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TENDINITIS Martens, et al describes patellar or quadriceps tendimitis as achronic overload lesion in the tendon near its insertion, which

occurs in athletes involved in repetitive activities such as running, jumping, bicycling, or kicking. This problem is sometimes called "jumper's knee" and presents with pain and tenderness in the affected area, sometimes accompanied by local edema. Pain is usually felt at the superior aspect of the patella, at the attachment of the. quadriceps mechanism, or most commonly, at the inferior pole of the patella (Fig. 9-10). Treatment is directed at reduction of inflammation and pain and at encouraging healing of the tendon, as discussed in Chapter 1. Rest is important, but immobilization is not necessary in most cases. Usually, avoiding activities that exacerbate pain is sufficient, for a period of up to 14 days, during which the stages of tendon healing described by Stanish, et al take place. Once symptoms are relieved, strengthening begins in carefully controlled increments, gradually increasing tensile forces. The tendon will then able to withstand functional stresses placed on it by normal activities. Pain should be the limiting factor in treatment by exercise once healing is under way. The popliteus tendon can develop tendinitis, especially during severely stressful activities such as running downhill, and pain is felt along the posterolateral aspect of the knee. Treatment is the same as for other tendons (Fig. 9-11). Jumper's knee This occurs commonly in sports such as jumping, basketball, volleyball or weight-lifting whose action requires repeated jumping off one leg [108]. It is associated with a small area of degeneration at the tendon attachment at the lower pole of the patella, characterized by pain and extreme local tenderness. Pain may be present at first only after activity, but in severe degrees it begins during activity and severely limits athletic performance and may be associated with a weakness or giving way of the knee. Clinical signs Pain is reproduced on resisting active knee extension. Crepitus may be present on passive movement of the patellar tendon. Tenderness, usually marked, is found localized at the lower pole of the patella, especially if the patella is pushed distally. Radiographs are normal but are necessary to exclude any patellar abnormality, stress fracture or an elongated lower pole of the patella.