From the Guidelines
Treatment for patellar tendon issues should prioritize relative rest, eccentric strengthening, and pain management to reduce inflammation and promote healing. The goal is to minimize further damage while allowing the tendon to recover. According to 1, relative rest and reduced activity are recommended to prevent further damage and promote healing and pain relief.
Key Recommendations
- Reduce activities that cause pain to prevent further damage and promote healing, as suggested by 1 and 1.
- Apply ice for 15-20 minutes several times daily to reduce inflammation, with cryotherapy providing acute relief of tendinopathy pain, as noted in 1.
- Use over-the-counter pain medications like ibuprofen (400-800mg three times daily) or naproxen (220-440mg twice daily) to manage pain and inflammation, as recommended by 1.
- Engage in physical therapy focusing on eccentric strengthening, which is effective in treating tendinopathy, including patellar tendinopathy, as mentioned in 1.
- Consider using a patellar tendon strap for persistent cases to distribute force away from the tendon, although the evidence for orthotics and braces is not conclusive, as stated in 1.
Additional Considerations
- Proper footwear and avoiding sudden increases in exercise intensity are crucial preventive measures.
- For more severe cases, options like corticosteroid injections, platelet-rich plasma therapy, or surgery may be considered, but these should be approached with caution and typically after conservative measures have failed, as indicated by 1 and 1.
Given the emphasis on minimizing morbidity, mortality, and improving quality of life, the most recent and highest quality study 1 provides the foundation for these recommendations, focusing on a multifaceted approach to treating patellar tendon issues.
From the Research
Treatment Options for Patellar Tendon Issues
The treatment for patellar tendon issues, also known as patellar tendinopathy, can vary depending on the severity of the condition. Some of the treatment options include:
- 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 2
- Surgical treatment: open or arthroscopic debridement of the patellar tendon, which is often considered for refractory cases that do not respond to nonoperative modalities 2
- Conservative management: physiotherapeutic interventions, such as exercise programs, iontophoresis, and dry needling, which have shown some effectiveness in reducing pain and improving function 3
- Extracorporeal shockwave therapy (EWST): a non-invasive treatment that has been shown to be safe and effective in reducing pain and improving function in patients with patellar tendinopathy 4
Effectiveness of Treatment Options
The effectiveness of these treatment options can vary, and the evidence to support their use is not always strong. For example:
- A systematic review of randomized controlled trials found that conservative treatment did not improve pain or function in patients with patellar tendinopathy compared to minimal intervention or invasive intervention 3
- A review of the literature on EWST found that it was a safe and promising treatment for patellar tendinopathy, but that further research was needed to determine its effectiveness 4
- A systematic review of clinical trials found that surgical management was associated with a lower rate of re-dislocation, but that it was unclear whether surgery produced greater functional outcomes than conservative management 5
Rehabilitation and Management
Rehabilitation and management of patellar tendinopathy typically involve a combination of rest, activity modification, anti-inflammatory medication, injection therapies, taping, eccentric exercises, and other treatments 6. The goal of rehabilitation is to reduce pain and improve function, and to help patients return to their normal activities. A guide to sports medicine and rehabilitation professionals' decision making in the management of patellar tendinopathy can be found in the literature 6.