Treatment of Knee Tendinopathy | Knee Tendonitis
Doctors find PRP effective for knee tendonopathy
Lubowitz JH. Editorial commentary: biologic enhancement of muscle and tendon healing. Arthroscopy. 2015 May;31(5):1016. doi: 10.1016/j.arthro.2015.02.037.
Here, we report a systematic literature review of basic research data from humans and animals that support the clinical use of PRP in tendinopathies and of clinical studies in the most common tendinopathies (elbow, knee, shoulder, and Achilles tendon).
Joint Bone Spine. 2015 Apr 13. pii: S1297-319X(15)00048-2. doi: 10.1016/j.jbspin.2015.02.004. [Epub ahead of print]
Does platelet-rich plasma deserve a role in the treatment of tendinopathy?
Nourissat G1, Ornetti P2, Berenbaum F3, Sellam J3, Richette P4, Chevalier X5.
Knee Surg Sports Traumatol Arthrosc. 2014 Dec 11. [Epub ahead of print]
Single injection of platelet-rich plasma (PRP) for the treatment of refractory distal biceps tendonitis: long-term results of a prospective multicenter cohort study.
Sanli I1, Morgan B, van Tilborg F, Funk L, Gosens T.
distal biceps tendonitis
Tendonitis is the most common injury to the knee, although not the most well-known one. In general, it refers to an inflammation, irritation or tear of a tendon, the thick fibrous cords that attach muscles to bone. One of the most frequent types of tendonitis of the knee is pes anserinus tendonitis, which involves the pes anserinus tendons that lie on the inside and just below the knee joint and prevents the lower leg from twisting outward while running. Middle-aged adult runners are most susceptible to the development of pes anserinus tendonitis, the most common form. Two other types of knee tendonitis are popliteus tendonitis and semimembranous tendonitis.
Patellar tendonitis is inflammation of the patellar tendon, which attaches the kneecap to the tibia or shinbone.The patellar tendon helps your muscles extend your knee.
How does knee tendonitis develop?
Tendonitis is caused by overuse, injury or aging. The pain is usually the result of a small tear in or inflammation of the tendon. Tendonitis can also be associated with inflammatory diseases that occur throughout the body, such as rheumatoid arthritis. Popliteus tendonitis is caused by excessive inward rolling of the feet, called pronation, as well as running downhill, which tends to put excessive stress on this tendon and can cause it to tear or become inflamed. Pes anserine tendonitis, on the other hand, is characterized by inflammation of the medial knee, and often coexists with other knee disorders. Semimembranous tendonitis is characterized by swelling over the posteromedial aspect of the knee and tenderness with resisted flexion or outward-turned strain.
Patellar tendonitis is an acute condition, such as knee pain following a run. If the tendon is stressed repeatedly, tiny tears can occur in the tendon. If this process persists, the tendon degenerates causing tendinosis.
What are the symptoms of knee tendonitis?
Knee tendonitis in general produces pain, tenderness and stiffness near a joint and is aggravated by movement. The inflamed tendons in the knee are usually painful when moved or touched, and the tendon sheaths may be visibly swollen from the accumulation of fluid and inflammation. Moving the joints near the tendon even slightly may also cause severe pain. The pain may be worse when ascending or descending stairs, when getting up from a seated position, and at night.
Traditional medicine treatments for tendonitis
The typical treatment regime for tendonitis, such as knee tendonitis, rotator cuff tendonitis or patellar tendonitis, includes rest, ice, non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy and cortisone injections. The problem with this approach is that it does nothing to strengthen the weakened tendon and, thus, does not alleviate the chronic pain that people with this condition experience. While ice, anti-inflammatory drugs and cortisone shots have been shown to produce short-term pain benefit, they result in long-term loss of function and even more chronic pain by actually inhibiting the healing process of soft tissues and accelerating cartilage degeneration. If the individual with tendonitis receives cortisone injections into the tendon, or if they take anti-inflammatories for a very long time, the tendonitis will become tendinosis. This means the tendon becomes degenerated.
Other modern medical treatment options include cryotherapy and massage. But again, although they may provide pain relief, they do not address the root of the problem – weakened and/or injured tendons and ligaments. When the patient tries these treatment modalities and the pain persists, patients who experience tendonitis may be referred to a surgeon. Unfortunately, surgery has consequences and side effects and may make the problem worse.
In treating tendonitis, which is occasionally misdiagnosed as bursitis, we recommend stimulating tendon repair and strengthening any weakened or lax ligaments with MEAT treatment, which consists of movement, exercise, analgesics and treatment, as well as herbal supplements. This approach will encourage the damaged tissues to heal as quickly as possible. Rest, ice and anti-inflammatory drugs will decrease the inflammation necessary for proper healing of tendons and ligaments. Cortisone injections and anti-inflammatory medications also block the feeling of pain. When someone with tendonitis continues to work out while taking these medications, the tendon will continue to degenerate. It is better to stop the particular athletics that caused the tendonitis and proceed with an exercise that does not put a lot of tension on the tendon. Cycling and swimming are examples of this type of exercise, as long as they do not cause excessive pain. Exercise is recommended because movement encourages healing of the tendon.
Tendonitis usually does not require Prolotherapy, while tendinosis, the degeneration of the tendon, benefits tremendously from Prolotherapy. However, with tendonitis, if the tendon does not continue to improve every week or if a tendonitis injury requires extra-quick healing, such as is the case with many athletes, Prolotherapy can be performed. When the tendon cannot heal on its own, an underlying ligament problem and joint instability may be occurring, allowing for too much movement of the knee joint. This movement irritates the tendon because the tendon is unable to contract against a stable knee. Prolotherapy strengthens the weakened tendons and ligaments.
Comprehensive Prolotherapy to the knee involves multiple injections of a dextrose-based solution directed at the affected tendons, ligaments and other affected structures of the knee. This causes a mild and localized inflammatory response which triggers the immune system to initiate repair of the injured tendons and ligaments. Blood supply dramatically increases at the injured area. The body is alerted that healing needs to take place and reparative cells are sent to the treated area of the knee that needs healing. The body also lays down new collagen at the treated areas, thereby strengthening the weakened structures. Once the tendons and ligaments are strengthened, the joint stabilizes and the tendonitis or tendinosis condition resolves.