The Aching Knee

Patella tendinopathy is a common overuse condition in athletes, particularly those involved in jumping and running sports, such as basketball and volleyball. It usually presents as anterior knee pain, which persists as an ache following activity. This basketballer presented with a three-month history of highly localised knee pain, provoked by activity. He was able to continue exercise as the pain would ‘warm-up’ and improve, however, he experienced aching in the knee afterwards.

On examination there was localised tenderness about the proximal pole of the patella tendon, otherwise, the knee was normal. The athlete’s pain was provoked with single leg squatting. An x-ray image of the knee is normal. On ultrasound imaging fusiform thickening is seen within the proximal 20-25mm of the left patellar tendon.

A graded strengthening programme resulted in successful improvement of the player’s symptoms over a four-month period, while he was able to continue training and playing. Initial relief was brought about from a taping soft tissue release and analgesics. Strengthening programmes are the mainstay of treatment for patella tendinopathy, with isometric exercise most useful in the acute setting. Isometric strengthening has been shown to produce a short-term analgesic effect. This can be followed by progressive eccentric exercises, often using a decline board. More refractory cases may do well with a gym-based heavy slow resistance programme. Players do well with a comprehensive rehabilitation programme, with 60-80% returning to their previous level of sport. Surgery is rarely needed however can be considered after the failure of such a programme.