From the Guidelines
Patellar tendinosis should be treated with a combination of relative rest, eccentric strengthening exercises, and pain management, with surgery considered only in cases where conservative therapy has failed for 3-6 months. The treatment of patellar tendinosis typically involves a multifaceted approach, including reducing activities that cause pain, applying ice for 15-20 minutes several times daily to decrease inflammation, and taking non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily) for pain relief, but limiting use to 1-2 weeks to avoid side effects 1.
Key Recommendations
- Reduce activities that cause pain and apply ice for 15-20 minutes several times daily to decrease inflammation
- Take NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily) for pain relief, but limit use to 1-2 weeks to avoid side effects
- Perform eccentric strengthening exercises, particularly slow, controlled squats and leg extensions, daily: 3 sets of 15 repetitions, gradually increasing resistance as tolerated 1
- Stretching the quadriceps and hamstrings helps maintain flexibility
- Consider a patellar tendon strap worn just below the kneecap during activities for persistent cases
- Corticosteroid injections are generally avoided as they may weaken the tendon 1
- Surgery is an effective treatment option in carefully selected patients who have failed conservative therapy for 3-6 months 1
Treatment Goals
The primary goal of treatment is to reduce pain, promote healing, and improve function, with the ultimate goal of returning to normal activities. This can be achieved through a combination of rest, physical therapy, and pain management, with surgery considered only in cases where conservative therapy has failed.
Important Considerations
It is essential to note that patellar tendinosis is a chronic degenerative condition, and recovery typically takes 3-6 months of consistent therapy. Proper rehabilitation is crucial for tissue remodeling and healing, and patients should be advised to be patient and consistent with their treatment plan. Additionally, corticosteroid injections should be used with caution, as they may weaken the tendon, and surgery should only be considered in cases where conservative therapy has failed for 3-6 months 1.
From the Research
Definition and Treatment of Patellar Tendinosis
- Patellar tendinopathy is a common condition characterized by anterior knee activity-related pain, with a high incidence among athletes engaged in jumping sports 2, 3.
- Various treatment methods are used in the management of patellar tendinopathy, including rest, activity modification, anti-inflammatory medication, injection therapies, taping, eccentric exercises, extra corporeal shock wave therapy, percutaneous electrolysis, and surgery 2, 3, 4.
Nonoperative Treatment Options
- Conservative management is considered to be the first line of treatment, with physical therapy and eccentric exercises being the mainstay of treatment for patellar tendinopathy 2, 3.
- Eccentric exercise therapies have been shown to be effective in the short-term, with a significant improvement in symptoms 5, 4.
- Platelet-rich plasma (PRP) injections have also been shown to be effective, with multiple injections offering more satisfactory results at long-term follow-up 5, 6.
- Extracorporeal shockwave therapy (ESWT) has also been shown to be effective, although results have varied widely 5, 4.
Surgical Treatment Options
- Surgical treatment is effective in many refractory cases unresponsive to nonoperative modalities, with both open and arthroscopic debridement of the patellar tendon being used 2, 4.
- Surgery can be considered for patients who fail to improve after 6 months of conservative treatment 4.
Comparison of Treatment Options
- A systematic review of 15 studies found that eccentric training with or without core stabilization or stretching improved symptoms, while surgery in patients refractory to nonoperative treatment also improved symptoms 4.
- Another systematic review of 22 studies found that PRP injections were superior to other traditional approaches such as shock-wave therapy and dry needling for patellar tendinopathy 6.
- However, the quality of the studies was generally poor, and more high-level evidence is needed to determine the most effective treatment options for patellar tendinopathy 5, 6.