Patellar tendinopathy is a common condition. There are a wide variety of treatment options available, the majority of which are nonoperative. No consensus exists on the optimal method of treatment.
Evidence Acquisition:
PubMed spanning 1962-2014.
Study Design:
Clinical review.
Level of Evidence:
Level 4.
Results:
The majority of cases resolve with nonoperative therapy: rest, physical therapy with eccentric exercises, cryotherapy, anti-inflammatories, corticosteroid injections, extracorporeal shockwave therapy, glyceryl trinitrate, platelet-rich plasma injections, and ultrasound-guided sclerosis. Refractory cases may require either open or arthroscopic debridement of the patellar tendon. Corticosteroid injections provide short-term pain relief but increase risk of tendon rupture. Anti-inflammatories and injectable agents have shown mixed results. Surgical treatment is effective in many refractory cases unresponsive to nonoperative modalities.
Conclusion:
Physical therapy with an eccentric exercise program is the mainstay of treatment for patellar tendinopathy. Platelet-rich plasma has demonstrated mixed results; evidence-based recommendations on its efficacy cannot be made. In the event that nonoperative treatment fails, surgical intervention has produced good to excellent outcomes in the majority of patients.
AdirimTAChengTL. Overview of injuries in the young athlete. Sports Med. 2003;33:75-81.
2.
AlfredsonHOhbergL. Neovascularisation in chronic painful patellar tendinosis—promising results after sclerosing neovessels outside the tendon challenge the need for surgery. Knee Surg Sports Traumatol Arthrosc. 2005;13:74-80.
3.
AlfredsonHOhbergL. Sclerosing injections to areas of neovascularization reduce pain in chronic achilles tendinopathy: a double blind randomised controlled trial. Knee Surg Sports Traumatol Arthrosc. 2005;13:338-344.
4.
AlmekindersLC. The efficacy of nonsteroidal anti-inflammatory drugs in the treatment of ligament injuries. Sports Med. 1990;9:137-142
5.
AndresBMMurrellGA. Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clin Orthop Relat Res. 2008;466:1539-1554
6.
BahrRFossanBLokenSEngebretsenL. Surgical treatment compared with eccentric training for patellar tendinopathy (jumper’s knee). A randomized, controlled trial. J Bone Joint Surg Am. 2006;88:1689-1698.
7.
BensonRTMcDonnellSMKnowlesHJReesJLCarrAJHulleyPA. Tendinopathy and tears of the rotator cuff are associated with hypoxia and apoptosis. J Bone Joint Surg. 2010;92:448-453.
8.
BickelKD. Flexor pollicis longus tendon rupture after corticosteroid injection. J Hand Surg Am. 1996;21:152-153.
9.
BjorkmanAJorgsholmP. Rupture of the extensor pollicis longus tendon: a study of aetiological factors. Scand J Plast Reconstr Surg Hand Surg. 2004;38:32-35.
10.
BohnsackMHalcourAKlagesP. The influence of patellar bracing on patellar and knee load-distribution and kinematics: an experimental cadaver study. Knee Surg Sports Traumatol Arthrosc. 2008;16:135-141.
11.
BowmanKFJrMullerBMiddletonKFinkCHarnerCFuF. Progression of patellar tendinitis following treatment. Knee Surg Sports Traumatol Arthrosc. 2013;21:2035-2039.
12.
BravermanSE. Orthotics for the fighting forces. Phys Med Rehabil Clin North Am. 2002;31:159-173.
13.
CapassoGTestaVMaffulliNBifulcoG. Aprotinin, corticosteroids and normosaline in the management of patellar tendinopathy in athletes: a prospective randomized study. Sports Exerc Inj. 1997;3:111-115.
14.
ChenSKLuCCChouPHGuoLYWuWL. Patellar tendon ruptures in weight lifters after local steroid injections. Arch Orthop Trauma Surg. 2009;129:369-372.
15.
ChungBWileyJP. Extracorporeal shockwave therapy: a review. Sports Med. 2002;32:851-865.
16.
CookJLKhanKMHarcourtPRGrantMYoungDABonarSF. A cross sectional study of 100 athletes with jumper’s knee managed conservatively and surgically. Br J Sports Med. 1997;31:332-336.
17.
De VosRJWeirACobbenLPTolJL. The value of power Doppler ultrasonograophy in Achilles tendinopathy: a prospective study. Am J Sports Med. 2007;35:1696-1701.
18.
FerrettiAConteducaFCamerucciEMorelliF. Patellar tendinosis: a follow-up study of surgical treatment. J Bone Joint Surg Am. 2002;84:2179-2185.
19.
FerrettiAIppolitoEMarianiP. Jumper’s knee. Am J Sports Med. 1983;11:58-62.
20.
FinestoneARadinELLevBShlamkovitchNWienerMMilgromC. Treatment of overuse patellofemoral pain: prospective randomized controlled clinical trial in a military setting. Clin Orthop Relat Res. 1993;(293):208-210.
21.
ForslundCBylanderBAspenbergP. Indomethacin and celecoxib improve tendon healing in rats. Acta Orthop Scand. 2003;74:465-469.
22.
FredbergUBolvigLPfeiffer-JensenM. Ultrasonography as a tool for diagnosis, guidance of local steroid injection and, together with pressure algometry, monitoring of the treatment of athletes with chronic jumper’s knee and Achilles tendinitis: a randomized, double-blind, placebo-controlled study. Scand J Rheumatol. 2004;33:94-101.
23.
FredbergUBolvigL. Jumper’s knee. Review of the literature. Scand J Med Sci Sports. 1999;9:66-73.
24.
FredbergU. Local corticosteroid injection in sport: review of literature and guidelines for treatment. Scand J Med Sci Sports. 1997;7:131-139.
FrohmASaartokTHalvorsenKRenstromP. Eccentric treatment for patellar tendinopathy: a prospective randomised short-term pilot study of two rehabilitation protocols. Br J Sports Med. 2007;41:e7.
27.
FuSCWangWPauHMWongYPChanKMRolfCG. Increased expression of transforming growth factor-beta1 in patellar tendinosis. Clin Orthop. 2002;400:174-183.
28.
GerrardDF. External knee support in rugby union: effectiveness of bracing and taping. Sports Med. 1998;25:313-317.
29.
GosensTDen OudstenBLFievezESpijkerPFievezA. Pain and activity levels before and after platelet-rich plasma injection treatment of patellar tendinopathy: a prospective cohort study and the influence of previous treatments. Int Orthop. 2012;36:1941-1946.
GriffithsGPSelesnickFH. Operative treatment and arthroscopic findings in chronic patellar tendinitis. Arthroscopy. 1998;14:836-839.
32.
HoksrudABahrR. Ultrasound-guided sclerosing treatment in patients with patellar tendinopathy (jumper’s knee): 44-month follow-up. Am J Sports Med. 2011;39:2377-2380.
33.
HoksrudAOhbergLAlfredsonHBahrR. Color Doppler ultrasound findings in patellar tendinopathy (jumper’s knee). Am J Sports Med. 2008;36:1813-1820.
34.
HoksrudAOhbergLAlfredsonHBahrR. Ultrasound-guided sclerosis of neovessels in painful chronic patellar tendinopathy: a randomized controlled trial. Am J Sports Med. 2006;34:1738-1746.
35.
JamesSLAliKPocockC. Ultrasound guided dry needling and autologous blood injection for patellar tendinosis. Br J Sports Med. 2007;41:518-521.
36.
JohnsonDPWakeleyCJWattI. Magnetic resonance imaging of patellar tendinitis. J Bone Joint Surg Br. 1996;78B:452-457.
37.
JonssonPAlfredsonH. Superior results with eccentric compared to concentric quadriceps training in patients with jumper’s knee: a prospective randomised study. Br J Sports Med. 2005;39:847-850.
38.
KannusPJozsaLNatriA. Effects of training, immobilization and remobilization on tendons. Scand J Med Sci Sports. 1997;7:67-71.
39.
KennedyJCWillisRB. The effects of local steroid injections on tendons: a biomechanical and microscopic correlative study. Am J Sports Med. 1976;4:11-21.
40.
KhanKMCookJLBonarF. Histopathology of common tendinopathies: update and implications for clinical management. Sports Med. 1999;27:393-408.
41.
KonEFilardoGDelcoglianoM. Platelet-rich plasma: new clinical application: a pilot study for treatment of jumper’s knee. Injury. 2009;40:598-603.
42.
KongsgaardMKovanenVAagaardP. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scand J Med Sci Sports. 2009;19:790-802.
43.
KulickMISmithSHadlerK. Oral ibuprofen: evaluation of its effect on peritendinous adhesions and the breaking strength of a tenorrhaphy. Am J Hand Surg. 1986;11:110-120.
44.
LavagninoMArnoczkySPDoddsJElvinN. Infrapatellar straps decrease patellar tendon strain at the site of the jumper’s knee lesion: a computational analysis based on radiographic measurements. Sports Health. 2011;3:296-302.
45.
LavagninoMArnoczkySElvinD. Patellar tendon strain is increased at the site of the jumper’s knee lesion during knee flexion and tendon loading. Am J Sports Med. 2008;36:2110-2118
46.
LevineJSplainS. Use of the infrapatellar strap in the treatment of patellofemoral pain. Clin Orthop Relat Res. 1979;(139):179-181.
47.
LianOScottAEngebretsenLBahrRDuronioVKhanK. Excessive apoptosis in patellar tendinopathy in athletes. Am J Sports Med. 2007;35:605-611.
48.
LianOBEngebretsenLBahrR. Prevalence of jumper’s knee among elite athletes from different sports: a cross-sectional study. Am J Sports Med. 2005;33:561-567.
49.
LorbachODiamantopoulosAPaesslerHH. Arthroscopic resection of the lower patellar pole in patients with chronic patellar tendinosis. Arthroscopy. 2008;24:167-173.
50.
MacAuleyD. Do textbooks agree on their advice on ice?Clin J Sport Med. 2001;11:67-72.
51.
MagraMMaffulliN. Genetic aspects of tendinopathy. J Sci Med Sport. 2008;11:243-247.
52.
MagraMMaffulliN. Matrix metalloproteases: a role in overuse tendinopathies. Br J Sports Med. 2005;39:789-791.
53.
MaierDBornebuschLSalzmannGMSudkampNPOgonP. Mid- and long-term efficacy of the arthroscopic patellar release for treatment of patellar tendinopathy unresponsive to nonoperative management. Arthroscopy. 2013;29:1338-1345.
54.
MaloneTREngelhardtDLKirpatrickJS. Nerve injury in athletes caused by cryotherapy. J Athl Train. 1992;27:235-237.
55.
MillerMDHirkinDTWisnowskiJW. The efficacy of orthotics for anterior knee pain in military trainees: a preliminary report. Am J Knee Surg. 1997;10:10-13.
OrchardJMasseyABrownR. Successful management of tendinopathy with injections of the MMP-inhibitor aprotinin. Clin Orthop Relat Res. 2008;466:1625-1632.
58.
PaavolaMKannusPJarvinenTLJoszaLJarvinenM. Treatment of tendon disorder. Is there a role for corticosteroid injection?Foot Ankle Clin. 2002;7:501-513.
59.
PaoloniJAAppleyardRCNelsonJ. Topical glyceryl trinitrate application in the treatment of chronic supraspinatus tendinopathy: a randomized, double-blinded, placebo-controlled clinical trial. Am J Sports Med. 2005;33:806-813.
60.
PaoloniJAAppleyardRCNelsonJ. Topical glyceryl trinitrate treatment of chronic noninsertional Achilles tendinopathy. A randomized, double-blind, placebo-controlled trial. J Bone Joint Surg Am. 2004;86:916-922.
61.
PaoloniJAAppleyardRCNelsonJ. Topical nitric oxide application in the treatment of chronic extensor tendinosis at the elbow: a randomized, double-blinded, placebo-controlled clinical trial. Am J Sports Med. 2003;31:915-920.
62.
PascarellaAAlamMPascarellaFLatteCDi SalvatoreMGMaffulliN. Arthroscopic management of chronic patellar tendinopathy. Am J Sports Med. 2011;39:1975-1983.
63.
PeersKHLysensRJBrysPBellemansJ. Cross-sectional outcome analysis of athletes with chronic patellar tendinopathy treated surgically and by extracorporeal shock wave therapy. Clin J Sport Med. 2003;13:79-83.
64.
PeersKHLysensRJ. Patellar tendinopathy in athletes: current diagnostic and therapeutic recommendations. Sports Med. 2005;35:71-87.
65.
PoppJEYuJSKaedingCC. Recalcitrant patellar tendinitis. Am J Sports Med. 1997;25:218-222.
66.
PurdamDRCookJLHopperDMKhanKM. Discriminative ability of functional loading tests for adolescent jumper’s knee. Phys Ther Sport. 2003;4:3-9.
67.
ReesJDMaffulliNCookJ. Management of tendinopathy. Am J Sports Med. 2009;37:1855-1867.
68.
RivenburghDW. Physical modalities in the treatment of tendon injuries. Clin Sports Med. 1992;11:645-659.
69.
RolfCGFuBSPauAWangWChanB. Increased cell proliferation and associated expression of PDGFRβ causing hypercellularity in patellar tendinosis. Rheumatology (Oxford). 2001;40:256-261.
70.
RomeoAALarsonRV. Arthroscopic treatment of infrapatellar tendonitis. Arthroscopy. 1999;14:341-345.
71.
RompeJDBuchMGerdesmeyerL. Musculoskeletal shock wave therapy: current database of clinical research [in German]. Z Orthop Ihre Grenzgeb. 2002;140:267-274.
SantanderJZarbaEIrapordaHPuleoS. Can arthroscopically assisted treatment of chronic patellar tendinopathy reduce pain and restore function?Clin Orthop Relat Res. 2012;470:993-997.
74.
SchmidMRHodlerJCathreinPDuewellSJacobHACRomeroJ. Is impingement the cause of jumper’s knee? Dynamic and static magnetic resonance imaging of patellar tendinitis in an open configuration system. Am J Sports Med. 2002;30:388-395.
75.
ScottALianOBahrRHartDADuronioV. VEGF expression in patellar tendinopathy: a preliminary study. Clin Orthop Relat Res. 2008;466:1598-1604.
76.
SemsADimeffRIannottiJP. Extracorporeal shock wave therapy in the treatment of chronic tendinopathies. J Am Acad Orthop Surg. 2006;14:195-204.
77.
ShelbourneKDHenneTDGrayT. Recalcitrant patellar tendinosis in elite athletes. Surgical treatment in conjunction with aggressive postoperative rehabilitation. Am J Sports Med. 2006;34:1141-1146.
78.
StahlSKaufmanT. The efficacy of an injection of steroids for medial epicondylitis: a prospective study of sixty elbows. J Bone Joint Surg Am. 1997;79:1648-1652.
79.
SteunebrinkMZwerverJBrandsemaRGroenenboomPAkker-ScheekIWeirA. Topical glyceryl trinitrate treatment of chronic patellar tendinopathy: a randomised, double-blind, placebo-controlled clinical trial. Br J Sports Med. 2013;47:34-39.
80.
SuzukiTNakamuraYMoriyaTSasanoH. Effects of steroid hormones on vascular functions. Microsc Res Tech. 2003;60:76-84.
VillarRN. Patellofemoral pain and the infrapatellar brace: a military view. Am J Sports Med. 1985;13:313-315.
83.
VisnesHBahrR. The evolution of eccentric training as treatment for patellar tendinopathy (jumper’s knee): a critical review of exercise programmes. Br J Sports Med. 2007;41:217-223.
84.
VisnesHHoksrudACookJBahrR. No effect of eccentric training on jumper’s knee in volleyball players during the competitive season: a randomized clinical trial. Clin J Sport Med. 2005;15:225-232.
85.
VolpiPMarioniLBaitCDe GirolamoLSchoenhuberH. Treatment of chronic patellar tendinosis with buffered platelet rich plasma: a preliminary study. Med Sport. 2007;60:595-603.
86.
WangCJKoJYChanYSWengLHHsuSL. Extracorporeal shockwave for chronic patellar tendinopathy. Am J Sports Med. 2007;35:972-978.
87.
WeilerJM. Medical modifiers of sports injury: the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in sports soft- tissue injury. Clin Sports Med. 1992;11:625-644.
88.
WillbergLSundingKForssbladMFahlstromMAlfredsonH. Sclerosing polidocanol injections or arthroscopic shaving to treat patellar tendinopathy/jumper’s knee? A randomised controlled study. Br J Sports Med. 2011;45:411-415.
89.
WongMWTangYNFuSCLeeKMChanKM. Triamcinolone suppresses human tenocyte cellular activity and collagen synthesis. Clin Orthop Relat Res. 2004;421:277-281.
90.
WorpHArkMRoerinkSPeppingGJAkker-ScheekIZwerverJ. Risk factors for patellar tendinopathy: a systematic review of the literature. Br J Sports Med. 2011;45:446-452.
91.
YoungMACookJLPurdamCRKissZSAlfredsonH. Eccentric decline squat protocol offers superior results at 12 months compared with traditional eccentric protocol for patellar tendinopathy in volleyball players. Br J Sports Med. 2005;39:102-105.
92.
YuJSPoppJEKaedingCCLucasJ. Correlation of MR imaging and pathologic findings in athletes undergoing surgery for chronic patellar tendinitis. AJR Am J Roentgenol. 1995;165:115-118.
93.
YuanJMurrellGAWeiAQAppleyardRCDel SoldatoPWangMX. Addition of nitric oxide via nitroflurbiprofen enhances the material properties of early healing of young rat Achilles tendons. Inflamm Res. 2003;52:230-237.
94.
ZwerverJHartgensFVerhagenEWorpHAkker-ScheekIDiercksRL. No effect of extracorporeal shockwave therapy on patellar tendinopathy in jumping athletes during the competitive season: a randomized clinical trial. Am J Sports Med. 2011;39:1191-1199.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
