Jumper's knee, a common term for patellar tendinitis, is an injury that usually results from overuse in jumping and lunging activities.

It can involve an inflammation of the patellar tendon (connecting thigh muscle to lower leg bone) where it inserts into the patella (kneecap), or it can be a degenerative process related to a partial tearing of the tendon where it inserts into the tibia below the knee.

Jumper's knee can afflict runners, climbers, kickers, and basketball players.

SYMPTOMS
The most obvious symptom of patellar tendinitis is pain in the area of the patellar tendon, usually near the patella but sometimes down at the other end of the tendon. It can start as a dull ache but can gradually increase over a period of time. The soreness is usually felt following a game or workout, but as the condition worsens, a person may feel stiffness, grinding, and swelling. The symptoms can be divided into four stages:

• Stage 1: the pain occurs only after an activity
• Stage 2: pain occurs at the beginning of an activity but then seems to dissipate after warming up for a while and then reappears again after the activity
• Stage 3: pain is present during and after an activity
• Stage 4: the tendon is ruptured.

TREATMENT
A majority of cases can be taken care of with non-operative treatment plans, especially those in stage 1 and 2 cases. In stage 3, there is more unpredictability, and more of those cases wind up under surgical care. Bone scans and MRIs (Magnetic Resonance Imaging) are helpful in determining whether surgery is needed.

Like any tendinitis, resting the injured area until the symptoms have subsided is important. The entire RICE regimen (rest, ice, compression and elevation) can also help alleviate soreness, as can the use of anti-inflammatories.

Often, patients will undergo a formal physical therapy program which uses a combination of ice and heat treatments, sometimes ultrasound or phonophoresis where a cortisone cream is used on the ultrasound device to try to get a small amount of cortisone to the area.

If surgery is necessary, the surgeon removes the damaged part of the tendon through a small incision and then sews the healthy tendon back together or reattaches the tendon directly to the bone. Although the rehabilitation is a slow process -- it can take anywhere from six weeks to six months -- the success rate in these cases is also very high.

PREVENTION
The use of Neoprene sleeves or tendon braces for the knee can help decrease or disperse the lunging or jumping force on the patella.

When someone is ready to return to an activity, we try to have him do adequate warm-ups and stretch the muscles in the leg, especially the hamstrings and quads, as well as taking anti-inflammatory medication both pre- and post-activity.

Dr. William H. Montgomery, III is the head team physician for the San Francisco Giants and a team physician for the University of San Francisco and the St. Ignatius and Sacred Heart High Schools.