Quadriceps tendinopathy or Jumper’s knee? (Kawhi Leonard)

Osteopath Dr Marcus Ng at Quay HealthHi guys,
Being a huge basketball fan, I thought I would start a blog covering some of the injuries that arise throughout the NBA season. So whether you are a fellow baller, play another sport or just a fanatic like myself, I’m here to share some insight with you from my perspective as a health practitioner.

Arguably the best two-way player in the NBA currently, Kawhi Leonard from the San Antonio Spurs has yet to step foot onto the court this season. He has been inactive all through training camp and pre-season due to a pesky right knee injury. Official statement from the Spurs listed him with a “right quadriceps tendinopathy”.

So what is a quadriceps tendinopathy, is it the right diagnoses? Why has it sidelined Kawhi for so long?

Tendinopathy broadly speaking is a disease of the tendon; it can include inflammation of the tendon (tendinitis) or inflammation of the sheath surrounding the tendon (tenosynovitis) as well.

As the name suggests, the quadriceps is formed from four individual muscles at the front of the thigh, their primary role are to straighten (extend) the leg at the knee joint. The four muscles converge to form the quadriceps tendon just a few cm above the knee cap (patella) and attaches to the upper boarder of the knee cap.

This tendon then runs over the knee cap, encasing it, and attaches to the bony bump below the knee cap as you run you hand down the front of your lower leg (tibial tuberosity); this part is technically the patellar tendon.

Anatomically speaking, they are named as the quadriceps tendon and a patellar tendon respectively, based on their attachments but both are made of the same tissue and work much like a link in a chain between the quadriceps muscle and its bony attachment and as such are governed by the same force and stress that go through it.

The diagnosis from the Spurs’ camp is essentially saying he has an injury to his quadriceps tendon. I believe Kawhi has Jumper’s Knee, which technically is patellar (not quadriceps) tendinopathy.

Jumper’s Knee is typically caused by overuse or repetitive movements such as running and jumping. The symptoms are pain over the knee and can present with or without swelling. The onset of the injury is also gradual over time rather then from one particular incident (such as a corked thigh).

It is often associated with other lower limb injuries such as history of ankle sprains. In Kawhi’s cause, it is worthy to note that he suffered two left ankle injuries just five days apart back in May/June during the playoffs. The latter, being highly controversial when his defender left him little room to safely land after taking a jump shot. Was it unsportsmanlike? You be the judge.

Having not played an NBA game for last five months, Kawhi’s injury has certainly taken much longer to recover then anticipated. The tendon tissue would have recovered by now, I believe if he is still experiencing pain in the knee, it is because of altered mechanics elsewhere in the lower limb. So while treatment of surrounding structures to the knee is important, and necessary, to alleviate the acute symptoms, the long term solution is to correct any imbalance the body may have developed that cause the injury in the first place. In Kawhi’s case, making sure his left ankle has returned to full range and function, and address any altered mechanicals that potential prolonged his right knee tendinopathy recovery.

Thanks for reading and if you have any input or feedback on what else you would like me to cover on future topics, you can reach me via marcus@quayhealth.com.au. Until next time, GO SPURS GO!

Dr Marcus Ng
Osteopath

References:
What is the most appropriate treatment for patellar tendinopathy? J L Cook, K M Khan
Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy J L Cook, C R Purdam