Knee Ultrasound-Guided Cortisone Injections for Patellar Tendinopathy

 

Introduction

Patellar tendinopathy, commonly referred to as jumper’s knee, is a condition characterised by chronic pain and dysfunction in the patellar tendon, which connects the kneecap (patella) to the shinbone (tibia). It is often caused by repetitive stress, overuse, or excessive loading, leading to microtears, collagen breakdown, and structural changes in the tendon.

This condition is frequently seen in athletes involved in jumping, running, and explosive movements, such as basketball, volleyball, and football players. However, it can also affect individuals who engage in repetitive knee loading in occupational or daily activities.

While conservative treatments such as physiotherapy, rest, and activity modification are commonly recommended, some individuals may experience persistent pain and functional limitations. In such cases, ultrasound-guided cortisone injections may be considered to help manage pain and inflammation, allowing individuals to continue rehabilitation effectively.

This blog will explore the anatomy, pathology, causes, symptoms, diagnosis, and management of patellar tendinopathy, with a focus on how ultrasound-guided cortisone injections may help in pain relief.

Anatomy of the Patellar Tendon

Structure and Function

The patellar tendon is a strong, fibrous structure that plays a crucial role in knee movement and stability. It connects the inferior pole of the patella to the tibial tuberosity, transmitting the force generated by the quadriceps muscles to facilitate movements such as:
✔ Knee extension (straightening the knee).
✔ Jumping and landing.
✔ Running and squatting.

The patellar tendon, despite its name, functions more like a ligament (connecting bone to bone), yet it is often referred to as a tendon due to its close association with the quadriceps muscle-tendon complex.

Pathology of Patellar Tendinopathy

Patellar tendinopathy is classified as a tendinopathy, rather than tendinitis, as it is predominantly a degenerative condition rather than an acute inflammatory response.

The key pathological changes in patellar tendinopathy include:

  • Collagen disorganisation — The normal structure of the tendon becomes irregular.
  • Increased vascularity — The formation of new, small blood vessels (neovascularisation) occurs.
  • Thickening of the tendon — Due to excessive stress and failed healing.
  • Loss of normal tendon stiffness — Leading to pain and reduced function.

These changes result in chronic pain and weakness, making it difficult for individuals to perform activities that involve sudden forceful contractions of the quadriceps.

Causes of Patellar Tendinopathy

1. Overuse and Repetitive Stress

  • Repeated jumping, running, or squatting can cause microtears in the tendon.
  • Common in athletes involved in sports such as basketball, volleyball, and football.

2. Sudden Increase in Load or Activity

  • A rapid increase in training intensity, duration, or frequency can overload the tendon.
  • Poor conditioning or improper training techniques may contribute to excessive stress.

3. Biomechanical Factors

  • Tight quadriceps or weak hip muscles can alter knee mechanics, increasing strain on the patellar tendon.
  • Flat feet (pes planus) or abnormal foot posture can also contribute to excessive tendon loading.

4. Age and Degenerative Changes

  • The risk of patellar tendinopathy increases with age, as tendon resilience decreases.
  • Poor blood supply to the tendon can impair healing and recovery.

5. Inadequate Recovery and Nutrition

  • Insufficient rest between activities may not allow the tendon to recover.
  • Deficiencies in collagen-supporting nutrients, such as Vitamin C and protein, may affect tendon repair.

Symptoms of Patellar Tendinopathy

Common Symptoms

  • Pain localised to the front of the knee, just below the kneecap.
  • Pain that worsens with activity, especially jumping, running, or climbing stairs.
  • Tenderness and thickening of the patellar tendon.
  • Stiffness or discomfort in the morning or after periods of inactivity.
  • Reduced knee function and difficulty in weight-bearing activities.

Patellar tendinopathy typically develops gradually, unlike acute injuries that cause sudden pain.

Diagnosis of Patellar Tendinopathy

Clinical Assessment at Alton Pain Clinic

A clinician will evaluate the condition through:
✔ Detailed history and symptom assessment.
✔ Physical examination — Palpation of the patellar tendon and assessment of knee movement.
✔ Functional testing — Evaluating pain during jumping, squatting, or step-down tests.

Imaging Studies

  1. Ultrasound Scan — Identifies tendon thickening, neovascularisation, and structural changes.
  2. MRI Scan — Provides a detailed view of the tendon to assess degenerative changes.

Treatment Options for Patellar Tendinopathy

Conservative Management

  1. Activity Modification — Reducing load on the tendon while maintaining conditioning.
  2. Physiotherapy — Eccentric exercises to promote tendon remodelling.
  3. Shockwave Therapy — Used in some cases to stimulate healing.
  4. Pain Management — NSAIDs may be considered for short-term relief.

Ultrasound-Guided Cortisone Injections for Patellar Tendinopathy

For individuals with persistent pain, ultrasound-guided cortisone injections may be considered to manage inflammation and discomfort.

Mechanism of Action of Cortisone Injections

Cortisone injections work by:
✔ Reducing inflammation — Suppressing inflammatory mediators in the tendon sheath.
✔ Alleviating pain — Temporarily reducing discomfort to facilitate rehabilitation.
✔ Minimising swelling — Preventing further irritation of the surrounding tissues.

Why Use Ultrasound Guidance?

At Alton Pain Clinic, ultrasound guidance is used to:
✔ Ensure precise delivery of cortisone into the inflamed region.
✔ Minimise risk of tendon weakening by avoiding direct injection into the tendon substance.
✔ Enhance treatment accuracy and reduce unnecessary discomfort.

Procedure Overview

  1. Preparation — The clinician cleans the knee area and applies a local anaesthetic.
  2. Ultrasound Guidance — Ensures accurate injection placement around the tendon sheath.
  3. Cortisone Injection — The medication is injected under direct visualisation.
  4. Post-Injection Care — Patients are advised to avoid high-impact activities for a short period.

✔ Experienced clinicians specialising in musculoskeletal conditions.
✔ Ultrasound-guided injections for precision and effectiveness.
✔ Personalised treatment plans tailored to patient needs.

Conclusion

Patellar tendinopathy is a challenging condition that requires appropriate diagnosis and management to prevent chronic dysfunction. Ultrasound-guided cortisone injections may provide short-term pain relief, allowing individuals to continue rehabilitation effectively.

At Alton Pain Clinic, we offer expert musculoskeletal care tailored to your needs, ensuring precision treatment for patellar tendinopathy.

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