Patellar Tendonitis and Fat Pad Impingement

Case 6: A 16-year-old basketball player has had intermittent anterior knee pain for the last six months that gets worse during basketball. He has pain with prolonged running and jumping. He denies an injury that began his symptoms. He points to the patellar tendon as to where he gets his pain. He has pain with resisted knee extension. He has tight hamstrings and difficulty with single leg squats as he goes into a valgus maneuver.

Patellar tendonitis (PT) or "jumper's knee" is a tendonitis (acute inflammation) or a tendonosis (chronic scarring and changes of the tendon) of the patellar tendon. It is a common overuse injury in sports that require jumping such as basketball. Pain occurs along the patellar tendon with knee flexion/extension, running and jumping. There is no knee effusion or instability. Athletes typically have very tight hamstrings and a weak core body. Treatment consists of daily rehabilitation focusing on core body strengthening and flexibility of the hamstrings and quadriceps. Iontophoresis (electrical delivery of a steroid) can be helpful in decreasing pain. Icing after activity for 15 to 20 minutes along with use of a patellar tendon strap as coutertraction can help decrease pain. Athletes may participate as long as they are not limping or having a significant increase in pain.

Fat pad impingement occurs with the same overuse mechanism as PT. A medial and lateral fat pad lie beneath the patellar tendon and may become inflamed with activity. Treatment is the same as PT although sometimes a steroid injection into the fat pad can decrease exquisite pain. Patellar tendons are never injected with steroids as they may cause tendon rupture or atrophy.

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