What is the treatment for jumper's knee?

Treatment for Jumper's Knee (Patellar Tendinopathy)

Eccentric exercise is the first-line treatment for jumper's knee, as it effectively reduces symptoms, increases strength, and promotes tendon healing. 1

First-Line Treatment Options

Conservative Management

1. Eccentric Exercise Program

   • Most effective non-surgical intervention for reducing pain and improving function 1
   • Should be performed daily with respect to pain tolerance
   • Decline squats are particularly effective as they place increased load on the patellar tendon 1, 2
   • Exercise program should progress gradually over 2-3 weeks

2. Physical Therapy Interventions

   • Deep transverse friction massage to reduce pain 1
   • Stretching of the quadriceps muscle before and after activity 3
   • Low-impact aerobic fitness exercises to maintain overall conditioning 1

3. Pain Management

   • Ice application after physical activity 3
   • NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) as adjunct therapy 3
   • Corticosteroid iontophoresis (electrical administration of corticosteroids) for pain relief 1

Second-Line Treatment Options

Injection Therapies

• Peritendinous corticosteroid injections
  • Can be a helpful and safe adjuvant when conservative treatment fails 3
  • Should be used before considering surgical options
  • Note: These are different from direct intratendinous injections, which should be avoided

Advanced Therapies

• Extracorporeal shock wave therapy
  • Showing positive results in recent studies 2
  • Consider when eccentric exercise program fails

Surgical Treatment

Surgical intervention should only be considered if:

• A prolonged (at least 6 months) and well-supervised conservative treatment program fails 3
• Patient has persistent pain that limits sports participation 4

Surgical options include:

• Arthroscopic treatment
  • Includes debridement of soft tissue at the lower patellar pole 5
  • May include resection of the bony lower patellar pole in cases with prominent lower pole 5
  • Provides benefits of minimally invasive approach with faster recovery 5

Treatment Algorithm

1. Initial Phase (First 4-6 weeks)

   • Eccentric exercise program
   • Ice application after activity
   • NSAIDs as needed
   • Activity modification with respect to pain

2. If symptoms persist (6-12 weeks)

   • Continue eccentric exercises
   • Add deep transverse friction massage
   • Consider corticosteroid iontophoresis
   • Evaluate training technique and equipment

3. Refractory cases (3-6 months)

   • Consider peritendinous corticosteroid injection
   • Extracorporeal shock wave therapy

4. Surgical consideration (>6 months of failed conservative treatment)

   • Arthroscopic debridement and/or resection

Common Pitfalls to Avoid

• Premature return to full activity - Gradual progression is essential
• Neglecting eccentric strengthening - The most evidence-based intervention
• Overreliance on passive treatments - Active rehabilitation is key
• Direct intratendinous steroid injections - May lead to tendon weakening and rupture
• Delayed treatment - Early intervention improves outcomes and prevents chronicity

The natural history of jumper's knee shows that without proper treatment, many athletes may need to reduce their sporting activities significantly or even give up sports 4, highlighting the importance of appropriate and timely management.