How can patella tendon degeneration be prevented?

Prevention of Patellar Tendon Degeneration

To prevent patellar tendon degeneration, avoid repetitive loading activities (especially jumping), maintain adequate quadriceps and hamstring strength through eccentric exercises, and ensure proper nutrition with adequate protein intake (≥1.6 g/kg body mass) supplemented with vitamin C-enriched gelatin and collagen peptides. 1, 2

Primary Prevention Strategies

Activity Modification and Load Management

• Reduce repetitive loading of the patellar tendon, particularly in jumping sports like basketball and volleyball, as repetitive loading places athletes at greatest risk for tendon degeneration 1
• Avoid training on hard surfaces, as this is a recognized risk factor for patellar tendinopathy development 3
• Modify technique to minimize repetitive stresses placed on the tendon during athletic and occupational activities 1
• Avoid complete immobilization, as this leads to muscular atrophy and deconditioning; instead, continue activities that do not worsen pain 1

Strengthening and Exercise Programs

• Implement eccentric strengthening exercises as a preventive measure, as tensile loading stimulates collagen production and guides normal alignment of collagen fibers 1
• Maintain quadriceps and hamstring strength, as weakness is a risk factor for tendon degeneration 1
• Include stretching exercises, which are widely accepted as helpful for tendon health 1
• For post-surgical patients (ACL reconstruction), initiate isometric quadriceps exercises including static contractions and straight leg raises during the first 2 postoperative weeks to promote faster recovery without compromising stability 1

Nutritional Support

• Maintain adequate protein intake of at least 1.6 g/kg body mass during training and rehabilitation to prevent muscle loss and support tendon healing 2
• Supplement with vitamin C-enriched dietary gelatin, identified by the British Journal of Sports Medicine as the most effective supplement for supporting tendon repair 2
• Add collagen peptides to support tendon healing and augment tendon hypertrophy during training 2
• Consider turmeric/curcumin for anti-inflammatory, antialgic, and antioxidant effects 2
• Avoid drastic reductions in energy intake, as the metabolic demand of tissue recovery processes is high 2

Secondary Prevention (Early Intervention)

Relative Rest Protocol

• Reduce activity to decrease repetitive loading at the first sign of anterior knee pain, especially pain exacerbated by navigating stairs or prolonged sitting 1
• Allow patients to continue activities that do not worsen pain while avoiding complete rest 1
• Most patients recover within 3-6 months with appropriate conservative treatment 1, 4

Cryotherapy

• Apply ice through a wet towel for 10-minute periods to reduce pain and swelling in early tendon irritation 1
• Ice applications slow the release of blood and proteins from surrounding vasculature by reducing tissue metabolism 1

Important Caveats

What to Avoid

• Do not use corticosteroid injections for prevention, as they may inhibit healing, reduce tensile strength, and potentially predispose to rupture 4
• Avoid glucosamine and chondroitin, as evidence is inconsistent for tendon health 2
• Vitamin D supplementation shows minimal to no benefit for tendinopathy prevention 2

Risk Factor Awareness

• Athletes with greater counter-movement jump height are at increased risk and require more aggressive preventive measures 3
• The condition predominantly affects young male athletes in jumping sports 5
• Patellar tendinopathy is fundamentally a degenerative disorder (tendinosis) rather than inflammatory, involving collagen breakdown, disorganization of collagen fibers, and increased mucoid ground substance 6, 3, 7

Monitoring and Early Detection

• Watch for activity-related anterior knee pain at the inferior pole of the patella, as this is the earliest sign of tendon degeneration 1
• Physical examination should assess for pain with resisted leg extension and decline squat testing 1
• The hypovascular region proximal to the tendon insertion is particularly vulnerable to hypoxic degeneration 1