Tendinitis of the apparatus bungee cord of the knee

The tendinitis of the apparatus bungee cord of the knee corresponds to the ignition of the Tendon S or their sheath of the muscular apparatus bungee cord of the Genou.

Anatomical recall

The tendon is the fibrous part which connects the Muscle to the bone. It slips inside a sheath.

Patellar tendon

The attack of the patellar tendon is by far the most frequent tendinitis of the knee: 80%. It relates to all the sports of impulses: tennis shoe, volleyball, jump, football… but also cycling.

The diagnosis is clinical:

With the interrogation the pain sits, generally, on the level of the point of the kneecap.
palpation finds the traditional tripod: pain with the pressure, pain with the stretching in inflection and the contraction against resistance. One will seek a pain with the squatting or the jumps on the spot.

Three complementary examinations are useful:

the Radiography standard research a too low kneecap or tendineuses calcifications.
the echography appreciates the gauge of the tendon and research nodules and calcifications.
IRM objectifies as well as possible microruptures, a œdémateuse infiltration, cysts or nodules.

Tendon of the quadriceps

The attack of the tendon of the Muscle quadriceps is rather not very frequent: 10%. It rather often succeeds a rupture partial of the tendon. It is rather specific of sport like the haltérophilie, the volleyball, the fencing, cycling.

The diagnosis is clinical:

With the interrogation the pain sits at the top of the kneecap and to irradiate little towards the quadriceps.
With palpation the three traditional signs are found: pain with the pressure, pain with the passive stretching of the tendon in inflection of the knee and with the isometric contraction in load on a foot.

Three complementary examinations are useful:

radiography in soft ray of profile seeks a thickening of the tendon or calcifications.
Echography appreciates the gauge of the tendon and research a partial rupture, a fibrous scar.
the IRM objectifies as well as possible microruptures, a œdémateuse infiltration, cysts or nodules

Treatment

In acute phase the treatment is medical:

independent measurement is the rest. It is also most difficult to obtain in the sportsman. This rest will be relative but long. From one 6 weeks duration minimum it can reach 6 months.

The recovery is authorized when 3 tests: palpation, stretching, opposed contraction are painless.

a medicamentous treatment is prescribed during the acute phase. The oral treatment associates the catch of Antalgique S and of Anti-inflammatoire S. the infiltrations careful and are limited at the patellar level and are disadvised on the level of the quadriceps.
Of “local” measurements is often useful: anti pomade or patch inflammatory, glazing, strapping.

rehabilitation associates Physiothérapie, massage and stretching. Physiotherapy calls upon various methods: ultrasounds, running antalgic, laser… The massages and the stretchings answer a precise technique.

the major transverse massage is a powerful massage applied transversely to the tendon and in a very supported way. During the exercise the pressure of the tendon is painful.
the treatment of stretching of the tendons comes in complement from the massages in phase from cure. Secondarily, in preventive phase, various causes of disordered state are sought and corrected.

monitoring of the sporting practices: respect of the techniques of heating, importance of the stretchings, good management of the periods of rest and modification of some sporting gestures.
the control of the rules of dietetic hygiene and hydration.
the adaptation of the material: adjustment of the pedals, checking of the surface of race and the chaussage. The shoe plays a crucial role in damping, statics and sporting dynamics.

The surgical treatment is seldom necessary:

It is considered only after failure of a medical care and kinesitherapic led well. The decision is made only after 3 months in the severe tendinitises and 6 months in the intermediate forms.
Its principle rests on the combing of the tendon to thicken it. It joins it an ablation of possible calcifications or nodules cicatricial and, if necessary, a joining of the partial ruptures.
the sports activity is taken again on the same level in 75% of the cases with 6 months an average time. This time is variable 3 months with 1 year. The quality of recovery depends partly on the presence of ruptures partial of the tendon. Rehabilitation plays, in this treatment, an important role.

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