[Jumper's knee--a review]

Jumper's knee has been defined as painful chronic overuse injury of the extensor mechanism of the knee joint. The disease has a high incidence in jumping sports and depends on training frequency and level of performance. Its natural course is protracted, repetitive, and often bilaterally occurring. Its etiology is a chronic overload of the knee extensor mechanism which is triggered by jumping sports (volleyball, basketball etc.) as well as different intrinsic (ligamentous laxity, Q-angle, patella height, tenderness, pattern of force development) and extrinsic dispositions (frequency of training, level of performance, hardness of underground). The place of pathology most often is the osteo-tendinous transition zone of the proximal patellar tendon. Histologic evaluation of the tendon showed that the disease is rather degenerative than inflammatory. The diagnosis is primarily based on the typical sports history, physical examination, and ultrasound. MRI is helpful in operation planning. Plain radiography, CT, and bone scans are used to rule out differential diagnoses. Therapy should be chosen according to the stage of the disease and usually starts with a non-surgical approach. This includes rest from sports activities, immobilisation, non-steroid antiphlogistics, para-tendinous cortisone injections, massage, electric therapy, ultrasound and extracorporal shock waves. Afterwards an increase of activities is begun (moderate training, adequate warm-up, ice cooling after activity, muscle stretching, eccentric strengthening of the quadriceps). Patella straps and soft insoles are used as prevention. Up to 42 % of patients need surgical therapy after failure of long-lasting non-surgical measures, carried out either open or arthroscopically. Surgical principles include excision of the para-tendon, excision of the degenerative tissue, resection of the lower patella pole, and longitudinal incisions into the tendon. Most patients are pain-free after surgery but return to sports only at a lower level.