Conservative treatment

Conservative treatment of patellar tendinitis is based upon what we believe to be the primary cause. In the vast majority of patients, it is due to some degree of repetitive minor injury, some degree of overuse and is often found in patients whose biomechanics predispose them to this condition.

For the acute phase, rest, ice and anti-inflammatories, either from oral preparations such as ibuprofen, or topically applied creams which contain anti-inflammatory drugs, can be used to bring about resolution.

However, the treatment is not over as quite often the inflammation will recur as soon as any repetitive activity is recommenced. It is therefore wise to extend the rest period in terms of avoiding repetitive or impact activities until all symptoms from day-to-day activities have ceased.

Many patients wish to start their recreational activities or training as soon as possible, however this is perhaps the one condition where this can be counter-productive and a more leisurely approach to reintroduction of activities is advised.

Research has shown that you are more likely to suffer conditions like patellar tendinitis and other related conditions if your activity levels remain in excess of what the body is capable of dealing with. This problem can be made worse by crowding your recreational activities over a period of one or two days. For runners therefore,it is wise to recommence gentle jogging spread out throughout the week and to consider reducing intensity, duration and frequency to begin with.

Setting yourself a clear calendar of activity and sticking to it is much more likely to be successful. Marking out activity days with a Conservative limit on distance and building it up on a week by week basis will allow you a quicker return

Additional treatments such as local supports, knee braces and orthotics can also be tried in combination with a disciplined rehabilitation/training programme.

Summarising conservative treatment:

Initial rest and symptomatic treatment                        1-2 weeks

Establish symptom-free day-to-day activities               4-6 weeks

Reintroduce activity with calendar/training programme   6-12 weeks

It is also worth considering the above regime if you have had a prolonged absence from your activity from other reasons.

If you have followed the above or are having problems it is wise to take advice at this stage.

What else can be done?

Most patients will accept a slower return if they can see good progress. There are a number of patients however his progress is slow but they still wish to avoid surgical treatment. Physiotherapy can be a suitable adjunct treatment and a physiotherapist has a wide range of weapons which can help bring about reduction in symptoms. They can also direct careful muscle development to offset the loss of muscle tone that normally occurs following any painful condition.

Local treatments with ultrasound, megapulse, etc can be helpful in reducing pain and do not cause any harm.

What about steroid injections?

Without doubt, injection of a corticosteroid into the tissues surrounding a painful tendon can bring about dramatic pain relief, however research has clearly shown that there can be significant damage caused to the tendon and there are well documented episodes of patella tendon rupture after steroid injection. I personally would never use injections in this scenario. Patellar tendon rupture is a devastating injury and carries a particularly poor prognosis if it occurs after steroid injection.

When do you consider surgical treatment?

Failure of Conservative treatment, long-standing symptoms supported by clinical and radiological diagnoses are a reasonable indication to consider surgical treatment.

See section on surgical treatment of patellar tendon inflammation

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