engleski

Jumper's knee - patellar tendinitis or tendinosis

There are numerous possible reasons for pain caused by overuse injuries around the knee joint. We would, however like to stress the etiology and treatment of one of the most frequent clinical entities-jumper's knee i.e. patellar tendinitis/tendinosis. The purpose of this paper is to present results of surgical treatment and to document histopathologic changes in bone, bone-tendon junction and in the patellar ligament in 34 athletes treated surgically by arthroscopically enhanced method of patellar apicotomy. The so called "half open" method of arthroscopically assisted apicotomy of the patella was performed. The procedure involves the removal of the tip of the patella similar to Kenneth-Jones procedure of loose transplant taking for the reconstruction of the anterior cruciate ligament. The sample was composed of 20 male (58%) and 14 female (42%) athletes with the age range between 16 and 39 years with and average age of 23 years. Postoperative follow-up period was from 1 to 8 years with a mean value of 4.7 years. The postoperative results were classified as very good if the athlete returned to his sport activity without any negative side effects, good if the athlete resumed his sports activities with painful sensations present only at maximum level of physical exertion, and bad if any reduction of athletic activity was present. In all surgically treated patients histopathological examination of resected bone and tendon tissue was performed. The specimens were stained with hematoxylineosin as well as with alcian and Prussian blue which enhances conspicuity of hyaline degeneration or detection of hemosiderin. On the basis of the evaluation scale described, very good results were achieved in 57.9% of operated knees, good result were achieved in 34, 2% Knees and bad result were achieved in 7.9% operated knees. Pathological changes in the bone were found in one third of operated patients and included: foci necrosis, fatty changed cancerous bone, bone replaced by highly vascularized granulation tissue with scattered mononuclear inflammatory cells. Abnormality on the bone-tendon junction were found in 75% of the patients and included: microtears of the tendinous tissues, destruction of bone architecture, foci of ossification, chronic inflammatory cell infiltration, exaggerated fibrocartilaginous metaplasia and mucoid degeneration. Changes in patellar tendon were found In all operated patients and included: cellular proliferation within the tendinous tissue accompanied by a prominence of capillary proliferation, hyaline degeneration, mucoid degeneration, microtears of tendinous tissues, neovascularization and tenocyte infiltration. Polarization microscopy showed loss of clear demarcation of collagen bundles accompanied by a loss of normal, dense, homogenous polarization pattern. The clinical results and histopathological examination in our series of examination in our series of 34 surgically treated athletes with chronic symptoms of jumper's knee justified our operative method. In the chronic stage these lesion seem to be irreversible and constitute permanent intratendinous disease. It thus seems logical to excise these lesions from their origin at the apex of the patella into the adjacent tendon. Also, on the basis of our histopathological examinations we support the opinion of majority of authors that the time has come to change the name of this overuse injury, colloquially named jumper's knee, from patellar tendinitis to patellar tendinosis.

jumpers knee; patellar tendinosis; histopathology

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