws or over-training

External causes

Dehydration

Lack of preparation and insufficient stretching

Hard surface

Outdoor temperature and wet climate

Terrain curve and slope

The various knee tendinitises and their location

The patellar tendinitis in the anterior part of the knee

The anserine tendinitis in the anterior part of the knee

The quadriceps tendinitis in the anterior part of the knee

The iliotibial band tendinitis or IT band syndrome in the external part of the knee

Patellar tendinitis

It is the most common tendinitis in the knee. It causes pain at the pole of the patella or at its low insertion, near the front tibial tuberosity

It occurs during sports involving runs, rotations, impulsions and jumps.

The palpation of the kneecap will determine the exact pain location. Pole, body, low insertion near the tibia.

The ultrasound is the reference examination for all tendinitises, including patellar tendinitises.

Anserine tendinitis

It is a tendinitis of the posterointernal part of the knee

There are three tendons in the anserine: The sartorius, the semitendinosus and the gracilis

The causes

Sports: athletics (hurdles, jumps), cycling, football and dancing, among others

Other cause: laxity and wrong posture (valgus, varus), inappropriate equipment, worn out shoes and hard surfaces.

Clinical expression:

  • Pain in the internal compartment of the knee, under the joint space
  • Swelling or enlargement
  • Painful infiltration
  • Pain during exertion++++

Quadriceps tendinitis 

The quadricipital tendon is formed by the combination of tendons from the four parts of the quadriceps, and is divided into 3 plans from the surface to the deep area.

This tendinitis related to dynamic sports and heavy use of the lower limbs in athletes with high muscle mass or with a rather strong quadricipital toning

Pain is observed when the tendon is palpated and helps identify an external medial tendinitis or an internal tendinitis

Medical imaging will confirm the diagnosis and may sometimes reveal nodules

Iliotibial band tendinitis or IT band syndrome

Cycling is often responsible for this tendinopathy or sports technopathy

The iliotibial band is a large fibrous band that runs down the external part of the thigh.

At the top, near the pelvis, it corresponds to the extension of a muscle (the tensor fascia lata), but also of a membrane (superficial femoral aponeurosis) that is directly connected to the gluteal muscles.

The role of this band is to stabilise and strengthen the external compartment of the knee.

The revealing sign: A pain in the external part of the knee occurring during workout

Also pain in everyday life, including when going up and down the stairs

Common treatment of all these tendinitises

Rest + Icing

Physical therapy and deep transverse massage DTM

Mesotherapy

Infiltration

Extracorporeal shock waves

Homeopathy

PRP :platelet rich plasma

The PRP is produced by a centrifugation process from the patient's blood. The centrifugation process will separate the various components of the blood, to retain only the plasma and the platelets.

Diet and hydration

Return-to-sport rehabilitation

 

Docteur Patrick Bacquaert

Médecin chef de l'IRBMS

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