What are the treatment options for patellar spurs?

Treatment Options for Patellar Spurs

The primary treatment approach for patellar spurs should focus on exercise therapy, particularly eccentric strengthening exercises, as these reduce symptoms, increase strength, and promote tendon healing. 1, 2

Initial Conservative Management

• Exercise therapy should be the cornerstone of treatment, focusing on:

  • Eccentric strengthening exercises for the quadriceps 1, 2
  • Both open and closed chain exercises with progressive loading modified based on pain response 1, 3
  • Hip and knee targeted exercise therapy, with greater focus on hip exercises in people with poor tolerance to loaded knee flexion 1

• Rest and activity modification:

  • Relative rest to prevent ongoing damage while allowing activities that don't worsen pain 1
  • Complete immobilization should be avoided to prevent muscular atrophy and deconditioning 1, 2

• Cryotherapy (ice therapy):

  • Effective for short-term pain relief 1
  • Applications of ice through a wet towel for 10-minute periods are most effective 1

• Pain management:

  • NSAIDs (oral or topical) for pain relief, especially during acute phases 1, 3
  • Topical NSAIDs eliminate the increased risk of gastrointestinal hemorrhage associated with systemic NSAIDs 1

Supportive Interventions

• Patellar taping:

  • Medially directed patellar taping can provide short-term relief of pain and improved function 1, 3

• Orthotic devices:

  • Medially wedged insoles for lateral compartment issues 1
  • Laterally wedged subtalar strapped insoles for medial compartment issues 1

• Manual therapy:

  • Recommended in combination with supervised exercise 1
  • Deep transverse friction massage for pain reduction 4

Advanced Interventions

• Corticosteroid treatments:

  • Intraarticular corticosteroid injections may be considered 1
  • Corticosteroid iontophoresis can be effective for treatment of patellar tendinosis pain and function 2
  • Locally injected corticosteroids may be more effective than oral NSAIDs for relief in the acute phase but do not tend to alter long-term outcomes 1
  • Caution: Corticosteroids may inhibit healing and reduce the tensile strength of the tissue, predisposing to spontaneous rupture 1

• Extracorporeal shock wave therapy:

  • A safe, noninvasive option for pain relief in chronic cases 2

Surgical Management

• Surgery should be reserved for patients who have failed conservative therapy for 3-6 months 4, 2

• Surgical indications include:

  • Persistent significant pain affecting quality of life 4
  • Inability to return to desired activity level despite appropriate non-surgical management 4

• Surgical techniques include:

  • Excision of abnormal tendon tissue 4
  • Longitudinal tenotomies to release areas of scarring and fibrosis 4

Important Considerations

• Most patellar tendinopathy cases represent chronic tendinosis rather than acute inflammation, as patients typically present after prolonged symptoms 2
• Education should underpin all interventions, addressing inaccurate beliefs, building confidence, and explaining that pain doesn't necessarily correlate with damage 1
• For overweight patients, weight loss counseling should be included as part of the treatment plan 1
• Diagnostic imaging (ultrasonography or MRI) may be helpful to confirm the diagnosis and assess the extent of the condition 1, 2

Treatment Algorithm

1. Start with exercise therapy (eccentric strengthening) and activity modification
2. Add cryotherapy and NSAIDs for pain management
3. Consider supportive interventions (taping, orthotics, manual therapy)
4. If symptoms persist after 6-12 weeks, consider advanced interventions (corticosteroid treatments, shock wave therapy)
5. If conservative measures fail after 3-6 months, consider surgical options