Patellar Tip
Syndrome }

Pathology

The patellar tendon connects the lower pole of the patella to the tibia. Patellar tendinopathy (PT), often referred to as jumper’s knee, is a chronic overuse injury of the patellar tendon.

The main clinical symptom is pain at the inferior pole of the patella. Diagnosis is based on the clinical features of the disease. Diagnostic imaging should be considered to rule out other causes of knee pain or to establish the diagnosis of PT when in doubt.

Similar to other tendinopathies, the etiology of PT is not completely understood, but repetitive overload is thought to be an important factor. Histologic examination of biopsy specimens from patients undergoing patellar tendon surgery for chronic symptoms has shown that chronic PT is associated with degenerative changes in the tendon. Accordingly, the disease is better characterized as “tendinopathy” than “tendinitis”, resembling the situation in other overuse tendon problems such as Achilles tendinopathy.

Athletes have a very high prevalence of PT, i.e., up to 40% among elite basketball and volleyball players. The condition can be debilitating and may prevent athletes returning to sport for long periods between 6 months and more than 2 years.

The treatment of PT should start with conservative treatment modalities including rest, physiotherapy, eccentric strengthening, bracing and non-steroidal anti-inflammatory drugs. Patients not responding to conservative treatment for six months should then undergo radial shock wave therapy (RSWT). Surgery should be considered for recalcitrant cases of PT. Numerous arthroscopic and open procedures have been described, but a consensus agreement about the best option is not available.

Treatment Procedure

1. PALPATE

Locate the area of pain through palpation and biofeedback.

2. MARK

Mark the area of pain.

3. APPLY GEL
Apply coupling gel to transmit shock waves to the tissue.

4. APPLY SHOCK WAVES
Deliver Radial or Focused Shock Waves to the area of pain while keeping the applicator firmly in place on the skin.

Recommended Settings

Swiss
DolorClast }

  Treatment
Number of treatment sessions 3 to 5
Interval between two sessions 1 week
Air pressure Evo Blue® 2 to 4 bar
Air pressure Power+ 1.5 to 3 bar
Impulses 2000 on the painful spot
Frequency 8Hz to 12Hz
Applicator 15mm
Skin pressure Light to moderate

Clinical Proofs

Crupnik J
Eccentric loading plus radial shock wave therapy in the treatment of chronic patellar tendinopathy. Abstracts 12th International Congress of the International Society for Musculoskeletal Shockwave Therapy, Sorrento, Italy, 2009, 26-27

Lohrer H, SchÖll J, Arentz S
Achillodynie und Patellaspitzensyndrom – Ergebnisse der Behandlung austherapierter, chronischer Fälle mit radialen Stosswellen. Sportverl Sportschad 2002; 16: 108-114
 

Risks

Side effects of Radial Shock Wave Therapy (RSWT®) using the Swiss DolorClast®

When performed properly, RSWT® with the Swiss DolorClast® has only minimal risks.
Typical device-related nonserious adverse events are:

  • Pain and discomfort during and after treatment (anesthesia is not necessary)
  • Reddening of the skin
  • Petechia
  • Swelling and numbness of the skin over the treatment area

These device-related nonserious adverse events usually disappear within 36h after the treatment.

Accordingly the following contraindications of RSWT using the Swiss DolorClast® must be considered:

  • Treatment over air-filled tissue (lung, gut)
  • Treatment of pre-ruptured tendons
  • Treatment of pregnant women
  • Treatment of patients under the age of 18 years (except for Osgood-Schlatter disease and muscular dysfunction in children with spastic movement disorders)
  • Treatment of patients with blood-clotting disorders (including local thrombosis)
  • Treatment of patients treated with oral anticoagulations
  • Treatment of tissue with local tumors or local bacterial and/or viral infections
  • Treatment of patients treated with cortisone

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