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What is the most appropriate treatment for patellar tendinopathy?
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  1. J L Cook1,
  2. K M Khan2
  1. 1Musculoskeletal Research Centre La Trobe University, Bundoora Victoria 3086, Australia J.Cook@latrobe.edu.au
  2. 2Department of Family Practice and School of Human Kinetics University of British Columbia, Canada kkhan@interchange.ubc.ca

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    Since the demise of the concept of an inflammatory basis for tendinopathy, treatment has been based on the degenerative concept.1 However, an alternative theory of a failed healing response may be more fitting,2 and treatment that maintains or encourages the healing response in the tendon is required. Currently, treatment remains empirically based, as it is not known what interventions may best stimulate a healing response.

    The conservative treatment of patellar tendinopathy recorded in the literature includes combinations of rest,3 exercise, especially eccentric exercise,4 modalities including ultrasound, heat, and cryotherapy,5 frictions,6 biomechanical adjustment,7 and pharmaceutical treatment.8 Many of these treatments are based on “clinical experience” rather than appropriately analysed data.

    The surgical management of patellar tendinopathy includes several different operative procedures and postoperative rehabilitation protocols. The choice of surgical treatment of patellar tendinopathy appears to be based on the surgeon's preference.9

    Recent literature reviews8, 10 document a dearth of controlled trials in the treatment of patellar tendinopathy. Hence, a review of treatment of patellar tendinopathy that used a randomised allocation or were prospective in nature was undertaken.

    Ten randomised trials were reviewed. These studies investigated the effects on the patellar tendon of anti-inflammatory medication (n = 7), exercise (n = 2), and local massage (n = 1). No randomised surgical papers were identified, hence three prospective studies on the surgical treatment of this condition were included.

    Conservative treatment

    exercise

    Two papers11, 12 review the effect of exercise regimens on patellar tendinopathy. These studies focus on strengthening of the muscles around the knee in subjects with jumper's knee, and measuring changes in strength, pain, and function after an eight and 12 week intervention. Outcome measures varied, but both measured changes in strength and pain; one study measured function (return to sport) as well.11

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