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Jumper's Knee

  • Author: Garrett Scott Hyman, MD, MPH; Chief Editor: Craig C Young, MD  more...
 
Updated: Oct 07, 2015
 

Background

Blazina et al first used the term jumper's knee (patellar tendinopathy, patellar tendinosis, patellar tendinitis) in 1973 to describe an insertional tendinopathy seen in skeletally mature athletes,[1] although Sinding-Larson, Johansson, and Smillie once described this condition. Jumper's knee usually affects the attachment of the patellar tendon to the inferior patellar pole. The definition was subsequently widened to include tendinopathy of the attachment of the quadriceps tendon to the superior patellar pole or tendinopathy of the attachment of the patellar tendon to the anterior tuberosity of the tibia. The term jumper's knee implies functional stress overload due to jumping (see image below).

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

For excellent patient education resources, visit eMedicineHealth's First Aid and Injuries Center. Also, see eMedicineHealth's patient education articles Knee Pain Overview, Knee Injury, and Tendinitis.

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Epidemiology

Frequency

United States

Jumper's knee is certainly one of the more common tendinopathies affecting skeletally mature athletes, occurring in as many as 20% of jumping athletes. With regard to bilateral tendinopathy, males and females are equally affected. With regard to unilateral tendinopathy, the male-to-female ratio is 2:1.

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Functional Anatomy

The rectus femoris and 3 vasti muscles (ie, the vastus medialis, vastus lateralis, and vastus intermedius muscles) join in a common quadriceps tendon that inserts on the patella, the largest sesamoid bone in the human body. This same tendon is known as the patellar tendon from the inferior pole of the patella to its distal insertion at the tibial tuberosity.

Radiologic and histologic studies have shown that the posterior proximal fibers of the patellar tendon appear to be most commonly affected in jumper's knee.[2] Counter to these findings, however, biomechanical research has demonstrated that these posterior fibers can withstand greater tensile strains before failing, compared with the anterior fibers.[3]

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Sport-Specific Biomechanics

Risk factors and biomechanics

Jumper's knee is believed to be caused by repetitive stress placed on the patellar or quadriceps tendon during jumping. It is an injury specific to athletes, particularly those participating in jumping sports such as basketball,[4, 5, 6, 7, 8] volleyball,[7, 8, 9, 10] or high or long jumping.[7, 10] Jumper's knee is occasionally found in soccer players, and in rare cases, it may be seen in athletes in nonjumping sports, such as weight lifting and cycling.

Investigators have implicated sex, greater body weight, genu varum and genu valgum, an increased Q angle, patella alta and patella baja, and limb-length inequality as intrinsic risk factors.[11] However, the only biomechanical impairment prospectively linked to jumper's knee is poor quadriceps and hamstring flexibility.

Vertical jump ability, as well as jumping and landing technique, are believed to influence tendon loading.[4, 10, 12] Volleyball players with a natural ability for jumping high are at increased risk for developing jumper's knee.[13]

In a cohort of elite young volleyball players, male sex, volume of training, and match exposure were all noted to be risk factors. One third of boys aged 16-18 years developed the condition compared with 8% of girls.[14] In a cross-sectional survey of 891 nonelite athletes in the Netherlands, the prevalence of jumper's knee varied from 14.4% and 2.5% for different sports (eg, basketball, volleyball, handball, korfball, soccer, field hockey, and track and field). Younger age, taller body stature, higher body weight, and sport-specific loading characteristics of the knee extensor apparatus were all risk factors for developing jumper's knee.[15]

Overtraining and playing on hard surfaces have been implicated as extrinsic risk factors.

Interestingly, the patellar tendon experiences greater mechanical load during landing than during jumping because of the eccentric muscle contraction of the quadriceps. Therefore, eccentric muscle action during landing, rather than concentric muscle contraction during jumping, may exert the tensile loads that lead to injury.[16, 17]

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Contributor Information and Disclosures
Author

Garrett Scott Hyman, MD, MPH President and Consulting Physician, Lake Washington Sports and Spine

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

Disclosure: Nothing to disclose.

Coauthor(s)

Gerard A Malanga, MD Founder and Partner, New Jersey Sports Medicine, LLC and New Jersey Regenerative Institute; Director of Research, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School; Fellow, American College of Sports Medicine

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

Disclosure: Received honoraria from Cephalon for speaking and teaching; Received honoraria from Endo for speaking and teaching; Received honoraria from Genzyme for speaking and teaching; Received honoraria from Prostakan for speaking and teaching; Received consulting fee from Pfizer for speaking and teaching.

Irfan Alladin, MD Staff Physician, Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School

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

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Russell D White, MD Clinical Professor of Medicine, Clinical Professor of Orthopedic Surgery, 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, American Medical Society for Sports Medicine

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, 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, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

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.

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