Star Third Baseman Brandon Inge Joins Rafael Nadal in the Battle with Patellar Tendinitis

By Asheesh Bedi, MD

It was announced this week that Detroit Tiger’s All Star will have surgical treatment of patellar tendinitis in both knees in the upcoming weeks with the hope of achieving a full recovery from an injury that plagued him the entire past season.

The patellar tendon is the strong tissue that connects the patella (“kneecap”) to the tibia (“shinbone”). This patellar tendon is remarkably important, as it is the critical structure that connects the powerful quadriceps muscles of the thigh to the tibia and allows for extension of the leg. Walking, jumping, running, and virtually all athletic activities require a functioning patellar tendon. Correspondingly, degeneration and inflammation of the patellar tendon (“patellar tendinitis”) can be both painful and debilitating for the elite athlete.

Patellar tendinitis is typically an overuse injury. Jumping sports, such as volleyball, tennis, basketball, or track and field, may pose a greater risk from the recurrent stretch and injury to the tendon. Sports with long, often grinding seasons, such as baseball, soccer, and basketball, may also be particularly difficult on players. However, athletes of virtually every sport can develop patellar tendinitis.  Tennis star Rafa Nadal and Mets pitcher Oliver Perez are no strangers to this chronic, nagging injury.

The diagnosis of patellar tendinitis is relatively straightforward, and will be manifest by tenderness of the patellar tendon. The most common location is directly below the kneecap at the origin of the tendon. This area may be swollen as well. The pain may be worsened with resisted leg extension, kneeling, or jumping exercises. Plain x-rays are usually normal, but occasionally will show some irregular bone spurs or fragments. MRI or US usually confirm the diagnosis, showing a localized area of inflammation with tendon degeneration and disorganized scar tissue.

The first line of treatment for patellar tendinitis is nonoperative. Rest, ice, and anti-inflammatory medications are often very effective. Stretching of the quadriceps and hamstrings is followed by a supervised rehabilitation program of strengthening. Sometimes, a knee sleeve brace or strap for the tendon (“Chopat strap”) can provide significant pain relief also. Despite these interventions, however, some athletes only partially benefit and are unable to return to their previous level of competition. Surgery for these refractory cases is performed to remove the area of tendon damage and inflammation and can be very effective. It is important to consult with your SportsMD physician to get prompt and effective treatment if you suspect that you have patellar tendinitis.


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