From the Guidelines
Patellar tendinopathy is a common overuse injury affecting the tendon that connects the kneecap (patella) to the shinbone (tibia), characterized by pain, tenderness, and sometimes swelling at the front of the knee, particularly just below the kneecap. This condition typically develops gradually from repetitive stress on the patellar tendon, often in athletes who participate in jumping sports like basketball or volleyball, which is why it's sometimes called "jumper's knee" 1. The injury involves degenerative changes in the tendon rather than inflammation, with microscopic tears that fail to heal properly.
Key Features of Patellar Tendinopathy
- Characterized by activity-related anterior knee pain
- Occurs in athletes and nonathletes alike
- Repetitive loading of the patellar tendon places jumping athletes at greatest risk
- Pain that is exacerbated by navigating stairs and prolonged sitting is common
Diagnosis and Treatment
Treatment usually begins with rest, ice, and anti-inflammatory medications like ibuprofen or naproxen for pain relief 1.
- Eccentric exercise is recommended to reduce symptoms, increase strength, and promote tendon healing 1
- Deep transverse friction massage is recommended to reduce pain
- Corticosteroid iontophoresis is effective for treatment of patellar tendinosus pain and function
- Physical therapy focusing on eccentric strengthening exercises is crucial for recovery, typically performed daily for 6-12 weeks For persistent cases, other interventions might include corticosteroid injections, platelet-rich plasma therapy, or in rare cases, surgery 1.
Important Considerations
- Most patients with overuse tendinopathies (about 80 percent) fully recover within three to six months, and outpatient treatment should consist of relative rest of the affected area, icing, and eccentric strengthening exercises 1
- Although topical and systemic nonsteroidal anti-inflammatory drugs are effective for acute pain relief, these cannot be recommended in favor of other analgesics 1
- Injected corticosteroids also can relieve pain, but these drugs should be used with caution 1
From the Research
Definition of Patellar Tendinopathy
- Patellar tendinopathy is a common condition characterized by anterior knee activity-related pain, often affecting the tendon's origin and causing pain at the front of the knee 2, 3, 4.
- It is a degenerative disorder rather than an inflammatory disorder, making the term "tendinosis" more appropriate than "tendinitis" 4.
Causes and Risk Factors
- Patellar tendinopathy is commonly associated with jumping sports, such as volleyball and basketball, due to the repetitive jumping that generates a considerable load of energy in the extensor mechanism 4.
- The condition can become chronic and has a high incidence among athletes engaged in jumping sports 3.
Treatment Options
- Nonoperative management is the first choice for treating patellar tendinopathy, with various nonsurgical treatment options available, including:
- Eccentric exercises, which are the mainstay of treatment and have shown good results 2, 3, 4.
- Extracorporeal shockwave therapy (ESWT) 3.
- Platelet-rich plasma (PRP) injections, which have demonstrated mixed results but may be a suitable option for long-term treatment 3, 5.
- Cryotherapy, anti-inflammatories, corticosteroid injections, glyceryl trinitrate, and ultrasound-guided sclerosis 2.
- Surgical treatment is indicated for cases that are refractory to nonsurgical treatment, with open or arthroscopic surgery being comparable options, although arthroscopic surgery results in a faster recovery time 2, 4.
Effectiveness of Treatment Options
- Eccentric exercises have been shown to be effective in the short-term, while multiple PRP injections may offer more satisfactory results at long-term follow-up 3.
- Strengthening exercises, including concentric, eccentric, eccentric-concentric, and isometric exercises, have been found to make little or no difference to pain and function compared to no treatment, glucocorticoid injection, or surgery, although the certainty of the evidence is low or very low 6.
- The available evidence suggests that exercise, including strengthening exercises, may be a suitable treatment option for patellar tendinopathy, but further research is needed to determine the most effective approach 6.