Open patella tendon decompression
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Patellar tendinopathy is a common condition that is, in the most part, self-limiting. Sometimes described as “jumper’s knee” it is seen in long and high jumpers, who repeatedly load the patellar tendon (PT) eccentrically during take-off. However it is not limited to this group of athletes, and in my practice I often see rugby players, basketball and netball players who suffer the same condition.
Surgical decompression of patellar tendinopathy is rarely indicated, because most cases resolve with conservative management, though is entirely appropriate for managing recalcitrant cases. Tendinopathies as an entity are still not fully understood despite comprehensive published research in the field. They can be a debilitating condition in any tendon so afflicted and most commonly the elbow, knee, ankle and foot are.
Recent theories on aetiology are that the tendon becomes “trapped” in a phase of degenerative damage and repair. This is supported by histological studies which show both degenerative tissue and also inflammatory tissue, making it therefore neither tendonitis nor tendinosis and most aptly called tendinopathy.
This case involves a 23 year old semi-professional rugby player who had a previous successful decompression on the opposite side 2 years previously and had failed conservative management on the side in question. Investigations demonstrated a thickened proximal 1/3 of the tendon. No osteophyte was found effecting the inferior pole of the patella. However, this is a common finding and will need excision at the time of surgery.
Author:Mr Andrew Pearse FRCS (Tr & Orth).
Institution: The Royal Worcestershire NHS trust, UK.