Severe Knee Tendinitis Can Be Alleviated With Surgery

From the WebMD Archives

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 treatment.

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.

Vital Information:

  • Jumper's knee, or patellar tendinitis, is a common injury among athletes where a tendon of the quadriceps develops a series of small tears.
  • For most people, a conservative treatment including muscle strengthening and stretching is effective, but in some cases surgery is necessary.
  • Another treatment, which is not approved in the U.S., is called extracorporeal sound wave therapy and focuses sound blasts to the area of pain.