Patellar & Quad Tendonitis

Two tendons work together to straighten the knee. The quadriceps tendon connects the thigh muscle to the top edge of the kneecap, and the patellar tendon connects the kneecap to the shinbone below. Both carry the force the thigh muscles use to straighten the knee, so both can develop a painful breakdown called tendinopathy when the demand outpaces their ability to recover: the fibers become disorganized, the tendon thickens and grows tender, and it tolerates load less well. Patellar tendinopathy, also called jumper's knee, hurts at the bottom edge of the kneecap and is most common in sports with explosive jumping and landing; quadriceps tendinopathy hurts at the top of the kneecap. Neither can be fully reversed, but both can be managed, and most people rebuild the tendon's tolerance with a structured loading program.

Common symptoms include:

• Pain at the bottom edge of the kneecap for patellar tendinopathy, or at the top of the kneecap for quadriceps tendinopathy, where the tendon attaches
• Pain that appears after a hard session early on, then at the start of activity as it progresses
• Pain that eases briefly as the tendon warms up and returns after cooling down
• Jumping and landing that feel less explosive or uncomfortable
• Pain with stairs, squats, or rising from a chair in more advanced cases

The diagnosis is made from the history and a focused exam. Tenderness pinpointed to the affected attachment, the bottom of the kneecap for the patellar tendon or the top edge for the quadriceps tendon, reproduced by pressing on that point, is the hallmark finding. An MRI or ultrasound can confirm the diagnosis and show the degree of tendon change, and is most useful when the diagnosis is uncertain or the tendon has not improved as expected.

The cornerstone of care is a structured loading program rather than complete rest:

• Load management, reducing the volume and intensity of jumping and landing
• Slow, heavy resistance training, such as controlled decline squats, the most evidence-backed approach
• A patellar tendon strap to redirect some load during activity
• A PRP injection in some cases when the steps above have not reduced the pain

Surgery is uncommon and considered only after a prolonged trial of structured loading has not brought the tendon under control. It removes the most damaged tissue and stimulates healing, with a lengthy recovery.

For a fuller explanation, including anatomy, diagnosis, and the full range of treatment:

• Patellar Tendon Tear — AAOS OrthoInfo