10/28 - Patellar Tendinopathy

Question 1

what structure is a hallmark for tendinopathy

Answer 1

lose highly striated, tightly packed, organized structure
- becomes highly degenerated

Question 2

what are 6 signs of a failed healing response

Answer 2

1. hypercellularity
2. microtearing (w/i tissue)
3. loss of tightly bundled collagen
4. inc proteoglycan content
5. neovascularization
6. absent / minimal inflammation

Question 3

what are 4 intrinsic factors that contribute to tendinopathy

Answer 3

age
body composition
ROM
strength (possibly)

Question 4

how is age an intrinsic factor for tendinopathy

Answer 4

prevalence inc w age
predisposition rather than cause
- inc stiffness & limited tolerance to load
—-> dec proteoglycans
—-> inc cross-links

Question 5

how is body composition an intrinsic factor for tendinopathy

Answer 5

inc waist circumference linked to patellar tendinopathy (and also achilles)

tendinopathy inc w inc adipose tissue

Question 6

how is ROM an intrinsic factor for tendinopathy

Answer 6

dec amt of DF
- inc amt & rate of loading

leading to both patellar and achilles tendinopathy

Question 7

how is strength an intrinsic factor for tendinopathy

Answer 7

literature mixed as to if there is a positive or negative association of tendinopathy with weakness

Question 8

what are 5 extrinsic factors for patellar tendinopathy

Answer 8

1. corticosteroids
2. training errors
   - distance, intensity, technique
3. training surface
   - uneven, incline, rigid
4. environment
   - cold, wet climate
5. footwear / equipment
   - esp if direct pressure

Question 9

what sports have a higher incidence of patellar tendinopathy and why

Answer 9

volleyball - inc GRF in take-off
basketball
running

jumping and landing sports, higher incidence d/t GRF

Question 10

what are anatomical factors that contribute to the epidemiology of patellar tendinopathy (2)

Answer 10

dec quad and hamstring flexibility
patellar maltracking

Question 11

what is the enthesis

Answer 11

part of tendon that attaches to bone

Question 12

what are 3 locations of patellar tendinopathy pathology

Answer 12

1. enthesis site
2. inferior pole of patella (post)
3. infrapatellar fat pad highly innervated

Question 13

what is a technique utilized with other pathologies that might not be useful in patellar tendinopathy

Answer 13

palpation - depends on patient

may be able to differentiate things within tendon or the fat pad if come off laterally

Question 14

during the exam what are hx questions we want to ask (3)

Answer 14

prior hx of patellar tendinopathy
prior hx of tendinopathy in other locations and where
pain w loading (jumping, stairs)

Question 15

what are 4 things to assess in the exam

Answer 15

1. strength - gluts, quads
2. ms length
   - limited quad and hamstring
   - (+) thomas, ely, SLR, 90-90
3. ROM - dec DF
4. palpation
   - inferior pole of patella
   - enthesis

Question 16

what is an outcome measure for determining patellar tendinopathy

Answer 16

VISA-P

Question 17

what are 5 differential dx for patellar tendinopathy and why are these probable

Answer 17

1. PFPS
2. osgood-schlatter’s dz
3. bursitis
4. ant meniscal tear
5. Hoffa’s dz

all present w ant knee pain
prox weakness or distal ROM/weakness can contribute to knee pain/dysfunction

Question 18

what imaging is appropriate for patellar tendinopathy and why

Answer 18

radiographs
- r/o osgood schlatter

CT - not often used bc radiation exposure

MRI** best sensitivity/specificity
- expensive and inc scan time

US - inc utilization
- highly operator dependent

Question 19

what imaging is the most commonly used to patellar tendinopathy and how is it utilized

Answer 19

US

assess for hypoechoic region
- disruption of collagen arrangement

Question 20

what is a risk factor for developing sx patellar tendinopathy and what is the significance of US in screening for this

Answer 20

asymptomatic hypoechoic regions of patellar tendon

doppler is able to pick up the neovascularity

Question 21

what are 4 interventions for patellar tendinopathy

Answer 21

1. relative rest / reduce tendon load
2. flexibility - quads, hammies
3. cross friction massage
4. eccentric exercise

Question 22

what does relative rest mean

Answer 22

immobilization is contraindicated

trying to just reduce tendon load

Question 23

why is cross friction massage utilized

Answer 23

break up degenerative tissue to incite normal inflammatory process and inc fibroblastic activity -> create healing environment w normal collagen alignment

Question 24

why is eccentric loading the primary exercise we want

Answer 24

helps to realign and restructure the collagen
- should be uncomfortable to disrupt the scar tissue
- we are using loading to remodel the tissue

Question 25

what anatomical changes were seen as a result of eccentric activity

Answer 25

inc type 1 collagen inc tendon stiffness dec neovascularity -> thus dec pain

Question 26

what is the main eccentric activity that should be introduced as soon as possible bc it is just *chefs kiss*

Answer 26

decline squat - whether both legs or unilateral

Question 27

why do we love decline squats in this population

Answer 27

inc patellar tendon force inc patellar tendon strain and quad EMG

Question 28

what did research show ab the duration of eccentric and tissue loading exercises

Answer 28

likely doesn't matter the duration as long as tissue is loaded

Question 29

what is PRP, what does the evidence say and how has this been utilized to treat patellar tendinopathy

Answer 29

taking platelet rich plasma (PRP) adn spinning in centrifuge and then injecting back into same site to stim healing mixed literature - depends on body part and patient combo w PT is important

Question 30

what are the 2 main predisposing factors to consider

Answer 30

flexibility training errors

Question 31

what is the typical duration of most protocols

Answer 31

10-12wks

Question 32

what should interventions address and be biased toward

Answer 32

address faulty biomechanics w bias toward eccentric strengthening