Tendonitis of the knee
Patellar tendonitis, knee tendonitis
The patellar tendonitis are most often tendonitis of insertion at the apex of the patella. This knee tendinitis ratherly occurs in sports that require racing and jumping, such as athletics, basketball, volleyball, handball, football, skii…
The knee tendonitis pain is most frequently located at the apex of the patella and in the body of the tendon, and finally at the low insertion on the tibial tuberosity. These knee tendonitis pains usually appear gradually, in some cases more brutally.
When the intensity of a knee tendonitis is high, it can be painful at rest : sitting in car, doing everyday life gestures, climbing stairs, downhill inclines, bi or uni-podal bending… It can also be an unlocking pain : the athlete is impeded during its first few minutes of activity and after the heating is carried out, the pain in this knee tendonitis completely disappears only to reappear when the sport is stopped or when it has been too long. In milder cases, the pain only occurs during high intensity efforts.
Quadriceps tendinitis, -hamstring tendonitis-
This knee tendonitis occurs in sports that involve dynamic load pulses, sudden or violent bending blocks : weightlifting, fencing, volleyball, basketball, skating…
The lesions are located at the front of the thigh between the pelvis and the knee.
The triggering gesture for the knee tendinitis seems to be especially the hard constraints imposed to the quadriceps during jump landings. The mechanism is probably a violent and repeated tendon stretch. The pain most often appears gradualy. The sudden onset is found more readily in patients with a high body weight or carrying very heavy loads. As for the patellar tendonitis, different intensities are possible.
The characteristic clinical exam of quadricipale knee tendonitis reveals pain at passive stretching of the leg.
Goose’s foot tendonitis, inner knee tendonitis
The knee counts 3 pes anserinus ( or goose’s foot) muscles : gracilis, sartorius and semitendinosus. They are bi-articular and all three end with a common insertion on the crest of the goose’s foot, on the medial face of the tibia. Their origin and innervation are different.
The sartorius and gracilis form the internal and external sides of the Scarpa triangle, the semitendinosus is the inner edge of the popliteal diamond. The sartorius muscle is satellite to the femoral artery all along its path.
These three muscles share a common action, namely: internal rotation of the thigh, flexion of the leg on the thigh. They contribute to the stability of the knee, preventing sprains by reinforcing the collateral medial action of the medial ligament.
Knee tendonitis of the goose’s foot muscles occurs during sports involving jump and violent impulses: tennis, jump, dance, football … but also in repetitive movements over long periods as in cyclism. Women after age 50 are often concerned by this knee tendonitis, alone or in association with osteoarthritis.
Repetition of incorrect positioning of the foot or the hip, favorise knee tendonitis. The more the foot turns in external rotation, the more the femur internally rotates which increases tension in the goose’s foot tendons.
On clinical examination, we find for this inner knee tendinitis :
– pain caused and reproduced by isometric testing of the goose’s foot muscles during movements of upset internal flexion rotation of the knee.
– pain caused upon stretching tendons
– exquisite pain on palpation at the insertions of the muscles of goose’s foot (inside of the knee under the joint).
This diagnosis will be considered after the exclusion of a local cellulalgia, a Palmer or Pellegrini-Stieda syndrome, an internal meniscus suffering, a fracture of the medial tibial plateau or an L3 root projected pain.
Tendinitis of the fascia lata, windscreen wiper syndrome, tendonitis of the external face of the knee.
The fascia lata is thick and wraps arround the sartorius. Lateral knee tendonitis or fascia lata tendonitis is caused by the friction of the iliotibial tract on the tubercle of the lateral condyle of the knee at each flexion-extension of the knee. Tendinitis of the fascia lata is also called windscreen wiper syndrome or iliotibial band syndrome or Maissiat band syndrome.
The name of “windscreen wiper syndrome” for this knee tendonitis comes from the fact that in extension of the knee, the iliotibial tract is located in front of the tuberosity of the lateral femoral condyle, and in flexion , it slides under the lateral condyle in the manner of a windscreen wiper. Thus, at each flexion-extension of the knee, there will be a conflict between the iliotibial tract and the lateral condyle.
This knee tendinitis concerns athletes practicing running, cycling and football. Pain is located at the outside of the knee, its intensity is variable. When the subject performs a race, he finds for a given distance a pain that forces him to quit the race. From the cessation of this activity, the pain decreases or disappears completely.
2 January 2018 - 9 h 20 min