Severe Knee Tendinitis Can Be Alleviated With Surgery
Dec. 8, 1999 (Atlanta) -- One of the most common injuries in athletes is
"jumper's knee" or patellar tendinitis. This injury is especially
common in sports such as basketball, volleyball, football, soccer, and track
and field, where jumping is frequent. The tendon of the thigh muscle -- the
quadriceps -- when overused develops a series of small tears in a condition
called patellar tendinitis. Atlanta Hawks guard Jim Jackson has suffered from
this condition since he had knee surgery last summer.
Although most sufferers of this condition can be treated conservatively,
occasionally the little tears in the tendon enlarge to create an area of dead
tissue within the tendon. British and Italian researchers reported on a new
surgical procedure in the current issue of Medicine and Science in Sports
and Exercise, which they believe should be the first line of surgical
Those most likely to benefit from surgery are those who have damaged, or
torn, the main body of the tendon, according to the investigators. "The
ones who had the marked commonly occurring jumper's knee ... were the ones in
whom the procedure is not indicated or warranted," study co-author
Nicola Maffulli, MD, PhD, associate professor of orthopedic surgery at the
University of Aberdeen Medical School in Scotland, tells WebMD.
The doctors used ultrasound to identify the damaged area of the knee and to
guide their surgery on 37 patients. "What we also found is that given this
procedure, it's not necessary to excise the area of degeneration [or dead
tissue]," Maffulli says. "It is sufficient to perform just longitudinal
tenotomies [cuts in the tendon]. So it should make the procedure faster and
less injurious to the remaining part of the tendon. We think that by performing
multiple ... longitudinal tenotomies, we end up stimulating an acute healing
response from the remaining part of the tendon."
"It is a minimally invasive procedure that when performed in the right
patients and followed by appropriate rehabilitation, has a high chance of
returning them to active sports in a reasonable time," Maffulli says. All
the patients in the study were treated as outpatients.
Conservative treatment for jumper's knee includes strengthening the
quadriceps muscle and stretching the hamstrings, the muscles at the back of the
thigh. Pain medications, cryotherapy, and massage have also been found to be
useful. Cryotherapy involves freezing, usually using liquid nitrogen or carbon
dioxide, to destroy tissue. Most doctors warn that good training in the
preseason is a good way to prevent this injury. After the injury occurs,
however, it is important to rest the muscle.
"[Once the injury occurs,] prevention is then the cure. Before getting
to the stage when they do warrant an operation, they should reduce their
training habits both in terms of intensity and time period of training in order
to give the tendon a chance to recover," Maffulli tells WebMD.
Basketball forward Jackson, however, is currently undergoing another new
form of treatment in Canada. The treatment, called extracorporeal sound wave
therapy (ESWT), involves focusing sound blasts to the area of pain. The
treatment is being used in Canada and Europe to treat chronic pain or pain over
a small area, particularly near a bone. The joint pain treated by this system
includes the shoulder, elbow, ankle, and, as in Jackson's case, the knee.
ESWT or Sonocur is not approved for use in the U.S. or Japan. It has minimal
side effects and does not require anesthesia or pain medication.