Quadriceps tendonitis is a common cause of activity-related anterior knee pain.
The main symptoms are pain and tenderness at the top of the kneecap that gets worth with exercise, and weakness.
Also known as quadriceps tendinopathy, it is typically an over-use injury caused by too much sport, training errors, muscle imbalance and weightlifting, but can also affect non-athletes.
When caught early, full recovery from quadriceps tendonitis knee pain may only take a few weeks, but if left to progress from inflammation to degeneration it may take 6 months to return to your pre-injury level, so early treatment is vital.
The quadriceps are a group of four muscles found on the anterior thigh. They work together to extend, straighten, the knee, and control knee flexion when you are on your feet. They play an important role in activities such as running, standing up from a chair, climbing stairs, jumping, squatting and kicking.
They combine together to form a common tendon in the lower thigh which wraps around the knee cap and extends down to the top of the shin bone, the tibia.
Whilst it is one continuous tendon, it is often referred to as two parts:
Here, we will be focusing on the area above the kneecap and the area below the kneecap is covered in the patellar tendonitis section.
Quadriceps tendonitis is inflammation of the quadriceps tendon where it attaches to the top of the kneecap.
In the early stages of quadriceps tendonitis, strain and overuse results in small tears in the tendon.
The body attempts to heal itself by increasing the blood flow to the area to bring in the oxygen, chemicals and nutrients needed for healing.
But unless there is sufficient period of rest, further tears develop and the tendon gradually breaks down and thickens in response to the ongoing wear and tear, known as quadriceps tendinosis.
The terms tendonitis and tendinosis are often used interchangeably, but they do refer to different things:
The collective term for these is Quadriceps Tendinopathy, which can refer to either condition, and also encompasses damage to the patellar tendon below the kneecap
Quadriceps tendinopathy can develop at the:
Anything which places undue stress on the quadriceps tendon can lead to knee tendonitis. Quadriceps tendinopathy is typically an overuse injury, usually affecting athletes, but it can also affect non-athletes.
Common causes of quadriceps tendonitis are:
Risk factors associated with quadriceps tendinopathy include younger age, taller height and higher weight.
The sports most commonly associated with quadriceps tendinopathy are:
Of these, volleyball and basketball are by far the most common sports to result in quadriceps tendonitis knee pain.
The symptoms of quadriceps tendinopathy usually come on gradually over time rather than suddenly. Typical symptoms of quadriceps tendonitis are:
Symptoms of quadriceps tendinopathy can be classified into 5 stages:
Early treatment for quadriceps tendinopathy can lead to faster recovery. Treatment for quadriceps tendonitis aims to:
Treatment options for quadriceps tendinopathy fall in to two categories, conservative (non-surgical) and surgical.
Most people suffering from quadriceps tendonitis pain respond well to non-surgical treatment which typically includes:
If the symptoms of quadriceps tendinopathy fail to improve with at least 3 months of conservative treatment, or the tendon has completely ruptured, then your doctor may advise knee surgery.
Surgery for quadriceps tendinopathy involves removing the damaged portion of tendon, repairing it and restoring the blood supply to the tendon, known as revascularisation.
Quadriceps tendonitis surgery is usually done arthroscopically, i.e. key-hole surgery, but in some case more extensive open surgery may be required.
If the tendon has completely ruptured, then quadriceps tendon repair surgery is needed to restore the extensor mechanism.
Holes are made in the kneecap with a special drill and sutures are places in the tendon.
The sutures are carefully tied onto the kneecap, through the drill holes, to ensure the right level of tension.
A knee immobiliser brace is usually worn after surgery while the quadriceps tendon is healing.
The sooner surgery is performed after injury, the better the outcome.
Most people go home the same day as their surgery, and should start physical therapy straight away for 6-8 weeks. Arthroscopic and open surgical procedures have shown good outcomes in people with severe symptoms of quadriceps tendinopathy where non-surgical treatment has failed
Most cases of acute quadriceps tendonitis knee pain will settle within 6-12 weeks with non-surgical treatment. Chronic quadriceps tendinosis may take longer, typically 3-6 months. The sooner treatment begins once you notice symptoms, the quicker you are likely to recover.
You will probably need 6-8 weeks of physical therapy alongside your daily programme of strengthening and stretching exercises.
As your strength, flexibility and endurance improves, you will be able to progress on to more challenging exercises and increase your activity level.
As the symptoms of quadriceps tendonitis begin to settle, you can gradually start returning to sport specific training, but start with low frequency, low intensity and short duration. Start slow and gradually build up, being guided by your knee pain – if it starts to hurt, that’s a sign you’ve done too much so back off a bit.
It is really important to avoid activities that aggravate your quadriceps tendonitis knee pain, and to continue you treatment until you have regained full range of motion, flexibility and strength in and around the knee. Failure to do so is likely to result in the symptoms coming back again.
Page Last Updated: 27/01/20
Next Review Due: 27/01/22