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Patella tip syndrome (PTS)

What is patella tip syndrome?

Patella tip syndrome is a chronic inflammation of the patellar tendon’s insertion point on the kneecap. It usually occurs after excessive strain and can be accurately diagnosed because the pain is clearly located at the lower patella tip and can be easily reproduced during an examination. 

Patella tip syndrome is divided into four levels.  At the first level, pain occurs exclusively after heavy strain. At the second level, pain occurs at the beginning of and after strain. At the third level, the pain is constant. At the fourth level, the patellar tendon will tear. 

Patella tip syndrome is the most common knee condition in elite athletes and aspiring amateur athletes. Sports with high tensile loads on the patellar tendon,  such as during jumping or shock absorbing, are  particularly prone to patella tip syndrome. In addition to high jump and long jump, this also includes ball sports such as volleyball and basketball as well as weight lifting and endurance running on hard surfaces.

The painful area in the case of patella tip syndrome

Location of the pain

Patella tip syndrome is an inflammation of the tendon that connects the thigh muscle with the shin (tibia) via the kneecap (patella). It occurs at the lower end of the kneecap directly on the transition between patellar tendon and patella.

 

Patella tip syndrome has many names 

Most people probably know patella tip syndrome (PTS) by the colloquial description “jumper’s knee.” The technical terms patellar tendinitis, patellar tendinosis, enthesiopathy and patellar tendinopathy are also used.


Causes of patella tip syndrome 

Patella tip syndrome is caused by chronic excessive strain on the tendon insertion point. The strain is strongest when the knee is bent because the tendon insertion point is flexed and tensed. 

Three areas can generally be involved in triggering patella tip syndrome: the active musculoskeletal system (muscles and tendons), the passive  musculoskeletal system (bones, joints and ligaments) and the individual body posture.  

  • Excessive strain  

Especially when landing after a jump, a maximum tensile load is applied to the kneecap In addition to the intensity, the frequency of the strain and the individual’s physical condition  play an important role.

 

  • Tensile forces caused by imbalances

A congenital ligament weakness, shortened or hardened thigh muscles, a shorter leg or other physical imbalances can increase the tensile forces that are exerted on the patellar tendon.

 

  • High-riding patella

In the case of high-riding patella, also known as patella alta or high-riding kneecap, the kneecap has shifted upwards, thus exerting increased tensile forces on the patellar tendon when the knee is bent. High-riding patella can be congenital or acquired. 

 

  • Misalignment (of the patella) 

If the kneecap shifts outwards, additional strain is applied, which can result in problems.


Comprehensive treatment of patella tip syndrome

To lay the foundation for successful treatment of patella tip syndrome, it’s firstly important to stop whatever is causing the strain. Depending on the intensity, a break of six to twelve weeks is recommended before starting to train again. 

Treatment with medical products

In the case of chronic or acute pain, a patella strap, such as the JuzoFlex Patella Xtra, helps to guide and stabilise the kneecap. The massage effect exerted by the nubs promotes blood circulation and therefore the healing process. If the cause of patella tip syndrome is a foot misalignment, orthopaedic insoles can compensate for imbalances. In severe cases, an orthosis such as the JuzoPro Patella Xtec provides additional stability, making it even more effective.

Treatment with the JuzoFlex Patella Xtra 

The best treatment for patella tip syndrome

The JuzoFlex Patella Xtra is used in the conservative treatment of patella tip syndrome. Its main aims are pain reduction and support of the regeneration process. A pad centres the kneecap, therefore improving its guidance. The stimulating and massaging effect of the nubs boosts the healing process. 

Treatment of patella tip syndrome can take up to 16 weeks. It requires a lot of patience and co-operation from the patient. If the treatment of patella tip syndrome is prematurely discontinued, the condition can become chronic. That’s why consistent treatment with the JuzoFlex Patella Xtra, supplementary measures and exercises for rehabilitation are essential.

Physical therapy

Depending on the level, pain pattern and indication, various types of physical therapy are used for patella tip syndrome. In addition to massages and physiotherapy, other options are thermotherapy, electrotherapy, ultrasound and shock wave therapy. The individual measures can be arranged and combined depending on the cause.

Movement

In order to reduce strain on the tendon insertion point, sporting activities that feature jumps or other extreme or frequent tensile loads should be avoided. To strengthen the supporting muscles, you and your doctor should discuss switching to gentler exercises, such as cycling or aqua jogging. Regularly stretching of the thigh muscles can reduce tension on the kneecap, while other  targeted exercises can compensate for imbalances. 

Eccentric exercises are particularly suitable during training. They contract the muscle quickly. Muscle tension generated in this way is relieved slowly and in a controlled manner during the eccentric phase. 

Surgery

Surgery should only be considered as the last option for patella tip syndrome. If conservative treatment does not cause long-term improvement, there are open as well as minimally invasive surgical options.