Joseph Yao, M.D.

Patella tendonitis

The large muscles in the front of the thigh are collectively called the quadriceps muscles. They attach to the top of the patella, which is also called the kneecap. The patella tendon is the band of tissue that anchors the lower end of the patella to the top of the tibia, also known as the shinbone or lower leg. 
     Inflammation of the patella tendon is called patella tendonitis. It usually occurs with overuse and is typically associated with sports such as basketball. In fact, patella tendonitis can occur with any activity that results in repetitive pulling on the patella tendon. Activities that can cause this include squatting, kneeling, stair climbing and jumping.
     Truck drivers engage in numerous activities that can cause patella tendonitis, including climbing in and out of their cab or trailer, using the clutch pedal and sitting for prolonged periods of time with their knee flexed (i.e., in a bent position). The problem can be aggravated if they have to do repetitive lifting while loading and unloading their trailers.
     People suffering from patella tendonitis have pain just beneath the patella. The pain often worsens with activities, such as those above, that stretch the patella tendon. Pain is of-ten better with rest. Walking can be painful when the patella tendon is more severely inflamed.
     Examination will reveal tenderness or pain with direct pressure over the patella tendon. Tenderness can be present anywhere along the patella tendon including its attachment to the patella or tibia or between these attachment sites. There will often be pain in the patella tendon with resisted knee extension or with flexing (i.e., bending) the knee. The person may be observed to walk with a limp.
     X-rays will not demonstrate patella tendonitis since it is a soft tissue problem and
x-rays will show only bone detail. MRI scanning may sometimes demonstrate an abnormal appearance to the patella tendon consistent with inflammation. Treatment includes rest, avoidance of activities that cause tension (i.e., stretch) of the patella tendon, nonsteroidal inflammatory medications, quadriceps muscle stretching, and physical therapy to assist with exercises and for the application of ultrasound, a method of delivering deep heat. Local steroid injections should be avoided because they can lead to tendon weakening and rupture. A knee immobilizer (i.e., a brace that helps to hold the knee straight) and crutches can be used to place the knee at rest in more severe cases.           Chronic patella tendonitis leads to degeneration and weakening of the patella tendon, which can result in rupture. People with patella tendon rupture can no longer extend their knees, effectively crippling the leg. Surgery is necessary to repair cases of patella tendon rupture.
     Dr. Joseph Yao has undertaken extensive subspecialty training in joint replacement after completing an orthopedic surgery residency. Dr. Yao has been in private practice orthopedic surgery since 1987, and he has treated many truck drivers for joint and nerve ailments.