Jumper's Knee Clinical Presentation

  • Author: Garrett Scott Hyman, MD, MPH; Chief Editor: Craig C Young, MD   more...
 
Updated: Jul 1, 2011
 

History

Jumper's knee (patellar tendinopathy, patellar tendinosis, patellar tendinitis) commonly occurs in athletes who are involved in jumping sports such as basketball and volleyball. Patients report anterior knee pain, often with an aching quality. The symptom onset is insidious. Rarely is a discrete injury described. Usually, involvement is infrapatellar at or near the infrapatellar pole, but it may also be suprapatellar.

Depending on the duration of symptoms, jumper's knee can be classified into 1 of 4 stages, as follows:

  • Stage 1 – Pain only after activity, without functional impairment
  • Stage 2 – Pain during and after activity, although the patient is still able to perform satisfactorily in his or her sport
  • Stage 3 – Prolonged pain during and after activity, with increasing difficulty in performing at a satisfactory level
  • Stage 4 – Complete tendon tear requiring surgical repair
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Physical

Physical examination may reveal the following findings:

  • Point tenderness at the inferior patellar pole, superior patellar pole, or tibial tuberosity
  • Hamstring and quadriceps tightness
  • Normal ligamentous stability of the knee during testing
  • Normal knee range of motion
  • Normal neurovascular examination
  • Normal hip and ankle examination
  • Intra-articular effusion of the knee (rare)
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Causes

The cause of jumper's knee remains unclear.

Histologic specimens are devoid of inflammatory cells; therefore, the disease process probably rarely involves a true tendinitis. Histologic studies have found increased numbers of mast cells associated with vascular hyperplasia, as well as an increased number of apoptotic cells.[14]

Biomechanical research has shown that a greater tensile load is borne by the anterior fibers.[3] This observation contradicts the theory that jumper's knee is caused by repetitive tensile loading, given that the proximal posterior patellar tendon is routinely affected.

The degenerative "tendinosis" rather than inflammatory "tendinitis" model has prevailed since the 1970s. Hamilton and Purdam have proposed an adaptive model, whereby compressive rather than tensile loads occur at the proximal posterior aspect of the tendon, resulting in structural changes from altered biomechanical forces.[15] This model is said to account for the presence of the routinely found asymptomatic lesions, and perhaps the absence of inflammatory cells in histologic specimens.

Almekinders et al suggested that stress shielding by the anterior fibers may lead to degenerative change or tendon wear of the posterior ones due to compressive forces.[2] They also proposed that such stress shielding and/or compressive forces, rather than repetitive tensile loads, may be more important etiologic factors in insertional tendinopathy.

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Contributor Information and Disclosures
Author

Garrett Scott Hyman, MD, MPH  Consulting Physician, Northwest Spine and Sports Physicians, PC; Clinical Assistant Professor, Department of Rehabilitation Medicine, University of Washington

Garrett Scott Hyman, MD, MPH is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, American Medical Association, and North American Spine Society

Disclosure: Nothing to disclose.

Coauthor(s)

Gerard A Malanga, MD  Director of Pain Management, Overlook Hospital; Director of PM&R Sports Medicine Fellowship, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Institute of Ultrasound in Medicine, International Spine Intervention Society, and North American Spine Society

Disclosure: Cephalon Honoraria Speaking and teaching; Endo Honoraria Speaking and teaching; Genzyme Honoraria Speaking and teaching; Prostakan Honoraria Speaking and teaching; Pfizer Consulting fee Speaking and teaching

Irfan Alladin, MD  Staff Physician, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry at New Jersey

Irfan Alladin, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Leslie Milne, MD  Assistant Clinical Instructor, Department of Emergency Medicine, Harvard University School of Medicine

Leslie Milne, MD is a member of the following medical societies: American College of Sports Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Russell D White, MD  Professor of Medicine, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

References

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The proximal patellar tendon is most commonly affected in jumper's knee.
 
 
 
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