PATELLAR TENDINOPATHIES
Anatomical overview Patellar tendinopathy (or jumper’s knee) is a chronic overload condition of the patellar tendon, characterised by pain located just below the patella. The main cause of tendinopathy in skiers, is caused by significant knee flexion (eccentric traction) due to maintaining the skier’s posture. Pathophysiology and skiing Unlike classic inflammation (tendinitis), this condition involves tissue disorganisation (tendinosis), with abnormal cell proliferation and neovascularisation, often without acute inflammation. This occurs in a tendon composed mainly of type I collagen bundles. Several areas can be distinguished (Cook and Purdam classification, 2009): 15 • Main area of involvement: The lesion is located predominantly at the lower pole (apex) of the patella, in the area where the tendon attaches (osteotendinous junction). • Critical treatment area: Often the proximal and posterior portion of the patellar tendon (adjacent to the patella). • Tendon and microtrauma: The pathological area typically presents with: disorganisation of collagen fibers, hypervascularization (pathological neovascularization), infiltration by fibroblasts and an absence of classic inflammatory cells (hence the term tendinosis).
Phase
Description of Pain
Functional consequence
Phase 1
Pain only after activity.
No limitation of performance.
Phase 2
Pain at the start of activity, disappears when warmed up, and reappears afterwards.
Able to participate in activity, but with discomfort.
Phase 3
Pain during and after activity. Performance is limited.
Significant reduction in training or competition load.
Phase 4
Constant pain (even during daily activities) and possible tendon rupture.
Complete cessation of sporting activity.
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