# Patella Tendonitis/Tendonosis



## jarlrmai (13 Oct 2014)

Anyone ever had/got over this?

I am seeing a sports therapist who is doing soft tissue release on the connecting muscles and I have an NHS MRI in a week to discover the exact issue.

Was hoping to hear stories from anyone who have been through this?

Currently my knee is getting inflamed (puffy and hot) occasionally, it hurts a bit going downstairs but i'm not putting my full weight through it walking and going upstairs are okay.

I am doing nothing but rest and weekly sports therapist visits at the moment, it has been getting better and then going a worse a bit again so it;s getting a little frustrating. I missed the lovely warm windless early Autumn.


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## Albert (14 Oct 2014)

I've had tendonitis along my shin just recently - very painful to begin with and very "grindy" to the touch when I flexed my foot. Ibruprofen Gel, some icing and complete rest for 3 weeks _seems to have done the trick. _I rode an easy 10 miles on Friday and 15 yesterday and it feels OK. I am stretching the area carefully now to help my rehab.
It is my first injury from over doing things. I diagnosed myself and got my Doctor who is a runner who has experience of this type of injury and he confirmed my conclusion.
Get well soon.


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## rualexander (14 Oct 2014)

I've had patella tendonitis and various other tendonitis over the years.
Ice is good, stretching of quads and hamstrings is good, ultrasound is good, and kinesio-taping is good, ask your physio about these.


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## vickster (14 Oct 2014)

I had it in my elbow, unfortunately did not clear up despite lots of physio, taping, acupuncture, injections

Rest is the best thing for it + ice. If it doesn't clear up, there are injections that might help


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## jarlrmai (14 Oct 2014)

Yeah rest is happening 3+ weeks now, I still need to get to work though walking seems to make it worse than riding where very easily seems to be the best.

The problem with the rest is that just basic day to day stuff like standing to do the washing up, walking a few feet at work seems to make it inflamed.


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## vickster (14 Oct 2014)

jarlrmai said:


> Yeah rest is happening 3+ weeks now, I still need to get to work though walking seems to make it worse than riding where very easily seems to be the best.
> 
> The problem with the rest is that just basic day to day stuff like standing to do the washing up, walking a few feet at work seems to make it inflamed.


Have you seen a specialist - a steroid jab might settle it down (or PRP if you have private healthcare or a bucket of cash)

Are you using Ice and anti-inflammatories?


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## Crackle (14 Oct 2014)

As someone rehabing from patella problems, not that one, it can take a while. This website below is pretty good

http://www.knee-pain-explained.com/patellar-tendonitis.html

3 weeks is not long I'm afraid. Muscle release sounds good. Most of my patella problems have been cured slowly over time with stretching and rolling but it took a few months before I could begin that.

I found a brace helpful too. This one is the one I used: Mueller Max Knee Strap


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## oiljam (14 Oct 2014)

I've had patella tendinitis now for 2 years, can't seem to get shut of it, had physio, ice'd it, pain killers/inflammatorys etc haven't shifted it. I've even tried resting it for months but as you say every day stuff sets it off again.
Mine is from marathon training/racing and its virtually finished my running career. 
Sorry to be all doom and gloom and I suspect its how badly you've got it. My physio did say cycling was good for it but I even find this flares it up but not to the extent running does.
I've sort of accepted it now that I'll have it forever which is a depressing thought.

Sorry again for the gloomy outlook


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## vickster (14 Oct 2014)

You might find something useful here (and elsewhere on the forum) http://www.kneeguru.co.uk/KNEEnotes/primers/patella-primer/overuse-syndromes-affecting-patella

For my tennis elbow tendon, I had steroid (which helped a bit) and Platelet Rich Plasma (just 1 jab which had no effect, so no point trying more, although if at all effective more are needed) before having to have the tendon surgically released and tidied up

If struggling for 2 years, I'd say it's worth seeing an orthopaedic knee specialist or a specialist sports physician (your physio should be able to suggest whom to see) - privately or via NHS GP referral


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## jarlrmai (14 Oct 2014)

vickster said:


> Have you seen a specialist - a steroid jab might settle it down (or PRP if you have private healthcare or a bucket of cash)
> 
> Are you using Ice and anti-inflammatories?



Been to a sports injury guy and to NHS orthopaedic knee specialist, that's where I got the MRI appt from. It does seem to get better but I have no faith it could stand up to anything more than a little bit of walking, let alone a hilly century at the moment, although there's no pain when cycling slowly it does seem to inflame it afterwards I have no idea if this is making it worse or not.

I will have the jabs if they are worth a go, given this come on after playing football once I'm hoping it's not a wear and tear issue.


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## jarlrmai (14 Oct 2014)

Ice and Anti-Inflammatories reduce the swelling yes but are they actually healing the injury?


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## vickster (14 Oct 2014)

Might depend on your hospital and specialist but if PRP not available on nhs it's many hundreds per jab privately. My elbow specialist quoted £600 or something crazy. Fortunately the hospital invested in the kit, Bupa paid and I gave the blood which got spun. Omfg did the injection hurt though!!!


jarlrmai said:


> Ice and Anti-Inflammatories reduce the swelling yes but are they actually healing the injury?



Yes they reduce the inflammation which is the issue. Now if you've torn the tendon that's a different kettle of cod and you'd know by now!!


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## jarlrmai (29 Oct 2014)

Okay I got hold of my MRI, bear in mind that no clinician has done any diagnosis here but here is my knee, you see the thickening and white bit below the patella in the red oval, that shouldn't be there and is the tendonitis.


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## vickster (29 Oct 2014)

There'll be people on the Kneegeeks forum who've had this. Proper rest, steroid, PRP probably the most like courses of action

Looks like a nice clear image  Mine always seem rather fuzzier


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## jarlrmai (29 Oct 2014)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971642/

I'm reading this

It says

Warmup bike no resistance 10 mins
Stretching, calf, hip flexor, quad hamstring gastrocnemius soleus
Deep transverse frition massage of tendon 5-10 minutes daily, use platic tool....!
Eccentric squats 25 decline board 3x15 and build up from there.


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## vickster (29 Oct 2014)

Plastic tool massage is called Graston. Best talk to physio before embarking on anything like this


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## jarlrmai (29 Oct 2014)

Yeah I'm going to see him today.


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## ayceejay (29 Oct 2014)

Just because ..here is an MRI scan of a normal knee
nor




mal knee.


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## jarlrmai (29 Oct 2014)

Yeah the black bits are the patella ligament / tendon and the meniscus (the black triangles between the bones)

Looking at other MRI's mine does seem a lot sharper, not sure if this is the equipment or something about my knee or just luck.

You can see how much thicker the tendon is below the kneecap on mine and the whiteness is the inflammation i think it shows more up on this one as it's the fat saturated proton density image. On the T2 fat sat images it a little less clear.


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## vickster (29 Oct 2014)

I'll post mine later for a diagnosis


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## vickster (29 Oct 2014)

@jarlrmai Here's mine (don't know if the same image)


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## ayceejay (29 Oct 2014)

That knee looks halowe'en ready vickster sometimes it's best not to know eh?
My dentist has a new toy: a scanner that he puts in your mouth and the result shows up on the computer, I kept telling him - I trust what you see - but now that image of the devastation and the cost to put it right will haunt me.


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## jarlrmai (29 Oct 2014)

Yup that's the same, sagittal (slices through the knee from side to side) and PD (positron density) you see the text in the top left.

Yours has a cool coronal location view as well so you can see where the slice is taken, can't work out how to get that on my viewer yet.

Will swap patella tendons with you, your's looks in great nick!


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## vickster (29 Oct 2014)

Swap you my spiky fibula for your tendon...tendons easier to sort than bones 

That's just the default view on the disc I got. I've no idea what you are talking about otherwise (guessing you are a medic of some sort)

@ayceejay if it was swollen, I'd dress my knee up as a pumpkin


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## jarlrmai (29 Oct 2014)

I work in a hospital but i'm not a medic, I worked on the technical attributes of the procurement of a new digital X-ray system so I had to gen up on the tech behind it all.

MRI's are taken on 3 planes, axial, coronal, and sagittal.

If you have the full disc of your MRI then you can use a program like http://www.microdicom.com/ to view all the views and slices.


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## vickster (29 Oct 2014)

Yes, I have that and have looked through but I have no idea what I'm looking for. On the left knee, the cartilage defect on the thigh bone is really obvious however


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## jarlrmai (6 Nov 2014)

Consultant confirms it's patella tendonitis has offered injection ostemil plus. No offer of physio at the moment. Lesser I know what I'm dealing with.


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## vickster (6 Nov 2014)

I've had ostenil plus, usually for arthritis, not tendon issues. PRP normally for soft tissue inflammation or cortisone jab, from when I had my tennis elbow

On my mri, nothing of major concern, treatment is slow down and much less cycling!


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## jarlrmai (6 Nov 2014)

vickster said:


> I've had ostenil plus, usually for arthritis, not tendon issues. PRP normally for soft tissue inflammation or cortisone jab, from when I had my tennis elbow
> 
> On my mri, nothing of major concern, treatment is slow down and much less cycling!



Yeah I don't this consultant cares unless he can do some surgery.

Glad to hear your MRI is clear, bad luck on the less cycling though it beats my no cycling at the moment.


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## vickster (7 Nov 2014)

I think ideally it would be no cycling, but I can't deal with that 

MRI not clear but no major abnormality, nothing to be overly concerned about apparently but there are degenerative changes in the tender area. I'll have a copy of the report tomorrow. Overloading deemed to be the main cause of the discomfort


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## jarlrmai (7 Nov 2014)

Was the ostenil injection painful?


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## albion (7 Nov 2014)

I have osteo problems with my knees, hips, shins and achilles.

I stopped walking to take off the weight and increased spining on the bike.
From being unable to crouch down, the massive shin/achilles pain subsided over 12 months so it can be a very slow progress.
I have zero knee pain too if I cycle spin correctly and I only seem to be out of luck with regards to my hip pain.


I'd suggest keeping the area warm as I'm sure my 12 month of pain was partly to do with a breathing/circulation difficulty I had at the time.


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## vickster (7 Nov 2014)

jarlrmai said:


> Was the ostenil injection painful?


Nope. I have had the course of three, the second did hurt as I wasn't relaxed and the needle hit the bone. Mine jabs were into the joint space. The plus injection was also fine, just a full and stiff feeling for a few days. Now the prp into tne tendon, that did fecking hurt as no anaesthetic can be used. I think anaesthetic can be used with the hyaluron jabs like ostenil though, not that my specialist did. He has had patients who did find it very painful but thinks they have since reformulated it to make it less viscous and thick
http://www.trbchemedica.co.uk/joint-pain/ostenil-injections

Still seems unusual for it to be used for tendonitis, but I believe the substance can calm inflammation too (I had durolane which is similar stuff Injected during my second arthroscopy to aid healing)


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## jarlrmai (7 Nov 2014)

He said peripatellar.


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## jarlrmai (11 Nov 2014)

Update from me, still getting pains but the swelling seems to have stopped happening so much or being as severe.

I've started a blog about it mainly as a personal thing so I can tell if it is getting better or not it's hard to remember how it was a few weeks a go.

http://ptrecovery.blogspot.co.uk/


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## jarlrmai (12 Dec 2014)

An update.

Still not riding in anger, 1.5 slow miles each way to work is all I do but that is relatively straightforward and doesn't cause pain.

The sharp pains have subsided a lot, it certainly feels better than it was, swelling has pretty much completely stopped.

The pains seem to come a while after doing something rather than during the doing of it.

I seem to have a lot of muscle wasting in the quad and I get a lot of other knee soreness around the whole joint, still doing my physio and strengthening exercises, they do seem to be gradually helping.

The hardest part is it'd not like a broken bone where you know the healing process etc, no-one can tell you what is going on for sure.


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## vickster (12 Dec 2014)

Story of my life with the injuries I've sustained! That said there are a lot of fractures you really don't want around the knee!


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## jarlrmai (20 Feb 2015)

update, I think it's on the the mend.

I'm at the point where pain is rare and I can walk okay and stairs are getting easier and my physio is progressing I'm doing single leg squats and lunges with no pain which would have been unthinkable a few months ago. Standing around for any length of time is getting easier but is still the most pain inducing activity.

The bike: last time I tried 40 mins on the trainer gave me issues a few weeks ago so I'm concentrating on leg stength, my quad muscles (esp VMO) seem be firing again but are not very strong.


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## Crackle (20 Feb 2015)

A familiar sounding scenario. It's taken me 12 months to clear up right patella pain and pes anserine tendonitis. Still not there yet but I'm finally back on the bike this year and increasing things without pain now, after an initial two steps forward, one step back phase. I have become very cautious and tend to ease back or postpone things if it feels a bit iffy, slowly though, confidence is returning. Keep at it.


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## jarlrmai (20 Feb 2015)

I'm cautious as hell at the moment.

I will probably see this therapist weekly now for as long as I can, working through the hip inflexibility that lead to the issue in the 1st place and getting proper leg strength.


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## jarlrmai (11 Jun 2015)

Update I rode a few 10 milers slight soreness, but riding actually seems to be better than some other things.


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## slenkar (5 Oct 2015)

I had the same injury and I realised that walking up the stairs puts strain on that tendon, it prevents it from healing.



All I did was avoid walking up stairs for a few weeks and it healed - mostly



You just have to walk upstairs using your good leg or just crawl up the stairs for a couple of weeks


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## jarlrmai (25 Apr 2016)

Another update.

Well I did 52 miles yesterday with the C group (14 MPH) did a lot of work up front as well, no issues during the ride, usual soreness afterwards which will subside as usual after a day or so.


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## PhilDawson8270 (25 Apr 2016)

I had the soreness after playing rugby, which subsided after a day or 2. I continued to persevere with it, but it turned into excruciating pain during exercise within a couple of months.

Mine was caused due to a grade 2 anterior ankle sprain, affecting all 3 ligaments. I rested for 1 week, then strapped the ankle and carried on training and playing, the lack of mobility in the ankle, caused strain to be put into my knee, resulting in patella tendonitis that I have been dealing with for almost 7 months now.

A few weeks rest, strengthening exercises, and intelligent training has all but fixed it. I keep a diary of the pain, during, and after exercise for however long it lasts, and make a note of the duration and intensity of the exercise.

The idea is to reduce the intensity or duration of the exercise until you get no pain, even for the day after the exercise (even if this means skipping sessions). You then build up to getting pain and/or discomfort, and backing off to an intensity/duration that doesn't cause it. Repeating this gradually will get you back into pre-injury levels.

I started with maybe just 5 or 10 minutes from a 1 hour session. At the very start, I did the warm up exercises with the team, then went home! When I could do this without pain, I added 5 minutes on, and so on.

Give it a go, joint injuries take time to recover. The more you ignore the pain (although it is manageable), the longer the recovery will take when you eventually do have to let your body do its thing.


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## jarlrmai (25 Apr 2016)

Yeah I've been doing that for around 1 and half years now.


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## Sailorsi (4 May 2016)

I'm now in Month 7 of Patellar Tendinopathy and seem to be recovering slowly. I had an ultrasound scan which revealed the core of my right knee tendon had degenerated and had been replaced by blood vessels. The blood vessels then allow nerves to grow which is where the pain comes from. I have been undertaking daily eccentric knee exercises using weights on an incline board and it has removed the blood vessels and killed off the nerves reducing the pain, I had it re-scanned and it looked much improved. I was cycling 250 miles a week and not really allowing my knees time to recover between rides, I'm now looking into other potential issues such as bike set-up to prevent a return of the injury now that I'm riding again. My right foot naturally points toe out and I think that having cleats which forced it to point straight have contributed to the damage. I would be interested to hear if anyone has used pedal extenders to allow the heel to get closer to the crank arm and therefore allowing the toe to point out more naturally. I'm considering a dynamic video bike fit to see if any issues can be captured, any recommendations for this on the south coast (Hampshire) would be welcomed. I found the following resource useful and signed up for e-mail letters. It was a good while before being asked to sign up and pay for a book and course but the free information offered was really good. http://www.fix-knee-pain.com/patellar-tendonitis-jumpers-knee/ . Fingers crossed for a full recovery


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## jefmcg (1 Jun 2016)

Ugh. Probably shouldn't have read this thread. I've just developed (self diagnosed) this after a 100 km ride on Sunday. However, I'm obviously much better off than people in this thread. Pain is quite distinct but not severe. I am apparently limping, but not aware of pain while walking. Sitting and standing up again are difficult. Riding - which is the cause of the injury - feels fine. 

I've consulted my personal orthopaedic surgeon, @vickster**, who has prescribed RICE which I will follow. 

**ok, she's not actually a doctor, but she's spent so much time with them, she'd be qualified if we had an apprenticeship scheme for surgeons.


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## jarlrmai (1 Jun 2016)

Go to a doctor, get an MRI with a diagnosis, then consider your options.


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## vickster (1 Jun 2016)

jarlrmai said:


> Go to a doctor, get an MRI with a diagnosis, then consider your options.


She's only had a sore knee for 48 hours, I'm sure RICE and a massage with voltaren gel will help while it's acute


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## jefmcg (1 Jun 2016)

jarlrmai said:


> Go to a doctor, get an MRI with a diagnosis, then consider your options.


Thanks. My level of pain is so low, I confused with (or it was masked by) muscle soreness for the first few days. I'll start with conservative treatment advised by my specialist (  ) and see how I get on.


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## PhilDawson8270 (1 Jun 2016)

If you have any discomfort then rest it immediately. The longer you deal with the mild pain the more severe it gets. And the longer the recovery takes.

By the time it actually prevents you will have a recovery period of 6+ months. 

If you are in any kind of discomfort, pain, or limping after exercise you need to stop and rest it.


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## jefmcg (4 Jun 2016)

jefmcg said:


> I've consulted my personal orthopaedic surgeon, @vickster**, who has prescribed RICE which I will follow.


This is working well. Some swelling, but zero pain now. In fact, I had to do a visual check to remember which leg to put the compression bandage on this morning.

Experimental ride out tomorrow with @vickster. Very flat - I'm sticking with the thames, so I can probably ride with zero climb. 

Hopefully I've been lucky. I'll keep you posted.

It's a bit sad, because I've been recently pushing myself on distances that are a little beyond my current fitness but much less than I have done before, but I've been able to manage with a bit of determination - not worrying at all about speed, and walking up hills if need, but keep pushing on. Now it seems I may have reached the age when I have to stop if it's "hard". Bugger!


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## jefmcg (8 Jun 2016)

jefmcg said:


> Hopefully I've been lucky. I'll keep you posted.




Went for a 30km gentle, flat ride on the weekend. No issues. Thought I was better. Last night I slept on a couch last night, pain came back as bad as ever.

Doctor appointment made.


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## jarlrmai (8 Jun 2016)

REST IT

When you go to your GP's make sure you get a referral to an Orthopaedic clinic describe the pain as unbearable and mention it's preventing you from cycling and keeping healthy affecting your life. Once you get to clinic, your goal is to get that MRI and radiology diagnosis, once you have it ask for a copy on CD (there will be a nominal charge) the consultant may offer you injections/surgery etc etc. DO NOT AGREED TO ANY OF THIS IMMEDIATELY. come back here and let us know what they say, in the meantime rest that knee.

Do you have any swelling/heat?


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## vickster (8 Jun 2016)

Ultrasound is better to diagnose tendonitis but it's clear the tendon is swollen. Try the ibuprofen gel, or take oral ibuprofen and get some algesal which is aspirin based and can be used with other NSAIDs

I really don't think you need to see an orthoapedic surgeon yet, could get on the waiting list which is likely up to 18 weeks in SW London, and 8 weeks to see a physio on NHS, but I very much doubt that any GP will do that with a two week history. Yes, maybe once it's chronic, and you've given physio a proper go, RICEd like a dervish etc

There's no good surgical option for patella tendonitis until it ruptures and then it's a serious emergency!


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## jarlrmai (8 Jun 2016)

An MRI will show PT and will also highlight if it's not PT but something else possibly they will do both.

My GP referred me straight away...


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## vickster (8 Jun 2016)

I expect an MRI of @jefmcg knee to show more which may have nothing to do with her symptoms

Mine shows all sorts of horrors which don't actually cause me much bother functionally if I'm sensible!

How long did you have symptoms for?


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## jarlrmai (8 Jun 2016)

2 or 3 weeks


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## Nigel-YZ1 (8 Jun 2016)

I still don't know what I've had/got 
My only advice to anyone is to insist on something being done. I've got lifetime problems thanks to a locum GP that didn't give a shoot.
When I was treated it was to repair the damage done by following his advice of 'come back in 4 weeks', said 3 times over.


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## jarlrmai (8 Jun 2016)

Damn right get the referral get the scans insist upon it.


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## vickster (8 Jun 2016)

Nigel-YZ1 said:


> I still don't know what I've had/got
> My only advice to anyone is to insist on something being done. I've got lifetime problems thanks to a locum GP that didn't give a shoot.
> When I was treated it was to repair the damage done by following his advice of 'come back in 4 weeks', said 3 times over.


What's wrong with your knee?


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## Nigel-YZ1 (8 Jun 2016)

It's both of them. I tore both cruciate ligaments.
GP just told me to rest and come back in a month.
By the time he'd told me to do that 3 times as I couldn't bend my knees without pain the oblique muscles were wasted so I had tracking problems and patellar bursitis.
On top of that I was told a year later I've probably worn the cartilage from my kneecaps.
I get bursitis flare ups regularly.

Apart from that I'm perky as pinky's mate


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