What Causes Tendinitis and Ruptured Tendons?
Knee tendon injuries range from tendinitis (inflammation of a tendon) to a ruptured (torn) tendon. If a person overuses a tendon during certain activities such as dancing, cycling, or running, the tendon stretches like a worn-out rubber band and becomes inflamed. Also, trying to break a fall may cause the quadriceps muscles to contract and tear the quadriceps tendon above the patella or the patellar tendon below the patella. This type of injury is most likely to happen in older people whose tendons tend to be weaker. Tendinitis of the patellar tendon is sometimes called jumper's knee because in sports that require jumping, such as basketball, the muscle contraction and force of hitting the ground after a jump strain the tendon. After repeated stress, the tendon may become inflamed or tear.
Symptoms and Diagnosis
People with tendinitis often have tenderness at the point where the patellar tendon meets the bone. In addition, they may feel pain during running, hurried walking, or jumping. A complete rupture of the quadriceps or patellar tendon is not only painful, but also makes it difficult for a person to bend, extend, or lift the leg against gravity. If there is not much swelling, the doctor will be able to feel a defect in the tendon near the tear during a physical examination. An x-ray will show that the patella is lower than normal in a quadriceps tendon tear and higher than normal in a patellar tendon tear. The doctor may use an MRI to confirm a partial or total tear.
Treatment
Initially, the doctor may ask a patient with tendinitis to rest, elevate, and apply ice to the knee and to take medicines such as aspirin or ibuprofen to relieve pain and decrease inflammation and swelling. If the quadriceps or patellar tendon is completely ruptured, a surgeon will reattach the ends. After surgery, the patient will wear a cast for 3 to 6 weeks and use crutches. For a partial tear, the doctor might apply a cast without performing surgery.
Rehabilitating a partial or complete tear of a tendon requires an exercise program that is similar to but less vigorous than that prescribed for ligament injuries. The goals of exercise are to restore the ability to bend and straighten the knee and to strengthen the leg to prevent repeat injury. A rehabilitation program may last 6 months, although the patient can return to many activities before then.
What Causes Osgood-Schlatter Disease?
Osgood-Schlatter disease is caused by repetitive stress or tension on part of the growth area of the upper tibia (the apophysis). It is characterized by inflammation of the patellar tendon and surrounding soft tissues at the point where the tendon attaches to the tibia. The disease may also be associated with an injury in which the tendon is stretched so much that it tears away from the tibia and takes a fragment of bone with it. The disease most commonly affects active young people, particularly boys between the ages of 10 and 15, who play games or sports that include frequent running and jumping.
Symptoms and Diagnosis
People with this disease experience pain just below the knee joint that usually worsens with activity and is relieved by rest. A bony bump that is particularly painful when pressed may appear on the upper edge of the tibia (below the knee cap). Usually, the motion of the knee is not affected. Pain may last a few months and may recur until the child's growth is completed.
Osgood-Schlatter disease is most often diagnosed by the symptoms. An x ray may be normal, or show an injury, or, more typically, show that the growth area is in fragments.
Treatment
Usually, the disease resolves without treatment. Applying ice to the knee when pain begins helps relieve inflammation and is sometimes used along with stretching and strengthening exercises. The doctor may advise the patient to limit participation in vigorous sports. Children who wish to continue moderate or less stressful sports activities may need to wear knee pads for protection and apply ice to the knee after activity. If there is a great deal of pain, sports activities may be limited until discomfort becomes tolerable.
What Causes Iliotibial Band Syndrome?
This is an overuse condition in which inflammation results when a band of a tendon rubs over the outer bone (lateral condyle) of the knee. Although iliotibial band syndrome may be caused by direct injury to the knee, it is most often caused by the stress of long-term overuse, such as sometimes occurs in sports training.
Symptoms and Diagnosis
A person with this syndrome feels an ache or burning sensation at the side of the knee during activity. Pain may be localized at the side of the knee or radiate up the side of the thigh. A person may also feel a snap when the knee is bent and then straightened. Swelling is usually absent and knee motion is normal. The diagnosis of this disorder is typically based on the symptoms, such as pain at the outer bone, and exclusion of other conditions with similar symptoms.
Treatment
Usually, iliotibial band syndrome disappears if the person reduces activity and performs stretching exercises followed by muscle-strengthening exercises. In rare cases when the syndrome doesn't disappear, surgery may be necessary to split the tendon so it isn't stretched too tightly over the bone.
