The patella is located as a sesame bone between the upper and lower leg on the front of the knee joint. It is part of the knee joint. It has a triangular shape, the base of this triangle pointing to the thigh and the tip to the lower leg. The extensor muscles of the thigh (quadriceps muscle, quadriceps muscle) ends sinewily at the base of the kneecap. The patellar tendon runs from the tip of the patella to the front of the lower leg (tuberosity tibiae). In this way (quadriceps muscle - quadriceps tendon - kneecap - patellar tendon - shin), the strength development of the hamstring muscles is transferred to the lower leg.
The knee cap tendon is exposed to particularly high loads when jumping, because this leads to a strong and jerky tensile stress on the tendon. The tendon tissue can be overloaded.
Causes Of Jumpers Knee
Jumpers Knee is a clinical picture that is caused by overloading the patellar tendon due to repeated, unfamiliar and / or violent tensile stresses.
There are both external factors that can cause Jumpers Knee as well as internal factors.
The activity causing the complaint is one of the external factors. Since there is a maximum tensile load on the patellar tendon, especially in jumping sports, sports such as volleyball, basketball, long jump or high jump are common triggers for Jumpers Knee. Hence the name Springerknie or Engl. Jumpers knee. The frequency of the stress, the intensity of the stress and the unusual nature of the stress (new sport, beginners) play an important role in the development of a Jumpers Knee.
But also in cycling, weightlifting, jogging on hard surfaces, tennis, a Jumpers Knee is found more often.
Internal factors include:
- the age (mostly patients over 15 years)
- an elevated patella (patella alta)
- a history of Osgood-Schlatter's disease
- a reduced elasticity of the leg muscles
- as well as a congenital ligament weakness (ligament laxity)
The structural damage to a jumpers knee affects the tendon / bone transition of the patellar tendon (patella) at the tip of the patella. Microscopic examinations showed significant degenerative (wear-related) changes in the tendon tissue, whereas inflammatory cells were missing. So it is a degenerative (wear-related), not an inflammatory disease.
Symptoms Of Jumpers Knee
Patients with Jumpers Knee report a stress-related pain in the area of the patella tip. Depending on the stage of the disease, the pain may be present at the beginning of the stress and disappear after the warm-up phase, while it recurs in the phase after the stress. In the advanced stage, the pain remains throughout the exercise. In very advanced cases, the kneecap not only hurts when doing sports but also permanently in everyday life, for example when climbing stairs. Some patients describe a prick-like pain in certain angular states of the knee joint under stress.
The persistent character of the symptoms is typical. Often it is a chronic clinical picture that lasts for many months to years with low-pain phases, but recurring symptoms after stress peaks.
Jumpers knee occurs on both sides to 20-30%.
Diagnosis Of Jumpers Knee
The medical history (anamnesis) of patients with jumping sports as hobbies is trend-setting. Frequent jogging on hard surfaces or bodybuilding are also mentioned more often.
During the physical examination, there is usually a pain in the pressure above the tip of the patella. A painful stretching movement of the lower leg against resistance is also typical. Visible redness or swelling is less common. Sometimes the knee joint is completely unremarkable, then only a suspicious diagnosis can be made based on the medical history. Some patients also complain of a feeling of stiffness and pain after long periods of sitting, e.g. after long car journeys.
Sonography (ultrasound) is an easily available and suitable method for diagnosing a jumper's knee. In order to be able to correctly assess any changes, the healthy opposite side should always be examined. Typical sonographic changes in a jumpers knee are tendon thickening, an irregularly limited tendon sliding tissue and a non-uniform tendon structure.
MRI examination of the knee is not part of the routine diagnosis of a knee of jumpers, even if it is a suitable procedure.
MRI is important for the localization of the degeneration area when the surgical removal of the changed tendon tissue is imminent. Furthermore, the quality of the patellar tendon can be better assessed with knee MRI than in sonography.
The x-ray does not help with the Jumpers knee and is used to diagnose other diseases.
MRI for Jumpers Knee
The imaging methods play an important role in the reliable diagnosis of Jumpers Knee.
The focus is on the X-ray image and sonography, through which changes in the bone and patella tendon are clearly visible.
In contrast to them, magnetic resonance imaging (MRI) is not part of the routine examinations of the jumper’s knee and is therefore rarely used.
The greatest advantage of this imaging method is that it enables a very precise localization of the degenerated area, which is why it is used in particular in the context of surgical removal of the affected tissue. In addition, the MRI enables the exclusion of differential diagnoses, such as degenerative changes in the cartilage, for example knee osteoarthritis.
Taping For A Jumpers Knee
For some years now, taping has found its way into various areas of medicine. The technique is becoming increasingly popular, especially in sports medicine and physiotherapy, and is used in the prophylaxis and treatment of various diseases.
Depending on the technology used and the tape used (the color of the tape should also play a role), the tape should have different effects on the target organ. Although many doctors and physiotherapists swear by taping, it should be emphasized that its effects have not yet been scientifically proven.
Kinesiological tape is also widely used in the therapy of Jumpers Knee. It is primarily used to prevent the disease as soon as the first signs of the Jumpers Knee appear.
With the so-called patella tendon tapes and patella bandages (jumper knee straps), long breaks in sport should be avoided.
In the case of pronounced complaints, however, longer sports leave can not be avoided even with tape. Furthermore, the taping should enable a quicker return to sport after a long break due to the Jumpers Knee. In both cases, it has the function of absorbing tensile forces on the tendon and instead of transferring them to the skin on which it was tightened.
Shock Wave Therapy
Jumpers Knee is usually treated conservatively, i.e. non-operatively. In addition to various medications, physiotherapy and physical measures are used. These include massages, cold and heat therapy and high-energy extracorporeal shock wave therapy. The target organ, in this case the knee, rests on a plastic cushion filled with water into which sound waves are introduced. These are bundled at the target location, i.e. the affected tissue of the patellar tendon.
Shock wave therapy is used for various diseases, with the main focus being on calcification and ossification.
A therapy session takes about two to five minutes and can be carried out on an outpatient basis. The cost of extracorporeal shock wave therapy is between 50 and almost 400 euros per session.
Surgery For A Jumpers Knee
In some cases, despite a consistent break in training and correct conservative therapy, a satisfactory result is not achieved. In these cases, surgical therapy remains the only way to restore the
- Sporting ability and
- Freedom from symptoms.
There are various options for treating the Jumpers Knee by surgery. Firstly, the tendon sliding tissue can be removed in order to remove the disruptive tissue.
The area around the tendons is cleared so that no disturbing signs of cartilage or inflammation rub against the tendons. The tendon at the tip of the patella can also be loosened. This reduces the tension of the tendon on the kneecap and improves the symptoms. In some cases, the tendons can be incised lengthways using a laser. This also reduces the tension of the tendons on the kneecap.
All of these procedures can be performed minimally invasively, arthroscopically. In addition, any procedure
- individually, but also in
- Combination can be applied.
Which procedure is used depends on the extent of the tendon change.To determine the surgical procedure, an MRI scan is essential before the operation. If the changes are only at the tendon insertion, minimally invasive therapy using arthroscopy is recommended. The tendon can be partially detached and the changed portion of the tendon removed.
In the event of severe or prolonged tendon damage or partial tendon necrosis, open surgery is often necessary.
The surgeon must individually decide which surgical procedure to use and how much tendon tissue has to be removed.
After the operation there should always be a post-treatment phase. How this looks exactly has to be decided individually. This depends on the findings and the operation performed.
The following phases can be used as a guide:
- The knee should be relieved using forearm crutches for the first 3-5 days after the operation.
- This is followed by light physiotherapy for approx. 2-6 weeks, which is slowly intensified through strength and coordination exercises.
- Approximately A light exercise on the Radergometer can be started 2-6 weeks after the operation.
- The first light running exercises can be started after 4-8 weeks and then slowly increased individually.
- The first strength exercises can be carried out after approx. 4-8 weeks.
- Jump training should only be started after 6 weeks - 4 months.
- On average, full sporting ability can be achieved after 2 to 6 months, depending on the findings.
Forecast For A Jumpers Knee
In most cases, conservative therapy is promising if sufficient sports leave is observed. With bandages and relief orthoses as well as a soft shoe sole, recurrences or illnesses can sometimes be avoided.
The success rate after operative therapy is given in the literature as 70-90% good and very good results. Often, however, the sport-specific return takes place at a lower sporting level.
If the Jumpers Knee occurs for the first time, the burden should be significantly reduced, in some cases even completely absent for a few days. So the inflammation in the knee joint can heal. In some cases, this is initially sufficient to become symptom-free again.
Physiotherapy is used in the acute phase with heat and cold applications and ultrasound. Later special stabilization and strengthening exercises are used to strengthen the tendons of the knee. Wearing a special knee bandage can also help significantly reduce pain and promote healing.
In rare cases, the Jumpers Knee cannot be cured conservatively. Then an operation is indicated, which in 70-90% of the patients leads to full physical fitness after about 2 to 6 months. However, the best therapy is prophylaxis.
Thorough are particularly important here
- Warm up before exercise and detailed
- Stretching exercises before and after sport.
Furthermore, sporting activities should not be increased too quickly so that the knee is not overloaded. A sufficient break between sports activities is also important to give the knee sufficient time to regenerate.
In the event of a misalignment of the leg, in the sense of O- or X-legs, special shoe insoles can avoid a Jumpers Knee. All of these prophylactic measures also apply if there is a Jumpers Knee and there are no or minor complaints. In this way, a recurrence of the Jumpers Knee can be avoided.
In addition, the individual improve
- Stretching exercises and the
- Bandage the chances of healing and shorten the healing time.
An exact period in a Jumpers Knee cannot be given. This depends on the extent of the tendon changes and the consistent implementation of adequate therapy and the right exercises.