Patellar tendinosis

Aetiology and pathogenesis not fully understood. It is thought that the inappropriate progression of the training load or duration may be contributing factors. Interesting those with natural ability to jump high are most at risk for reasons not fully understood. There is consensus that degenerative change is main process. However the relationship between pain and tendon pathology is unclear. Patients can present without obvious clinical, imagery findings while tendon abnormality can be found in sports people without symptoms. It has been suggested this group of patients have difficulty grading the activation of their quadriceps during activities due to increased corticospinal excitability. This could lead to overshooting or undershooting quadriceps recruitment.

• Pain - localised to inferior pole of patellar. Worse with loading which is relieved by unloading. Pain is dose dependent worse with higher jump or deeper squat.
• Metabolic factors e.g diabetes and obesity are often causes of tendon degeneration.
• Load related pain that increases with demand placed on extensors.
• More pain with higher hop or deeper squat.

• Quad strength-Increased or decreased are both risk factors.
• Reduced lower limb flexibility.
• Inferiorly displaced patellar.

• X-Ray to assess for degenerative joint disease (DJD)
• MRI to assess for tendon degeneration and or other structural abnormality.

Patellofemoral OA, Anterior knee pain.

• Discussion regarding training volume.
• Ensure accurate belief about their condition.
• Discussion regarding risk factors.
• Exercise prescription dependent on findings.

Failure to improve with conservative measures.