yogabook / pathologie / Patellar tip syndrome

patella tip syndrome patella apex syndrome / osteopathia patellae, jumper’s knee, Patellar tendinopathy, in adolescents: Sinding-Larsen-Johansson

Definition

Painful chronic degenerative overuse disorder(overuse syndrome) at the bone-tendon junction of the patellar ligament in the sense of (insertional tendinopathy or enthesiopathy) at the distal patellar pole or at the patellar tuberosity. The cause is repeated excessive load peaks, usually as part of cyclical movements. The diagnosis is usually made clinically. The condition is not usually inflammatory, but rather degenerative in nature. Accordingly, inflammatory parameters or inflammatory mediators are not measured to be elevated, but rather sprouting nerves and vessels, which indicate tendinosis. The tendon tissue appears more gray and frayed than in physiological findings.

Like most insertional tendinopathies, this is usually treated conservatively, whereby rest and anti-inflammatory or analgesic medication can be supplemented by physical therapy and physiotherapy. Corticosteroid infiltrations, as is often the case, pose a clear risk of tendon damage. Cases that are resistant to conservative therapy or frequent recurrences indicate surgical intervention. There are various procedures to choose from. Full weight-bearing is possible after surgery, but forced flexion should not exceed 90 degrees for six weeks in order to keep the required muscle power in eccentric contraction away from the point at which the tendon is strained for elasticity, taking into account the existing sarcomere length. In 30% of cases, patellar tendinopathy occurs on both sides. It is classified into degrees as follows:

1. 1: Pain after ending the load
2. 2: Pain at the start of exercise and after finishing, pain-free during exercise
3. 3: Permanent pain that precludes exercise
4. 4: Patellar tendon rupture

This disorder is thought to occur in 45% of volleyball players, 32% of basketball players, 9% of rugby players. Age peak: 15-35 years, localization mostly on the distal patellar pole, then on the tibial tuberosity. Before the age of 15, patellar tendinopathy corresponds to Sinding-Larsen-Johansson disease M92.4.

Patellar tendinopathy occurs most frequently at the caudal patellar pole in the lower tendon layers, where the tension is highest under load. The insertion at the tuberositas tibiae is also frequently affected. This is often accompanied by bursitis infrapatellaris. There is also a relationship between patellar tendinopathy and changes in the Hoffa’s fat body.

ICD M76.5

Cause

1. Repeated and unusual tensile loads and tensile movements of the patellar tendon as in many sports, especially jumping, but also gymnastics and weight training

Predisposing

– Behavior

1. Sports: volleyball, basketball, handball, long jump, high jump
2. Sports with frequent abrupt braking or landing: Jumping, stops
3. inadequate training surfaces, inadequate training equipment, inadequate training load, high-intensity training and repetitive loads

– Musculoskeletal system

1. idiopathic ligament weakness
2. Lack of strength or stretching of the quadriceps, patellar elevation
3. Foot and knee anomalies and pathologies
4. Lack of extension of the hip joint
5. Lack of flexibility of the ankle joint
6. Lack of rotational stability of the leg axis during rapid combination movements
7. Foot and knee anomalies and pathologies
8. Leg length differences

– Other factors

1. Overweight

Diagnosis

1. Sono: thickened tendon
2. MRI: edema of the tendon insertion, possibly bone marrow edema at the tip of the patella
3. X-ray mostly o.B.

Symptoms

1. Localized load-dependent pain, sometimes lasting for years, even during normal movements. Depending on the degree: load-dependent, alternating or permanent pain
2. Signs of inflammation: Tumor, Rubor, Dolor
3. Pressure pain at the distal patellar pole
4. Pain and stiffness after exertion, starting pain
5. Urge to move after a long period in the same position

Therapy

1. Rest (6-12 weeks), slow (!) resumption of training
2. physical: cold, shock waves
3. Massage
4. KG
5. Local glucocorticoids, but not in the tendon and not repeatedly, as there is a risk of rupture!
6. NSAIDS
7. Orthosis if necessary
8. only if conservative measures fail OP
9. Training adjustment according to degree:
10. Transversal friction techniques (friction massage)
11. Strengthening and stretching the quadriceps
12. Strengthening other supporting muscles, e.g. calf muscles