Musculo-skeletal   [back to the Category]

Knee tendinitis   [read the french version]

Author :   Docteur Anne Thiescé

General comments

Tendon disorders of the knee are common amongst dancers. They can be multiple and bilateral and affect all age groups.

Quadricipital tendinitis and patellar tendinitis

The specific causes of quadricipital tendinitis or Jumper’s knee and patellar tendinitis in classical dancing, are the same as those for extensor mechanism pathologies and, consequently, patellar pathology. These include badly performed turn outs, plié control performed using only the quadriceps femoris, retracted quadriceps femoris and quadricipital dystonia.

These injuries can also be induced by a short Achilles' tendon that reduces the depth of the "plié".

The other constant factor is the increase of exercise intensity: increase in practise hours (training courses, rehearsals) and lessons which expressly study jumps. Apophysitis tibialis adolescentium or Osgood Schlatter's disease or Sinding Larsen Johanson's syndrome replace these tendon disorders amongst children.

Treatment is conservative with initial, relative rest, adapted barre exercises that stay beneath the pain threshold, NSAID applied locally and taken internally, ice applications, physiotherapy, deep transverse massages and progressive stretching exercises. Re-education must be handled in accordance with the clinical elements and technical shortcomings of the dancer.

Surgical combing of the patellar tendon coupled with a resection of the point of the patella would only be suggested when the echographia shows nodular or cystic lesions on the patellar tendon and when faced with a lack of improvement in symptomatology.

Other tendon disorders can be present.

Posterior disorders of the knee tendons
They combine popliteal tendinitis and the gastrocnemius muscles at their upper insertions.

Inducible factors are always an increase in work load, over-tiredness and, on a more light hearted note, the wearing of "too-tight tights" that finish at the knee.
Treatment lies in rest, NSAIDs, physiotherapy and re-education.

Pes anserinus tenosynovitis.

Pes anserinus tendinitis involves the gracilis, semitendineus and sartorius tendons. It occurs on a genu valgum or after a medial collateral sprain, with residual mobility.
Pain is to be found on the medial side of the upper extremity of the tibia, 2 fingers' breadth from the articular joint. It is increased by thwarted flexion, external rotation and sudden extension. Generally speaking, the condition can be cured with medical treatment.

Pretibial and prepatellar bursitis.

They are linked to repeated microtraumas. It comprises more or less inflammatory tumefactions. They must be detected very early amongst dancers. After a treatment of local ice applications and rest, the wearing of protective knee bandages is prescribed during choreographic exercises comprising numerous falls on to the knees or prolonged exercises on the knees. They are to be found predominantly in jazz and contemporary dancing.

Tendinitis of the biceps and tensor fasciae latae is rarely found in ballet.

Bibliography:

Kahn K., Brown J., Way S., Vass N., Crichton K., Alexender R., Baxter A., Butler M., Wark J.: Overuse injuries in Classical Ballet. Sports Med., 1995, 19, 5, p341-356.

Rochcongar P.: Lésions chroniques de l’appareil locomoteur chez le sportif. Encycl. Med. Chir. (Elsevier, Paris) Appareil locomoteur, 15-902-A,1999, 8p.

Sabourin F.: Le genou du danseur. Pré-actes du 4° Congrès international sur la recherche en Danse, 25-29.09.1989.

Ziegler G., Euller-Ziegler L.: Rhumatismes abarticulaires (épaule non comprise). Enc. Med. Chir. (Paris-France), Ed. Elsevier. Appareil locomoteur,14360A-10, 4-1989, 10p.