How do you treat knee tendonitis

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Doctor Wei... My Tendonitis Is Killing Me... What Do I Do?

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Knee tendonitis is relatively common. There are three major areas where tendonitis can occur.

The quadriceps tendon connects the quadriceps muscle in the thigh to the patella (kneecap). Tendonitis may occur here as a result of doing deep knee bends, running without stretching properly, or climbing too many stairs. The pain is felt at the top of the kneecap with bending and straightening of the knee. This may be associated with swelling.While the diagnosis is a clinical one, diagnostic ultrasound or magnetic resonance imaging (MRI) can be used to confirm the clinical suspicion.Treatment involves rest, ice, topical therapies, and anti-inflammatory medicines. Bracing may be of use. A potential danger is quadriceps rupture.The patellar tendon connects the lower pole of the patella with the upper tibia (lower leg bone). Patellar tendonitis affects people who engage in athletic activities requiring a lot of jumping and running. Patellar tendonitis is referred to as “jumper’s knee.” Pain is felt at the lower pole of the patella with bending and straightening of the knee as well as with jumping. Magnetic resonance imaging and diagnostic ultrasound can help substantiate the diagnosis.Rest, ice, anti-inflammatory medications, and physical therapy can be helpful.The iliotibial band (ITB) is a long ligament-like structure running along the outside of the thigh. It starts at the ilium, a part of the pelvis, and connects to the outside part of the tibia (shinbone). When the knee is bent more than 30 degrees, the ITB sits behind the lateral femoral condyle, the bony prominence on the upper outer portion of the knee joint. When the knee is extended, the ITB moves in front of the lateral femoral condyle. Repeated bending and straightening of the knee moves the ITB back and forth over this bony structure.

When the ITB becomes irritated and inflamed, iliotibial band syndrome is the result. This can lead to lateral knee pain.

The patient, usually an athlete, will complain of knee pain brought on by repetitive bending and straightening of the knee and may have a limp following exertion. Swelling is not present usually. In this case, magnetic resonance imaging and diagnostic ultrasound are very helpful for diagnosis confirmation.

Treatment involves rest, stretching, anti-inflammatory medicines, and frequent icing.

Steroid injection should be avoided for both patellar tendonitis as well as quadriceps tendonitis because it can lead to weakening of tendon tissue with subsequent rupture.

Patients with iliotibial band syndrome may respond to steroid injection given using ultrasound needle guidance.

Patients who have these types of tendonitis and who don’t respond to conservative measures may require tenotomy with autologous tissue grafting. This is a minimally invasive procedure requiring a small gauge needle, local anesthetic, and ultrasound guidance.