Patella & Quadriceps Tendinopathy

Patella tendinopathy—commonly called “jumper’s knee” and quadriceps tendinopathy are two closely related conditions affecting the front of the knee. Both involve degeneration of tendon fibres: either those connecting the kneecap (patella) to the shin bone (patellar tendon), or the fibres connecting the thigh muscles (quadriceps) to the top of the patella (quadriceps tendon).

Patellar tendinopathy is particularly common in sports that involve repeated jumping, sprinting, or explosive lower-limb movements such as basketball, volleyball, football, and athletics (Cook and Purdam, 2009). Quadriceps tendinopathy, though less frequent, is seen in athletes who place high repetitive loads on the knee during running, weightlifting, or kicking sports, particularly when training with poor technique or insufficient recovery.

These conditions are not simply inflammatory “tendonitis.” Instead, they are considered to be tendinopathic, meaning a chronic degenerative processes in which microtears in the collagen fibres fail to heal properly. Over time, the tendon thickens, loses elasticity, and becomes painful when loaded (Scott et al., 2015).

Symptoms
Patients typically report localised pain and tenderness either just below the kneecap (patellar tendon) or above it (quadriceps tendon). Pain is aggravated by activity such as squatting, jumping, running, or climbing stairs. Stiffness or aching after rest, particularly in the morning or after sitting, is also common. In advanced cases, pain can interfere with simple daily activities and significantly reduce knee function (van der Worp et al., 2011).

Why it develops
Contributing factors include repetitive overload without adequate rest, sudden spikes in training intensity, poor biomechanics (such as excessive forward knee travel in squats or poor landing mechanics), muscle imbalance or tightness, reduced ankle mobility, and training on hard surfaces or with inappropriate footwear (Malliaras et al., 2013).

Our approach at The Injury Hub
Diagnosis begins with a detailed clinical assessment and high-resolution ultrasound imaging. Ultrasound provides real-time visualisation of tendon changes, showing whether the process is inflammatory or degenerative, the degree of fibre disruption, and any associated swelling or neovascularity.

Treatment aims to address both pain relief and long-term tendon recovery. At The Injury Hub we use:

• Hydrodissection – saline and local anaesthetic are injected under ultrasound guidance to release the tendon from surrounding structures such as the Hoffa’s fat pad (in patellar tendinopathy), reducing irritation and improving mobility.

• Prolotherapy – a dextrose injection to stimulate the body’s healing response and strengthen tendon structure over time.

• Shockwave therapy – promotes blood flow and tissue regeneration in chronic degenerative tendon tissue, with strong evidence for patellar tendinopathy (Zwerver et al., 2011).

• Platelet-rich plasma (PRP) – patient-derived platelets injected into the tendon to encourage repair and regeneration, especially in recalcitrant cases (Dragoo et al., 2014).

• Fenestration (dry needling under local anaesthetic) – controlled stimulation of healing in degenerative regions.

• Progressive eccentric loading – supervised by our onsite strength and conditioning coach, a structured programme of eccentric and heavy slow resistance exercises is introduced to restore tendon capacity and strength (Rio et al., 2015).

• Hands-on therapy – targeted manual treatment to relieve surrounding muscle tightness, improve joint mechanics, and address biomechanical contributors.

Prognosis
With the right combination of load management, progressive rehabilitation, and regenerative treatments, most patients improve within weeks to months. Chronic or severe cases may require longer rehabilitation, but surgery is rarely necessary unless there is significant structural tendon damage.

At The Injury Hub, our goal is not only to relieve pain but also to restore tendon resilience and function so patients can return to sport and activity with confidence.

References

• Cook, J.L. and Purdam, C.R. (2009) ‘Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy’, British Journal of Sports Medicine, 43(6), pp. 409–416.

• Dragoo, J.L. et al. (2014) ‘Comparison of the efficacy of platelet-rich plasma and corticosteroid injection in the treatment of chronic patellar tendinopathy: a randomized controlled trial’, American Journal of Sports Medicine, 42(3), pp. 610–618.

• Malliaras, P. et al. (2013) ‘Patellar tendinopathy: clinical diagnosis, load management, and advice for challenging case presentations’, Journal of Orthopaedic & Sports Physical Therapy, 43(11), pp. 844–854.

• Rio, E. et al. (2015) ‘Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy’, British Journal of Sports Medicine, 49(19), pp. 1277–1283.

• Scott, A. et al. (2015) ‘Tendinopathy: update on pathophysiology’, Journal of Orthopaedic & Sports Physical Therapy, 45(11), pp. 833–841.

• van der Worp, H. et al. (2011) ‘Prevalence, incidence and risk factors of patellar tendinopathy in non-elite athletes: a cross-sectional study’, American Journal of Sports Medicine, 39(9), pp. 1984–1988.

• Zwerver, J. et al. (2011) ‘Clinical course and prognostic factors of patellar tendinopathy in elite volleyball and basketball players: a prospective cohort study’, American Journal of Sports Medicine, 39(9), pp. 1906–1914

The knee contains two menisci—C-shaped wedges of fibrocartilage that sit between the femur (thigh bone) and tibia (shin bone). Their role is to act as shock absorbers, distribute load evenly, and provide stability to the joint (Makris et al., 2011).

A meniscus tear can occur suddenly, often from twisting or pivoting on a slightly bent knee—common in football, tennis, skiing, and dance or develop gradually over time due to wear and tear. Tears are classified by their shape and location, for example horizontal, radial, flap, or bucket-handle tears, and whether they are traumatic (from a specific injury) or degenerative (from gradual breakdown).

Symptoms
Patients with meniscal tears typically report pain localised to either the inner (medial) or outer (lateral) side of the knee, swelling that develops over hours rather than instantly, and a feeling of “catching” or “locking” in the joint. Other common complaints include difficulty fully straightening the knee and the sensation that the knee may “give way” under load.

Diagnosis
At The Injury Hub, diagnosis begins with a thorough clinical examination, including orthopaedic tests designed to stress the meniscus and reproduce symptoms. High-resolution ultrasound can detect certain peripheral tears, particularly those at the outer edge where the meniscus has its own blood supply (Draghi et al., 2016). However, tears in the deeper, avascular inner portion cannot be seen on ultrasound and require MRI for confirmation. We can arrange same-day MRI referrals when needed.

Why the location matters
The outer third of the meniscus (the “red-red zone”) has a blood supply and therefore a better chance of healing naturally or with surgical repair. By contrast, the inner two-thirds (the “white-white zone”) have little or no blood supply, meaning tears here rarely heal on their own and may require further intervention if symptoms persist (Makris et al., 2011).

Treatment approach
Historically, many meniscus tears were operated on, often with partial meniscectomy (removing the damaged portion). However, long-term studies have shown that removing meniscal tissue increases the risk of early-onset knee osteoarthritis (Englund et al., 2003). As a result, surgery is now generally reserved for specific cases such as large mechanical tears causing true locking or unstable flap tears in active individuals.

Where possible, we prioritise conservative management, which may include manual therapy to improve joint mobility and reduce surrounding muscle tension, targeted strengthening of the quadriceps, hamstrings, and hip muscles to improve knee control, and progressive eccentric or closed-chain loading exercises to stimulate tissue adaptation. Activity modification to reduce irritation while healing is also key. In select cases, shockwave therapy may be used to promote tissue metabolism and provide pain relief.

Regenerative treatments are gaining increasing attention, particularly for degenerative tears where surgery is not indicated. Options such as platelet-rich plasma (PRP), injectable hydrogels (e.g., Arthrosamid), or hyaluronic acid aim to reduce pain, improve lubrication, and potentially slow cartilage breakdown (Campbell et al., 2015; Filardo et al., 2019).

If surgery is required, the modern approach focuses on meniscus preservation repairing rather than removing tissue wherever possible. This is especially important for younger, active patients to help preserve long-term joint health.

At The Injury Hub, we guide patients through every stage, from accurate diagnosis to the most up-to-date, evidence-based treatment options, ensuring surgery is only undertaken if it is genuinely in the patient’s best interest.

References

• Campbell, A.B. et al. (2015) ‘Meniscal repair outcomes at greater than five years: a systematic literature review and meta-analysis’, Journal of Bone and Joint Surgery, 97(20), pp. 1737–1744.

• Draghi, F. et al. (2016) ‘MR imaging of meniscal tears: an update on diagnostic accuracy’, Insights into Imaging, 7(1), pp. 115–128.

• Englund, M. et al. (2003) ‘Meniscectomy and osteoarthritis: what is the cause and what is the effect?’, Arthritis & Rheumatism, 48(3), pp. 605–608.

• Filardo, G. et al. (2019) ‘Platelet-rich plasma injections for the treatment of degenerative cartilage lesions and osteoarthritis of the knee: a systematic review’, Arthroscopy: The Journal of Arthroscopic & Related Surgery, 31(4), pp. 796–805.

• Makris, E.A. et al. (2011) ‘The knee meniscus: structure–function, pathophysiology, current repair techniques, and prospects for regeneration’, Biomaterials, 32(30), pp. 7411–7431.

Ligament Injuries

The knee’s stability depends heavily on four main ligaments: the anterior cruciate ligament (ACL), which prevents the shin bone from sliding forward on the thigh bone; the posterior cruciate ligament (PCL), which prevents it from sliding backward; the medial collateral ligament (MCL), which resists inward forces; and the lateral collateral ligament (LCL), which resists outward forces. These ligaments work together to keep the knee stable during walking, running, pivoting, and landing.

When any of these ligaments are overstretched or torn, the result can be pain, swelling, instability, and restricted movement. Injuries often occur during sports that involve sudden changes of direction, twisting, or impact, such as football, rugby, skiing, and basketball—but can also arise from falls or road traffic accidents.

Anterior cruciate ligament (ACL) injuries are particularly common in athletes and can range from mild sprains to complete ruptures. A torn ACL often produces a distinct “pop” sensation, followed by rapid swelling and instability. At The Injury Hub, we see a high number of ACL ruptures due to our work with professional dancers, where complex twisting landings place exceptional strain on the joint. In these cases, aspiration of the knee to relieve swelling is sometimes required; finding a haemarthrosis (blood in the joint) strongly suggests significant trauma at the ligament attachment site. Same-day MRI can then confirm the diagnosis, allowing us to refer directly to trusted orthopaedic surgeons where appropriate.

Traditionally, most complete ACL ruptures in active individuals were managed surgically. However, recent research suggests that intensive, structured rehabilitation programmes can allow selected patients to return to high activity without reconstruction (Filbay et al., 2019). That said, younger patients and high-demand athletes often still benefit from ACL reconstruction to restore stability and reduce the risk of further damage to the cartilage or meniscus (van Melick et al., 2016).

Posterior cruciate ligament (PCL) injuries are less common and typically result from direct blows to the front of the shin, such as during contact sports or car accidents. Many partial PCL tears heal well with structured rehabilitation, though complete ruptures may require surgery in younger or very active individuals (Logerstedt et al., 2018).

Medial collateral ligament (MCL) injuries are among the most frequent ligament injuries, usually caused when the knee is forced inward. At The Injury Hub, we are particularly skilled at identifying Grade 1, 2, and 3 tears using a combination of clinical stress testing and high-resolution ultrasound. MCL injuries typically respond well to conservative treatment, including TECAR therapy, shockwave treatment, and prolotherapy injections to stimulate healing and strengthen the ligament. With the right rehabilitation, even higher-grade MCL tears often recover without the need for surgery (Wijdicks et al., 2010).

Lateral collateral ligament (LCL) injuries are less common but may be more complex, sometimes occurring alongside injuries to nearby structures such as the posterolateral corner of the knee. Accurate imaging with ultrasound or MRI helps ensure no associated damage is missed.

Treatment at The Injury Hub
We use a combination of clinical examination, ultrasound, and MRI where required to confirm ligament injury and assess severity. Treatment is tailored to each patient and may include:

• Early pain and swelling control through manual therapy, gentle mobilisation, and soft tissue techniques.

• Progressive rehabilitation guided by our onsite strength and conditioning coach, with a focus on restoring muscular strength, movement control, and knee stability.

• Bracing or taping where appropriate to support healing and prevent re-injury during sport or work.

• Regenerative options such as platelet-rich plasma (PRP) injections in certain partial tears, which have shown encouraging results in supporting ligament healing (Figueroa et al., 2016).

• Surgical referral when reconstruction is clearly the best option, particularly for complete ACL ruptures in active populations.

Our aim is not only to get patients back on their feet but to restore complete confidence in the knee, whether that means returning to competitive sport, physically demanding work, or simply moving without fear of instability.

References

• Filbay, S.R. et al. (2019) ‘Return to sport matters—longer-term quality of life after ACL reconstruction in young adults is associated with return to sport’, British Journal of Sports Medicine, 53(16), pp. 1032–1038.

• Figueroa, D. et al. (2016) ‘Platelet-rich plasma in anterior cruciate ligament reconstruction: a systematic review’, Arthroscopy: The Journal of Arthroscopic & Related Surgery, 32(1), pp. 181–188.

• Logerstedt, D.S. et al. (2018) ‘Evidence for ACL and PCL rehabilitation: 2017 update’, Journal of Orthopaedic & Sports Physical Therapy, 47(11), pp. A1–A42.

• van Melick, N. et al. (2016) ‘Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation’, British Journal of Sports Medicine, 50(24), pp. 1506–1515.

• Wijdicks, C.A. et al. (2010) ‘Medial knee injury: Part 2, load sharing between the posterior oblique ligament and superficial medial collateral ligament’, American Journal of Sports Medicine, 38(7), pp. 1484–1491.

Osteoarthritis (OA) is one of the most common causes of chronic knee pain we see at The Injury Hub. It is a degenerative condition in which the smooth articular cartilage covering the ends of the femur, tibia, and underside of the patella gradually wears away. Without this protective layer, the underlying bone becomes exposed, leading to increased friction, inflammation, and progressive structural changes within the joint.

The disease process involves several overlapping mechanisms. Cartilage gradually breaks down, losing its cushioning ability and resulting in joint space narrowing as the bones move closer together. The body often attempts to stabilise the joint by producing osteophytes (bony spurs), while the synovial lining may become inflamed, leading to swelling and effusion. Beneath the cartilage, subchondral bone changes can develop, including sclerosis and cyst formation, all of which contribute to pain and stiffness (Hunter & Bierma-Zeinstra, 2019).

Symptoms usually develop slowly but may fluctuate. Pain is typically provoked by weight-bearing activities such as walking, climbing stairs, or standing for long periods. Stiffness is most noticeable in the morning or after inactivity, often described as “start-up stiffness.” Swelling or a feeling of fullness in the joint is common, and patients frequently notice crepitus (grinding or catching) with movement. Pain may not always be localised to the knee itself, OA can present with discomfort radiating down the shin, up the thigh, or even mimic hip pain, which makes careful assessment essential.

Diagnosis
A detailed case history and clinical examination form the foundation of diagnosis. Ultrasound is particularly valuable for assessing synovitis, effusion, osteophytes, and surrounding soft tissues. X-rays remain the gold standard for demonstrating joint space narrowing and bony change, while MRI is helpful in early or complex cases, allowing assessment of cartilage thickness and bone marrow lesions (Roemer et al., 2011).

Treatment at The Injury Hub
Our approach is tiered and evidence-based, combining symptom relief with strategies to slow progression. Manual therapy and mobilisation techniques help reduce stiffness and improve mechanics, while exercise therapy, particularly strengthening of the quadriceps, gluteals, and hip stabilisers, has been consistently shown to reduce pain and improve function (Fransen et al., 2015).

Injection therapies form an important part of our toolkit. Hyaluronic acid (HA) injections restore lubrication and cushioning in the joint, with research showing pain and function improvements lasting 6–12 months in many patients (Altman et al., 2015). Platelet-rich plasma (PRP) is increasingly supported by evidence for early-to-mid stage OA, with studies suggesting it may stimulate cartilage activity and improve long-term outcomes (Di Martino et al., 2019). Corticosteroid injections remain effective for acute flares or severe pain, but frequent use is avoided due to evidence linking repeated steroid exposure with accelerated cartilage degeneration (McAlindon et al., 2017).

We also employ offloading strategies such as knee braces, orthotics, and gait retraining to reduce mechanical stress, alongside weight management and lifestyle modification. Even small reductions in body weight can significantly lessen joint load and symptom burden. In advanced OA where conservative measures are no longer effective, we work closely with leading orthopaedic surgeons to provide rapid referrals for surgical opinion, including partial or total knee replacement.

The latest research has shifted emphasis toward earlier intervention, using regenerative injections such as PRP or novel injectables like Arthrosamid® (a polyacrylamide hydrogel designed to improve joint cushioning) in combination with structured strengthening programmes, aiming to slow disease progression and delay the need for surgery (Bannuru et al., 2019; Skou et al., 2022).

At The Injury Hub, our goal is not simply to “manage” knee OA but to help patients remain active, mobile, and pain-free for as long as possible, with tailored multimodal care grounded in the latest evidence.

References

• Altman, R.D. et al. (2015) ‘Intra-articular hyaluronic acid injections for knee osteoarthritis: a review of the literature and meta-analysis’, Cartilage, 6(4), pp. 246–253.

• Bannuru, R.R. et al. (2019) ‘Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis’, Annals of Internal Medicine, 172(6), pp. 385–395.

• Di Martino, A. et al. (2019) ‘Platelet-rich plasma versus hyaluronic acid injections for the treatment of knee osteoarthritis: results at 5 years of a randomized controlled trial’, American Journal of Sports Medicine, 47(2), pp. 347–354.

• Fransen, M. et al. (2015) ‘Exercise for osteoarthritis of the knee: a Cochrane systematic review’, Cochrane Database of Systematic Reviews, (1), CD004376.

• Hunter, D.J. & Bierma-Zeinstra, S. (2019) ‘Osteoarthritis’, The Lancet, 393(10182), pp. 1745–1759.

• McAlindon, T.E. et al. (2017) ‘Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: a randomized clinical trial’, JAMA, 317(19), pp. 1967–1975.

• Roemer, F.W. et al. (2011) ‘State of the art: imaging in osteoarthritis’, Radiology, 260(2), pp. 332–354.

• Skou, S.T. et al. (2022) ‘Appropriate management of knee osteoarthritis: systematic review and meta-analysis of international guidelines’, BMJ Open, 12(3), e050043.

Patella tracking disorder occurs when the kneecap (patella) does not glide smoothly within its groove (the trochlear groove of the femur) as the knee bends and straightens. Instead, it may shift too far laterally (to the outside) or, less commonly, medially (to the inside). This abnormal movement can irritate the surrounding soft tissues and, over time, contribute to chondromalacia patellae softening, fraying, or erosion of the cartilage on the underside of the patella.

This condition is particularly common in active individuals such as runners, cyclists, dancers, and athletes who perform repeated squatting or lunging. However, it is not restricted to sport and can affect anyone with anatomical or biomechanical predispositions, such as altered limb alignment or muscle imbalance. Research shows that patellofemoral pain syndrome, often linked to patellar maltracking, is one of the most common overuse injuries in both the athletic and general population (Crossley et al., 2016).

Symptoms
Typical symptoms include a dull, aching pain at the front of the knee, especially noticeable when climbing or descending stairs, squatting, kneeling, or sitting for prolonged periods (sometimes referred to as “movie-goer’s knee”). Clicking, grinding, or popping sensations behind the kneecap are common, and occasional swelling may develop around the joint. In more advanced cases of chondromalacia, the pain can become sharp with certain movements, and some patients report a sense of instability or “giving way.”

Why it develops
Patella maltracking can arise from a number of interacting factors. Muscle imbalance is one of the most important contributors: weakness in the vastus medialis oblique (VMO) muscle combined with tightness in the lateral quadriceps or iliotibial band can pull the patella off-centre. Structural differences, such as a shallow trochlear groove, patella alta (a high-riding kneecap), or abnormal rotation of the femur or tibia, can predispose an individual to maltracking. Overuse through repetitive bending and loading irritates the patellofemoral joint, while previous knee injuries or surgery may alter normal tracking mechanics (Smith et al., 2018).

Our approach at The Injury Hub
At The Injury Hub, we focus on targeted rehabilitation to restore normal patella mechanics, reduce irritation, and prevent long-term cartilage damage. Our onsite strength and conditioning coach, Neil, designs individualised programmes that emphasise strengthening the VMO and gluteal muscles, improving hip and ankle mobility, and stretching tight lateral structures such as the iliotibial band and lateral quadriceps.

This is complemented by manual therapy to mobilise the patella, release tight soft tissues, and optimise lower limb mechanics. Activity modification is an important part of early recovery, helping patients to adjust training loads and temporarily avoid aggravating activities such as deep knee flexion. In selected cases, taping or bracing techniques may be used to guide the patella into a more optimal alignment during movement.

With consistent rehabilitation, most patients achieve significant symptom improvement within a few months, often avoiding the need for invasive treatments. By addressing the root causes early and applying an evidence-based, multidisciplinary approach, we can prevent cartilage deterioration and help patients return to pain-free activity with lasting confidence.

References

• Crossley, K.M., Stefanik, J.J., Selfe, J., Collins, N.J. & Davis, I.S. (2016) ‘Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester’, British Journal of Sports Medicine, 50(14), pp. 842–850.

• Smith, B.E., Selfe, J., Thacker, D., Hendrick, P., Bateman, M., Moffatt, F., Rathleff, M.S. & Logan, P. (2018) ‘Incidence and prevalence of patellofemoral pain: a systematic review and meta-analysis’, PLoS One, 13(1), e0190892.