What Are the Treatments for Patellar Problems?

Your knee is one complicated joint. Bones, tendons, and ligaments all come together so you can run, jump, and kick to your heart’s content. The kneecap, also called the patella, is at the center of it all -- and gets a lot of the wear and tear. Here are some common kneecap issues and how they’re typically treated.

Kneecap Fracture

This is a serious injury where you break your kneecap, usually in a fall. If the broken pieces are still lined up, you’ll get a cast to hold everything in place as you heal. Sometimes, you can still put weight on your knee. In other cases, you might be off your feet for 6 to 8 weeks.

For a more serious fracture, you typically need surgery. Your doctor may use screws, pins, or wires to hold the bone pieces in place.

In either case, you’ll need physical therapy to work through stiffness, get your range of motion back, and build leg strength.

Patellar Tendon Tear

The patellar tendon starts in your thigh muscles, wraps around your kneecap, and connects to the top of your shinbone. If you completely tear the tendon above the kneecap (the quadriceps tendon) or below it (the patellar tendon), you won’t be able to straighten your knee.

  • Small tears. For small tears, you typically wear a brace and have crutches for 3 to 6 weeks. The brace keeps your knee straight while your tendon heals. You’ll also get physical therapy to help with leg strength and range of motion.
  • Large tears. Most people need surgery for a large patellar tendon tear. It usually takes 6 to 8 weeks for the tendon to heal after surgery, but it can take up to a year for a full recovery.

Patellar Tendinitis

Also called patellar tendinopathy or jumper’s knee, this is an injury to the patellar tendon. It’s common with people who play sports like basketball and volleyball.

You typically start treatment with basic self-care, like rest and over-the-counter pain relievers.

From there, you might need to see a physical therapist who can:

  • Reduce pain and swelling with ice massage, ultrasound, or iontophoresis, which uses a small amount of electricity to push cortisone, a drug, into your body through your skin
  • Give you stretches and strengthening exercises for your thigh muscles
  • Show you how to use a patellar tendon strap to relieve pressure on the tendon

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If these treatments don’t work, your doctor may talk to you about getting a cortisone injection to help with pain and swelling. The drawback with this treatment is that it can also weaken the tendon and make a tear more likely. Another option is to get an injection of platelet-rich plasma. But this has not been proven to work better than physical therapy or other treatments.

It’s rare, but if nothing else works, you might need surgery to remove damaged tissue and repair the tendon.

Patellofemoral Pain Syndrome

Typically caused by overuse, patellofemoral pain syndrome can lead to pain, stiffness, or a buckling feeling in the knee and lower thighbone. It’s common in athletes, especially females and young adults.

Often, it gets better with over-the-counter pain relievers and the “RICE” method:

  • Rest. Avoid activities that trigger pain, and try not to put any weight on your knee.
  • Ice. Wrap an ice pack in a towel and apply it 20 minutes at a time, several times a day.
  • Compress. Use a stretchy bandage that has a hole for your kneecap. You want it to feel snug but not tight.
  • Elevate. Keep your knee higher than your heart as much as possible.

Your doctor may suggest physical therapy to:

  • Improve strength and range of motion in your thigh, hip, abs, and lower back
  • Show you how to tape your knee or use a brace to reduce pain
  • Teach you how to correct your form if your knee moves in when you squat

Rarely, you might need surgery to remove damaged cartilage, loosen tendons, or realign the patellar tendon and the top of the shinbone.

Chondromalacia Patellae

Damage to the cartilage behind the kneecap is called chondromalacia. You may feel a dull pain around or under your kneecap that gets worse when you go down stairs.

Again, you’ll start with self-care:

  • Avoiding activities that cause pain
  • Applying an ice pack wrapped in a towel for 15 to 20 minutes, four times a day for several days
  • Over-the-counter pain meds

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You might also see a physical therapist for help with:

  • Changes in how you exercise -- you’ll need to avoid high-impact activities as well as kneeling and squatting
  • Choosing the best footwear for your activities
  • Safe exercises to stretch and strengthen your thigh and hamstring
  • Shoe inserts, if you need them
  • Tape, brace, or a sleeve to keep your kneecap aligned

If these treatments don’t work, you may need surgery to remove damaged cartilage and correct kneecap alignment.

Unstable Kneecap

Your kneecap moves through a V-shaped groove in your thighbone. If that groove is uneven or isn’t deep enough, your kneecap can slide partly or totally out of place.

If it’s only part of the way out, you’ll get a brace to keep you from moving your knee. Within 1-2 weeks, you’ll start physical therapy to strengthen your thigh muscles. You can expect about 1-3 months for recovery.

If it pops totally out, your doctor will first gently push it back into place. In some cases, you might also need surgery to repair damage to your thighbone or the cartilage behind your knee.

If it keeps happening, you may need surgery to tighten the tendons and help keep your kneecap on track.

Prepatellar Bursitis

A bursa is a small, fluid-filled sac. It eases friction between bones and soft tissue, like tendons. With prepatellar bursitis, the bursa in the front of your knee gets irritated and swells with extra fluid. That puts pressure on your knee that leads to pain.

If it happens due to an injury, it usually goes away on its own with a little self-care:

  • Avoid activities that trigger pain
  • Wrap an ice pack in a towel and apply it for 20 minutes, three to four times a day
  • Keep your knee above your heart as much as possible
  • Take over-the-counter pain relievers

If these treatments don’t work, your doctor may:

  • Take fluid out of the bursa using a needle
  • Give you a cortisone injection to help with pain and swelling

If the bursa is infected, you’ll also need antibiotics. If they don’t help, you may need surgery to get out the extra fluid.

If you have repeated problems with the bursa, your doctor may suggest you have surgery to remove it.

WebMD Medical Reference Reviewed by Tyler Wheeler, MD on May 10, 2017

Sources

SOURCES:

University of California, San Francisco: “Knee: Quadriceps and Patellar Tendon Rupture.”

OrthInfo: “Patellar (Kneecap) Fractures,” “Patellar Tendon Tear,” “Patellofemoral Pain Syndrome,” “Unstable Kneecap,” “Prepatellar Bursitis.”

Houston Methodist: “Patellar Tendonitis,” “Patellofemoral Pain Syndrome,” “Prepatellar Bursitis.”

Kid’s Health: “Jumper’s Knee.”

Mayo Clinic: “Patellar Tendonitis,” “Patellofemoral Pain Syndrome.”

National Institute of Arthritis and Musculoskeletal and Skin Diseases: “Knee Problems.”

Cleveland Clinic: “Knee Pain (Chondromalacia Patellae).”

Cedars-Sinai: “Chondromalacia.”

Harvard Medical School: “Chondromalacia.”

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