Can patellar tendinopathy cause pain a hand's length or lower below the knee on the front of the lower leg?

Patellar Tendinopathy Does Not Cause Pain a Hand's Length Below the Knee

Patellar tendinopathy causes pain localized specifically to the inferior pole of the patella (the bottom of the kneecap), not a hand's length or lower below the knee on the front of the lower leg. 1, 2

Pain Location in Patellar Tendinopathy

• Pain is localized to the inferior pole of the patella, which is at the junction where the patellar tendon attaches to the bottom of the kneecap 1, 3, 2
• The condition causes activity-related anterior knee pain, not lower leg pain 1, 4
• Physical examination elicits pain at the inferior pole of the patella with resisted leg extension when the leg is fully extended 1, 5
• Pain is described as "sharp" or "stabbing" and is exacerbated by navigating stairs and prolonged sitting 3

What Pain a Hand's Length Below the Knee Suggests

If pain is located a hand's length or lower below the knee on the front of the lower leg, this suggests:

• A different diagnosis entirely - this location is too distal (far from the knee) to be patellar tendinopathy
• Possible alternative diagnoses include tibialis anterior muscle strain, anterior compartment syndrome, stress fracture of the tibia, or other lower leg pathology
• This pain pattern should prompt evaluation for other conditions, not treatment for patellar tendinopathy

Key Diagnostic Features of True Patellar Tendinopathy

• Load-related pain that increases with demand on the knee extensors, particularly in activities that store and release energy in the patellar tendon (jumping, landing) 2
• Decline squat test reproduces pain by placing increased load on the patellar tendon 1, 5
• Pain with resisted leg extension in full extension at the inferior patellar pole 1, 5
• Insidious onset of localized pain on the anterior aspect of the knee coinciding with increased activity 3

Clinical Pitfall to Avoid

• Do not diagnose patellar tendinopathy based on pain location alone if the pain is not at the inferior pole of the patella - this will lead to inappropriate treatment and missed alternative diagnoses 2
• The diagnosis of patellar tendinopathy remains clinical, and pain location is the hallmark feature that must be present 2