Kaeding, Christopher C. MD
The Ohio State University Department of Orthopaedics
ABSTRACT Patella tendinosis typically occurs at the inferior pole of the patella at the bone-tendon junction. Tendinosis is an overuse injury with recalcitrant symptoms of pain with tendon loading. These intratendinous lesions are not inflammatory but degenerative in nature and appear to result from a failed adaptive response. Numerous nonoperative treatments for patella tendinosis have been reported with various success rates. Surgical intervention falls into 3 categories. The first being the excise and stimulate group; the second, the excise, stimulate, and decompress group; and the third group being the stimulate alone group. Indications for surgery on clinical grounds are a patient with grade III symptoms for over 4 months and failed conservative management of at least 3 months. Magnetic resonance imaging will confirm the diagnosis and accurately localize the lesion. Surgical treatment of tendinosis consists of a full-thickness longitudinal tenotomy as well as aggressive excision the lesion. If the magnetic resonance imaging reveals that the tendinosis lesion extends up over the anterior aspect of the distal patella such that with knee flexion, the degenerative tendon impinges on the bony projection of the inferior pole of the patella, then an excision of 5 mm of the inferior pole of the patella may be warranted. Postoperative rehabilitation begins with gentle strengthening and range of motion exercises and gradually progresses to sport-specific activities. A very aggressive icing and stretching program is maintained for the first year postoperatively. Performing patella tendon surgery on a patient with patellofemoral syndrome should be done with caution. Success is defined as an athlete with presurgery Blazina grade III symptoms whose symptoms decrease to a Blazina 0 or I. Taking a Blazina III to a Blazina II would be considered a fair result. The future of surgical treatment of patellar tendinosis will involve addressing the biologic problem of a poor adaptive capacity in this location.
Techniques in Knee Surgery: Volume 3(1) March 2004 pp 29-35