Evidence-Based Approaches to Patellar Tendinopathy: A Critical Analysis of Therapeutic Interventions
DOI:
https://doi.org/10.12775/QS.2026.52.69450Keywords
Conservative treatment, Orthopedics, Review, Knee, Patellar tendon, Patellar Tendinopathy, Jumper’s knee, SurgeryAbstract
Background. Patellar tendinopathy (PT) also known as jumper’s knee is an overuse injury that occurs in both professional and recreational athletes. The main complaint is pain in the anterior part of the knee, which impacts both sport and daily activities. Most patients are successfully treated with non-surgical methods but some of them eventually require surgical intervention.
Aim. The objective of this study is to evaluate both surgical and non-surgical treatment methods for Patellar tendinopathy and seeks to introduce doctors and patients to the assets and downsides associated with them.
Results. Jumper’s knee occurs in up to 45% of professional athletes and up to 8.5% of non-elite athletes. It is a non-inflammatory injury caused by repetitive microinjuries to the patellar tendon. Most common risk factors are: the male gender, involvement in sports (particularly volleyball), training hours, playing surface, small patellar tendon lever and moment arm movements, jump height, heavier load on the tendon and landing strategy of the athlete.
Conclusions. There is a wide range of available conservative treatment methods for Patellar Tendinopathy including physical therapy, various injections, and medication. They should be considered as the first line treatment showing high success rate for mild and moderate cases. Surgical methods have high success rates as well though they are considered more invasive and performed only on chronic patients. Best approach ought to be carefully selected for each patient based on severity of symptoms and patient needs.
References
Aicale, R., Bisaccia, R. D., Oliviero, A., Oliva, F., & Maffulli, N. (2020). Current pharmacological approaches to the treatment of tendinopathy. Expert Opin Pharmacother, 21(12), 1467-1477. https://doi.org/10.1080/14656566.2020.1763306
Andriolo, L., Altamura, S. A., Reale, D., Candrian, C., Zaffagnini, S., & Filardo, G. (2019). Nonsurgical Treatments of Patellar Tendinopathy: Multiple Injections of Platelet-Rich Plasma Are a Suitable Option: A Systematic Review and Meta-analysis. Am J Sports Med, 47(4), 1001-1018. https://doi.org/10.1177/0363546518759674
Anitua, E., Andía, I., Sanchez, M., Azofra, J., del Mar Zalduendo, M., de la Fuente, M., Nurden, P., & Nurden, A. T. (2005). Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture. J Orthop Res, 23(2), 281-286. https://doi.org/10.1016/j.orthres.2004.08.015
Bahr, R., Fossan, B., Løken, S., & Engebretsen, L. (2006). Surgical treatment compared with eccentric training for patellar tendinopathy (Jumper's Knee). A randomized, controlled trial. J Bone Joint Surg Am, 88(8), 1689-1698. https://doi.org/10.2106/jbjs.E.01181
Breda, S. J., Oei, E. H. G., Zwerver, J., Visser, E., Waarsing, E., Krestin, G. P., & de Vos, R. J. (2021). Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial. Br J Sports Med, 55(9), 501-509. https://doi.org/10.1136/bjsports-2020-103403
Brockmeyer, M., Diehl, N., Schmitt, C., Kohn, D. M., & Lorbach, O. (2015). Results of Surgical Treatment of Chronic Patellar Tendinosis (Jumper's Knee): A Systematic Review of the Literature. Arthroscopy, 31(12), 2424-2429.e2423. https://doi.org/10.1016/j.arthro.2015.06.010
Brukner, P., Khan, K. M., Bahr, R., Blair, S., Cook, J. L., Crossley, K., McConnell, J., McCrory, P. R., & Noakes, T. . (2012). Brukner & Khan's Clinical Sports Medicine. McGraw-Hill Education.
Buchbinder, R., Green, S. E., Youd, J. M., Assendelft, W. J., Barnsley, L., & Smidt, N. (2005). Shock wave therapy for lateral elbow pain. Cochrane Database Syst Rev, 2005(4), Cd003524. https://doi.org/10.1002/14651858.CD003524.pub2
Campbell, R. S., & Grainger, A. J. (2001). Current concepts in imaging of tendinopathy. Clin Radiol, 56(4), 253-267. https://doi.org/10.1053/crad.2000.0653
Cannell, L. J., Taunton, J. E., Clement, D. B., Smith, C., & Khan, K. M. (2001). A randomised clinical trial of the efficacy of drop squats or leg extension/leg curl exercises to treat clinically diagnosed jumper's knee in athletes: pilot study. Br J Sports Med, 35(1), 60-64. https://doi.org/10.1136/bjsm.35.1.60
Capasso, G., Testa, V., Maffulli, N., & Bifulco, G. (1997). Aprotinin, corticosteroids and normosaline in the management of patellar tendinopathy in athletes: a prospective randomized study (Vol. 3).
Chen, S. K., Lu, C. C., Chou, P. H., Guo, L. Y., & Wu, W. L. (2009). Patellar tendon ruptures in weight lifters after local steroid injections. Arch Orthop Trauma Surg, 129(3), 369-372. https://doi.org/10.1007/s00402-008-0655-1
Chung, B., & Wiley, J. P. (2002). Extracorporeal shockwave therapy: a review. Sports Med, 32(13), 851-865. https://doi.org/10.2165/00007256-200232130-00004
Coleman, B. D., Khan, K. M., Maffulli, N., Cook, J. L., & Wark, J. D. (2000). Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group. Scand J Med Sci Sports, 10(1), 2-11. https://doi.org/10.1034/j.1600-0838.2000.010001002.x
Cook, J. L., Khan, K. M., Harcourt, P. R., Grant, M., Young, D. A., & Bonar, S. F. (1997). A cross sectional study of 100 athletes with jumper's knee managed conservatively and surgically. The Victorian Institute of Sport Tendon Study Group. Br J Sports Med, 31(4), 332-336. https://doi.org/10.1136/bjsm.31.4.332
Cook, J. L., Khan, K. M., Kiss, Z. S., Purdam, C. R., & Griffiths, L. (2001). Reproducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players. Victorian Institute of Sport tendon study group. Br J Sports Med, 35(1), 65-69. https://doi.org/10.1136/bjsm.35.1.65
Cook, J. L., Khan, K. M., Maffulli, N., & Purdam, C. (2000). Overuse tendinosis, not tendinitis part 2: applying the new approach to patellar tendinopathy. Phys Sportsmed, 28(6), 31-46. https://doi.org/10.3810/psm.2000.06.956
Cook, J. L., Khan, K. M., & Purdam, C. R. (2001). Conservative treatment of patellar tendinopathy. Physical Therapy in Sport, 2(2), 54-65. https://doi.org/https://doi.org/10.1054/ptsp.2001.0069
Dan, M., Phillips, A., Johnston, R. V., & Harris, I. A. (2019). Surgery for patellar tendinopathy (jumper's knee). Cochrane Database Syst Rev, 9(9), Cd013034. https://doi.org/10.1002/14651858.CD013034.pub2
de Mos, M., van der Windt, A. E., Jahr, H., van Schie, H. T., Weinans, H., Verhaar, J. A., & van Osch, G. J. (2008). Can platelet-rich plasma enhance tendon repair? A cell culture study. Am J Sports Med, 36(6), 1171-1178. https://doi.org/10.1177/0363546508314430
de Vries, A. J., van der Worp, H., Diercks, R. L., van den Akker-Scheek, I., & Zwerver, J. (2015). Risk factors for patellar tendinopathy in volleyball and basketball players: A survey-based prospective cohort study. Scand J Med Sci Sports, 25(5), 678-684. https://doi.org/10.1111/sms.12294
Everhart, J. S., Cole, D., Sojka, J. H., Higgins, J. D., Magnussen, R. A., Schmitt, L. C., & Flanigan, D. C. (2017). Treatment Options for Patellar Tendinopathy: A Systematic Review. Arthroscopy, 33(4), 861-872. https://doi.org/10.1016/j.arthro.2016.11.007
Ferrero, G., Fabbro, E., Orlandi, D., Martini, C., Lacelli, F., Serafini, G., Silvestri, E., & Sconfienza, L. M. (2012). Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy. J Ultrasound, 15(4), 260-266. https://doi.org/10.1016/j.jus.2012.09.006
Ferretti, A. (1986). Epidemiology of jumper's knee. Sports Med, 3(4), 289-295. https://doi.org/10.2165/00007256-198603040-00005
Figueroa, D., Figueroa, F., & Calvo, R. (2016). Patellar Tendinopathy: Diagnosis and Treatment. J Am Acad Orthop Surg, 24(12), e184-e192. https://doi.org/10.5435/jaaos-d-15-00703
Forslund, C., Bylander, B., & Aspenberg, P. (2003). Indomethacin and celecoxib improve tendon healing in rats. Acta Orthop Scand, 74(4), 465-469. https://doi.org/10.1080/00016470310017802
Gosens, T., Den Oudsten, B. L., Fievez, E., van 't Spijker, P., & Fievez, A. (2012). Pain and activity levels before and after platelet-rich plasma injection treatment of patellar tendinopathy: a prospective cohort study and the influence of previous treatments. Int Orthop, 36(9), 1941-1946. https://doi.org/10.1007/s00264-012-1540-7
Haake, M., König, I. R., Decker, T., Riedel, C., Buch, M., & Müller, H. H. (2002). Extracorporeal shock wave therapy in the treatment of lateral epicondylitis : a randomized multicenter trial. J Bone Joint Surg Am, 84(11), 1982-1991. https://doi.org/10.2106/00004623-200211000-00012
Haraldsson, B. T., Langberg, H., Aagaard, P., Zuurmond, A. M., van El, B., Degroot, J., Kjaer, M., & Magnusson, S. P. (2006). Corticosteroids reduce the tensile strength of isolated collagen fascicles. Am J Sports Med, 34(12), 1992-1997. https://doi.org/10.1177/0363546506290402
Hart, L. (2011). Corticosteroid and other injections in the management of tendinopathies: a review. Clin J Sport Med, 21(6), 540-541. https://doi.org/10.1097/01.jsm.0000407929.35973.b9
Jain, N. K., & Gulati, M. (2016). Platelet-rich plasma: a healing virtuoso. Blood Res, 51(1), 3-5. https://doi.org/10.5045/br.2016.51.1.3
Jensen, K., & Di Fabio, R. P. (1989). Evaluation of eccentric exercise in treatment of patellar tendinitis. Phys Ther, 69(3), 211-216. https://doi.org/10.1093/ptj/69.3.211
Jonsson, P., & Alfredson, H. (2005). Superior results with eccentric compared to concentric quadriceps training in patients with jumper's knee: a prospective randomised study. Br J Sports Med, 39(11), 847-850. https://doi.org/10.1136/bjsm.2005.018630
Kannus, P., Józsa, L., Natri, A., & Järvinen, M. (1997). Effects of training, immobilization and remobilization on tendons. Scand J Med Sci Sports, 7(2), 67-71. https://doi.org/10.1111/j.1600-0838.1997.tb00121.x
Karjalainen, P. T., Soila, K., Aronen, H. J., Pihlajamäki, H. K., Tynninen, O., Paavonen, T., & Tirman, P. F. (2000). MR imaging of overuse injuries of the Achilles tendon. AJR Am J Roentgenol, 175(1), 251-260. https://doi.org/10.2214/ajr.175.1.1750251
Kettunen, J. A., Kvist, M., Alanen, E., & Kujala, U. M. (2002). Long-term prognosis for jumper's knee in male athletes. A prospective follow-up study. Am J Sports Med, 30(5), 689-692. https://doi.org/10.1177/03635465020300051001
Khan, K. M., Bonar, F., Desmond, P. M., Cook, J. L., Young, D. A., Visentini, P. J., Fehrmann, M. W., Kiss, Z. S., O'Brien, P. A., Harcourt, P. R., Dowling, R. J., O'Sullivan, R. M., Crichton, K. J., Tress, B. M., & Wark, J. D. (1996). Patellar tendinosis (jumper's knee): findings at histopathologic examination, US, and MR imaging. Victorian Institute of Sport Tendon Study Group. Radiology, 200(3), 821-827. https://doi.org/10.1148/radiology.200.3.8756939
Lian, O. B., Engebretsen, L., & Bahr, R. (2005). Prevalence of jumper's knee among elite athletes from different sports: a cross-sectional study. Am J Sports Med, 33(4), 561-567. https://doi.org/10.1177/0363546504270454
Lohrer, H., Schöll, J., & Arentz, S. (2002). [Achilles tendinopathy and patellar tendinopathy. Results of radial shockwave therapy in patients with unsuccessfully treated tendinoses]. Sportverletz Sportschaden, 16(3), 108-114. https://doi.org/10.1055/s-2002-34752 (Achillodynie und Patellaspitzensyndrom - Ergebnisse der Behandlung austherapierter, chronischer Fälle mit radialen Stosswellen.)
MacAuley, D. (2001). Do textbooks agree on their advice on ice? Clin J Sport Med, 11(2), 67-72. https://doi.org/10.1097/00042752-200104000-00001
Masiello, F., Pati, I., Veropalumbo, E., Pupella, S., Cruciani, M., & De Angelis, V. (2023). Ultrasound-guided injection of platelet-rich plasma for tendinopathies: a systematic review and meta-analysis. Blood Transfus, 21(2), 119-136. https://doi.org/10.2450/2022.0087-22
Muaidi, Q. I. (2020). Rehabilitation of patellar tendinopathy. J Musculoskelet Neuronal Interact, 20(4), 535-540.
Nutarelli, S., da Lodi, C. M. T., Cook, J. L., Deabate, L., & Filardo, G. (2023). Epidemiology of Patellar Tendinopathy in Athletes and the General Population: A Systematic Review and Meta-analysis. Orthop J Sports Med, 11(6), 23259671231173659. https://doi.org/10.1177/23259671231173659
Ohberg, L., Lorentzon, R., & Alfredson, H. (2001). Neovascularisation in Achilles tendons with painful tendinosis but not in normal tendons: an ultrasonographic investigation. Knee Surg Sports Traumatol Arthrosc, 9(4), 233-238. https://doi.org/10.1007/s001670000189
Palazón-Bru, A., Tomás Rodríguez, M. I., Mares-García, E., Hernández-Sánchez, S., Carbonell-Torregrosa, M., & Gil-Guillén, V. F. (2021). The Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P): A Reliability Generalization Meta-analysis. Clin J Sport Med, 31(5), 455-464. https://doi.org/10.1097/jsm.0000000000000810
Peers, K. H., & Lysens, R. J. (2005). Patellar tendinopathy in athletes: current diagnostic and therapeutic recommendations. Sports Med, 35(1), 71-87. https://doi.org/10.2165/00007256-200535010-00006
Pierets, K., Verdonk, R., De Muynck, M., & Lagast, J. (1999). Jumper's knee: postoperative assessment. A retrospective clinical study. Knee Surg Sports Traumatol Arthrosc, 7(4), 239-242. https://doi.org/10.1007/s001670050155
Ribbans, W. J., & Collins, M. (2013). Pathology of the tendo Achillis: do our genes contribute? Bone Joint J, 95-b(3), 305-313. https://doi.org/10.1302/0301-620x.95b3.30066
Rivenburgh, D. W. (1992). Physical modalities in the treatment of tendon injuries. Clin Sports Med, 11(3), 645-659.
Rompe, J. D., Buch, M., Gerdesmeyer, L., Haake, M., Loew, M., Maier, M., & Heine, J. (2002). [Musculoskeletal shock wave therapy--current database of clinical research]. Z Orthop Ihre Grenzgeb, 140(3), 267-274. https://doi.org/10.1055/s-2002-32477 (Muskuloskeletale Stosswellenapplikation - Aktueller Stand der klinischen Forschung zu den Standardindikationen.)
Rompe, J. D., Küllmer, K., Vogel, J., Eckardt, A., Wahlmann, U., Eysel, P., Hopf, C., Kirkpatrick, C. J., Bürger, R., & Nafe, B. (1997). [Extracorporeal shock-wave therapy. Experimental basis, clinical application]. Orthopade, 26(3), 215-228. https://doi.org/10.1007/s001320050088 (Extrakorporale Stosswellentherapie. Experimentelle Grundlagen, klinischer Einsatz.)
Schwartz, A., Watson, J. N., & Hutchinson, M. R. (2015). Patellar Tendinopathy. Sports Health, 7(5), 415-420. https://doi.org/10.1177/1941738114568775
Terslev, L., Qvistgaard, E., Torp-Pedersen, S., Laetgaard, J., Danneskiold-Samsøe, B., & Bliddal, H. (2001). Ultrasound and Power Doppler findings in jumper's knee - preliminary observations. Eur J Ultrasound, 13(3), 183-189. https://doi.org/10.1016/s0929-8266(01)00130-6
Tsai, W. C., Hsu, C. C., Chou, S. W., Chung, C. Y., Chen, J., & Pang, J. H. (2007). Effects of celecoxib on migration, proliferation and collagen expression of tendon cells. Connect Tissue Res, 48(1), 46-51. https://doi.org/10.1080/03008200601071295
van der Worp, H., van Ark, M., Zwerver, J., & van den Akker-Scheek, I. (2012). Risk factors for patellar tendinopathy in basketball and volleyball players: a cross-sectional study. Scand J Med Sci Sports, 22(6), 783-790. https://doi.org/10.1111/j.1600-0838.2011.01308.x
Verheyden, F., Geens, G., & Nelen, G. (1997). Jumper's knee: results of surgical treatment. Acta Orthop Belg, 63(2), 102-105.
Visentini, P. J., Khan, K. M., Cook, J. L., Kiss, Z. S., Harcourt, P. R., & Wark, J. D. (1998). The VISA score: an index of severity of symptoms in patients with jumper's knee (patellar tendinosis). Victorian Institute of Sport Tendon Study Group. J Sci Med Sport, 1(1), 22-28. https://doi.org/10.1016/s1440-2440(98)80005-4
Visnes, H., Hoksrud, A., Cook, J., & Bahr, R. (2005). No effect of eccentric training on jumper's knee in volleyball players during the competitive season: a randomized clinical trial. Clin J Sport Med, 15(4), 227-234. https://doi.org/10.1097/01.jsm.0000168073.82121.20
Warden, S. J., & Brukner, P. (2003). Patellar tendinopathy. Clin Sports Med, 22(4), 743-759. https://doi.org/10.1016/s0278-5919(03)00068-1
Weatherall, P. T., & Crues, J. V., 3rd. (1995). Musculotendinous injury. Magn Reson Imaging Clin N Am, 3(4), 753-772.
Weiler, J. M. (1992). Medical modifiers of sports injury. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in sports soft-tissue injury. Clin Sports Med, 11(3), 625-644.
Weinberg, E. P., Adams, M. J., & Hollenberg, G. M. (1998). Color Doppler sonography of patellar tendinosis. AJR Am J Roentgenol, 171(3), 743-744. https://doi.org/10.2214/ajr.171.3.9725308
Wilson, J. J., & Best, T. M. (2005). Common overuse tendon problems: A review and recommendations for treatment. Am Fam Physician, 72(5), 811-818.
Witvrouw, E., Bellemans, J., Lysens, R., Danneels, L., & Cambier, D. (2001). Intrinsic risk factors for the development of patellar tendinitis in an athletic population. A two-year prospective study. Am J Sports Med, 29(2), 190-195. https://doi.org/10.1177/03635465010290021201
Young, M. A., Cook, J. L., Purdam, C. R., Kiss, Z. S., & Alfredson, H. (2005). Eccentric decline squat protocol offers superior results at 12 months compared with traditional eccentric protocol for patellar tendinopathy in volleyball players. Br J Sports Med, 39(2), 102-105. https://doi.org/10.1136/bjsm.2003.010587
Zwerver, J., Bredeweg, S. W., & van den Akker-Scheek, I. (2011). Prevalence of Jumper's knee among nonelite athletes from different sports: a cross-sectional survey. Am J Sports Med, 39(9), 1984-1988. https://doi.org/10.1177/0363546511413370
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Kamil Swoboda, Michał Olejnik, Kamil Tomasz Pielusiński, Alicja Pyzik, Zuzanna Wiater, Aleksandra Włodarczyk, Karolina Brankowska, Marta Jakubowska, Piotr Artur Górka, Szymon Domagała

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 121
Number of citations: 0