Treatment
Once diagnosed, and assuming that advanced tissue
degeneration within the patellar tendon has not yet occurred,
treatment is almost always initiated by non-operative means.
A program of physical therapy may include quadriceps (frontal
thigh muscle) stretching with special augmentation techniques,
light conditioning exercise, multi-angle quadriceps isometrics,
eccentric quadriceps strengthening, ice and friction massage to
the tendon, dexamethasone iontophoresis, and sometimes ultrasound.
Such therapy often proves effective, particularly when accompanied
by oral anti-inflammatory medication. Obviously, avoiding the
inciting stress or abnormal activity that caused the problem in
the first place is helpful as well.
Cases that prove unresponsive to activity modification, physical
therapy and oral anti-inflammatory medication may often be successfully
treated by way of appropriately administered corticosteroid (cortisone)
injection. This treatment should be used very judiciously and
only with proper injection technique, which usually involves placing
a small dose of this anti-inflammatory medicine directly at the
inflamed tendon-bone junction and an additional dose deep to (beneath)
the upper tendon. In my experience, approximately 9 out of
10 cases of patellar tendinitis respond satisfactorily to non-operative
treatment. However, if treatment is unsuccessful or if the
condition is left untreated and allowed to progress, gradual tissue
degeneration can weaken the patellar tendon and may occasionally
result in spontaneous and unexpected tendon rupture during
vigorous physical exertion. This is an unwelcome and sometimes
catastrophic occurrence.
In cases where advanced inflammatory degeneration has occurred
within the upper tendon and/or in cases that have proven unresponsive
to 6-12 months of non-operative management, surgical treatment
is often the best option. A cure, or at least a significant improvement
in symptoms, can usually be obtained by surgically excising the
deteriorated tendon substance through a small skin incision located
directly over the affected area. The small, unfilled space left
by the excision of the chronically inflamed and degenerated tendon
tissue gradually fills in with benign, fibrous scar tissue, usually
bringing relief of the patient's pain. While the ability to kneel
on hard surfaces in total comfort may never return, surgery often
provides gratifying relief for many difficult cases of this condition.
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