Abstract
Formerly known as ‘jumper’s knee’, patellar tendinopathy gives rise to considerable functional deficit and disability in recreational as well as professional athletes. It can interfere with their performance, often perseveres throughout the sporting career and may be the primary cause to end it. The diagnosis of patellar tendinopathy is primarily a clinical one but new imaging techniques, such as Doppler ultrasonography, may provide additional diagnostic value. Current therapeutic protocols are characterised by wide variability ensuing from anecdotal experience rather than evidence. Moreover, numerous reports in recent years have shattered previous doctrines and dogmatic belief on tendon overuse. Histopathological and biochemical evidence has indicated that the underlying pathology of tendinopathy is not an inflammatory tendinitis but a degenerative tendinosis. Consequently, pain in chronic patellar tendinopathy is not inflammatory in nature, but its exact origin remains unexplained. In pursuit of pathology- and evidence-based management, conservative therapy should be shifted from anti-inflammatory strategies towards a complete rehabilitation with eccentric tendon strengthening as a key element. If conservative management fails, surgery is opted for. However, considering the heterogeneity of surgical procedures and the absence of randomised studies, no conclusive evidence can be drawn from the literature regarding the effectiveness of surgical treatment for patellar tendinopathy. Parallel with the improved knowledge on the pathophysiology and pain mechanisms in patellar tendinopathy, new treatment strategies are expected to emerge in the near future.
Similar content being viewed by others
References
Khan KM, Maffulli N. Tendinopathy: an Achilles’ heel for athletes and clinicians. Clin J Sport Med 1998; 8: 151–4
Clement DB, Taunton JE, Smart GW. Achilles tendinitis and peritendinitis: etiology and treatment. Am J Sports Med 1984; 12: 179–84
Kiss ZS, Kellaway DP, Cook JL, et al. Postoperative patellar tendon healing: an ultrasound study. VIS Tendon Study Group. Australas Radiol 1998; 42: 28–32
Scapinelli R. Studies on the vasculature of the human knee joint. Acta Anat (Basel) 1968; 70: 305–31
Scapinelli R. Blood supply of the human patella: its relation to ischaemic necrosis after fracture. J Bone Joint Surg Br 1967; 49: 563–70
Soldado F, Reina F, Yuguero M, et al. Clinical anatomy of the arterial supply of the human patellar ligament. Surg Radiol Anat 2002; 24: 177–82
Cook JL, Khan KM. What is the most appropriate treatment for patellar tendinopathy? Br J Sports Med 2001; 35: 291–4
Khan KM, Maffulli N, Coleman BD, et al. Patellar tendinopathy: some aspects of basic science and clinical management. Br J Sports Med 1998; 32: 346–55
Khan KM, Cook JL, Bonar F, et al. Histopathology of common tendinopathies: update and implications for clinical management. Sports Med 1999; 27: 393–408
Maffulli N, Khan KM, Puddu G. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy 1998; 14: 840–3
Blazina ME, Kerlan RK, Jobe FW, et al. Jumper’s knee. Orthop Clin North Am 1973; 4: 665–78
Ferretti A, Ippolito E, Mariani P, et al. Jumper’s knee. Am J Sports Med 1983; 11: 58–62
Linenger JM, West LA. Epidemiology of soft-tissue/musculoskeletal injury among US Marine recruits undergoing basic training. Mil Med 1992; 157: 491–3
Lysens RJ, de Weerdt W, Nieuwboer A. Factors associated with injury proneness. Sports Med 1991; 12: 281–9
Lysens R, Steverlynck A, Vanden Auweele Y, et al. The predictability of sports injuries. Sports Med 1984; 1: 6–10
Richards DP, Ajemian SV, Wiley JP, et al. Knee joint dynamics predict patellar tendinitis in elite volleyball players. Am J Sports Med 1996; 24: 676–83
Richards DP, Ajemian SV, Wiley JP, et al. Relation between ankle joint dynamics and patellar tendinopathy in elite volleyball players. Clin J Sport Med 2002; 12: 266–72
Ferretti A. Epidemiology of jumper’s knee. Sports Med 1986; 3: 289–95
Lian O, Engebretsen L, Ovrebo RV, et al. Characteristics of the leg extensors in male volleyball players with jumper’s knee. Am J Sports Med 1996; 24: 380–5
Lian O, Holen KJ, Engebretsen L, et al. Relationship between symptoms of jumper’s knee and the ultrasound characteristics of the patellar tendon among high level male volleyball players. Scand J Med Sci Sports 1996; 6: 291–6
Myllymaki T, Bondestam S, Suramo I, et al. Ultrasonography of jumper’s knee. Acta Radiol 1990; 31: 147–9
Ferretti A, Conteduca F, Camerucci E, et al. Patellar tendinosis: a follow-up study of surgical treatment. J Bone Joint Surg Am 2002; 84-A: 2179–85
Witvrouw E, Bellemans J, Lysens R, et al. Intrinsic risk factors for the development of patellar tendinitis in an athletic population: a two-year prospective study. Am J Sports Med 2001; 29: 190–5
Kettunen JA, Kvist M, Alanen E, et al. Long-term prognosis for jumper’s knee in male athletes: a prospective follow-up study. Am J Sports Med 2002; 30: 689–92
Coleman BD, Khan KM, Kiss ZS, et al. Open and arthroscopic patellar tenotomy for chronic patellar tendinopathy: a retrospective outcome study. Victorian Institute of Sport Tendon Study Group. Am J Sports Med 2000; 28: 183–90
Coleman BD, Khan KM, Maffulli N, et al. 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 2000; 10: 2–11
Leadbetter WB. Cell-matrix response in tendon injury. Clin Sports Med 1992; 11: 533–78
Kannus P. Etiology and pathophysiology of chronic tendon disorders in sports. Scand J Med Sci Sports 1997; 7: 78–85
Archambault JM, Wiley JP, Bray RC. Exercise loading of tendons and the development of overuse injuries: a review of current literature. Sports Med 1995; 20: 77–89
Mafi N, Lorentzon R, Alfredson H. Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis. Knee Surg Sports Traumatol Arthrosc 2001; 9: 42–7
Almekinders LC, Vellema JH, Weinhold PS. Strain patterns in the patellar tendon and the implications for patellar tendinopathy. Knee Surg Sports Traumatol Arthrosc 2002; 10: 2–5
Basso O, Amis AA, Race A, et al. Patellar tendon fiber strains: their differential responses to quadriceps tension. Clin Orthop 2002; 400: 246–53
Yuan J, Wang MX, Murrell GA. Cell death and tendinopathy. Clin Sports Med 2003; 22: 693–701
Yu JS, Popp JE, Kaeding CC, et al. Correlation of MR imaging and pathologic findings in athletes undergoing surgery for chronic patellar tendinitis. AJR Am J Roentgenol 1995; 165: 115–8
Colosimo AJ, Bassett III FH. Jumper’s knee: diagnosis and treatment. Orthop Rev 1990; 19: 139–49
Khan KM, Bonar F, Desmond PM, et al. Patellar tendinosis (jumper’s knee): findings at histopathologic examination, US, and MR imaging. Victorian Institute of Sport Tendon Study Group. Radiology 1996; 200: 821–7
Roels J, Martens M, Mulier JC, et al. Patellar tendinitis (jumper’s knee). Am J Sports Med 1978; 6: 362–8
Fritschy D, Wallensten R. Surgical treatment of patellar tendinitis. Knee Surg Sports Traumatol Arthrosc 1993; 1: 131–3
Martens M, Wouters P, Burssens A, et al. Patellar tendinitis: pathology and results of treatment. Acta Orthop Scand 1982; 53: 445–50
Martens M. Tendinitis of the patellar tendon. Acta Orthop Belg 1982; 48: 453–4
Rolf CG, Fu BS, Pau A, et al. Increased cell proliferation and associated expression of PDGFRbeta causing hypercellularity in patellar tendinosis. Rheumatology (Oxford) 2001; 40: 256–61
Fu SC, Wang W, Pau HM, et al. Increased expression of transforming growth factor-beta1 in patellar tendinosis. Clin Orthop 2002; 400: 174–83
Fu SC, Chan BP, Wang W, et al. Increased expression of matrix metalloproteinase 1 (MMP1) in 11 patients with patellar tendinosis. Acta Orthop Scand 2002; 73: 658–62
Stone D, Green C, Rao U, et al. Cytokine-induced tendinitis: a preliminary study in rabbits. J Orthop Res 1999; 17: 168–77
Khan KM, Cook JL, Maffulli N, et al. Where is the pain coming from in tendinopathy? It may be biochemical, not only structural, in origin. Br J Sports Med 2000; 34: 81–3
Alfredson H, Forsgren S, Thorsen K, et al. In vivo microdialysis and immunohistochemical analyses of tendon tissue demonstrated high amounts of free glutamate and glutamate NMDAR1 receptors, but no signs of inflammation, in jumper’s knee. J Orthop Res 2001; 19: 881–6
Ackermann PW, Spetea M, Nylander I, et al. An opioid system in connective tissue: a study of achilles tendon in the rat. J Histochem Cytochem 2001; 49: 1387–95
Ackermann PW, Li J, Finn A, et al. Autonomic innervation of tendons, ligaments and joint capsules: a morphologic and quantitative study in the rat. J Orthop Res 2001; 19: 372–8
Khan KM, Cook JL. Overuse tendon injuries: where does the pain come from? Sports Med Arthrosc Rev 2000; 8: 17–31
Johnson DP, Wakeley CJ, Watt I. Magnetic resonance imaging of patellar tendonitis. J Bone Joint Surg Br 1996; 78: 452–7
McLoughlin RF, Raber EL, Vellet AD, et al. Patellar tendinitis: MR imaging features, with suggested pathogenesis and proposed classification. Radiology 1995; 197: 843–8
Allen GM, Tauro PG, Ostlere SJ. Proximal patellar tendinosis and abnormalities of patellar tracking. Skeletal Radiol 1999; 28: 220–3
Tyler TF, Hershman EB, Nicholas SJ, et al. Evidence of abnormal anteroposterior patellar tilt in patients with patellar tendinitis with use of a new radiographic measurement. Am J Sports Med 2002; 30: 396–401
Schmid MR, Hodler J, Cathrein P, et al. Is impingement the cause of jumper’s knee? Dynamic and static magnetic resonance imaging of patellar tendinitis in an open-configuration system. Am J Sports Med 2002; 30: 388–95
Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 1982; 10: 150–4
Noyes FR, McGinniss GH, Grood ES. The variable functional disability of the anterior cruciate ligament-deficient knee. Orthop Clin North Am 1985; 16: 47–67
Nirschl RP. Elbow tendinosis/tennis elbow. Clin Sports Med 1992; 11: 851–70
Visentini PJ, Khan KM, Cook JL, et al. 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 1998; 1: 22–8
Cook JL, Khan KM, Kiss ZS, et al. 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 2001; 35: 65–9
Cook J, Khan KM, Maffulli N, et al. Overuse tendinosis, not tendinitis, part 2: applying the new approach to patellar tendinopathy. Phys Sportsmed 2000; 28: 31–46
Brukner P, Khan K. Clinical sports medicine. 2nd ed. Sydney: McGraw-Hill, 2001
Rasmussen OS. Sonography of tendons. Scand J Med Sci Sports 2000; 10: 360–4
Campbell RS, Grainger AJ. Current concepts in imaging of tendinopathy. Clin Radiol 2001; 56: 253–67
Mahlfeld K, Kayser R, Mahlfeld A, et al. Ultrasound findings of the patellar tendon and its insertion sites [in German]. Ultraschall Med 1997; 18: 249–53
Hartgerink P, Fessell DP, Jacobson JA, et al. Full- versus partial-thickness Achilles tendon tears: sonographic accuracy and characterization in 26 cases with surgical correlation. Radiology 2001; 220: 406–12
Weatherall PT, Crues III JV. Musculotendinous injury. Magn Reson Imaging Clin N Am 1995; 3: 753–72
Karjalainen PT, Soila K, Aronen HJ, et al. MR imaging of overuse injuries of the Achilles tendon. AJR Am J Roentgenol 2000; 175: 251–60
Khan K, Kannus P. Use of imaging data for predicting clinical outcome [letter]. Br J Sports Med 2000; 34: 73
Giles FJ, Cooper MA, Silverman L, et al. Phase II study of SU5416: a small-molecule, vascular endothelial growth factor tyrosine-kinase receptor inhibitor: in patients with refractory myeloproliferative diseases. Cancer 2003; 97: 1920–8
Cook JL, Khan KM, Harcourt PR, et al. Patellar tendon ultrasonography in asymptomatic active athletes reveals hypoechoic regions: a study of 320 tendons. Victorian Institute of Sport Tendon Study Group. Clin J Sport Med 1998; 8: 73–7
Cook JL, Kiss ZS, Khan KM. Patellar tendinitis: the significance of magnetic resonance imaging findings [letter]. Am J Sports Med 1999; 27: 831
Cook JL, Khan KM, Kiss ZS, et al. Patellar tendinopathy in junior basketball players: a controlled clinical and ultrasonographic study of 268 patellar tendons in players aged 14–18 years. Scand J Med Sci Sports 2000; 10: 216–20
Kalebo P, Sward L, Karlsson J, et al. Ultrasonography in the detection of partial patellar ligament ruptures (jumper’s knee). Skeletal Radiol 1991; 20: 285–9
Fredberg U, Bolvig L. Significance of ultrasonographically detected asymptomatic tendinosis in the patellar and achilles tendons of elite soccer players: a longitudinal study. Am J Sports Med 2002; 30: 488–91
Khan KM, Cook JL, Kiss ZS, et al. Patellar tendon ultrasonography and jumper’s knee in female basketball players: a longitudinal study. Clin J Sport Med 1997; 7: 199–206
Khan KM, Visentini PJ, Kiss ZS, et al. Correlation of ultrasound and magnetic resonance imaging with clinical outcome after patellar tenotomy: prospective and retrospective studies. Victorian Institute of Sport Tendon Study Group. Clin J Sport Med 1999; 9: 129–37
Newman JS, Adler RS. Power doppler sonography: applications in musculoskeletal imaging. Semin Musculoskelet Radiol 1998; 2: 331–40
Ohberg L, Lorentzon R, Alfredson H. Neovascularisation in Achilles tendons with painful tendinosis but not in normal tendons: an ultrasonographic investigation. Knee Surg Sports Traumatol Arthrosc 2001; 9: 233–8
Weinberg EP, Adams MJ, Hollenberg GM. Color Doppler sonography of patellar tendinosis. AJR Am J Roentgenol 1998; 171: 743–4
Terslev L, Qvistgaard E, Torp-Pedersen S, et al. Ultrasound and power doppler findings in jumper’s knee: preliminary observations. Eur J Ultrasound 2001; 13: 183–9
Richards PJ, Dheer AK, McCall IM. Achilles tendon (TA) size and power Doppler ultrasound (PD) changes compared to MRI: a preliminary observational study. Clin Radiol 2001; 56: 843–50
Peers KH, Brys PP, Lysens RJ. Correlation between power Doppler ultrasonography and clinical severity in Achilles tendinopathy. Int Orthop 2003; 27: 180–3
Öhberg L, Alfredson H. Ultrasound guided sclerosis of neovessels in painful chronic Achilles tendinosis: pilot study of a new treatment. Br J Sports Med 2002; 36: 173–5
Ferretti A, Puddu G, Mariani PP, et al. The natural history of jumper’s knee: patellar or quadriceps tendonitis. Int Orthop 1985; 8: 239–42
Sandmeier R, Renstrom PA. Diagnosis and treatment of chronic tendon disorders in sports. Scand J Med Sci Sports 1997; 7: 96–106
Kannus P, Jozsa L, Natri A, et al. Effects of training, immobilization and remobilization on tendons. Scand J Med Sci Sports 1997; 7: 67–71
Weiler JM. Medical modifiers of sports injury: the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in sports soft-tissue injury. Clin Sports Med 1992; 11: 625–44
Almekinders LC, Temple JD. Etiology, diagnosis, and treatment of tendonitis: an analysis of the literature. Med Sci Sports Exerc 1998; 30: 1183–90
Astrom M, Westlin N. No effect of piroxicam on achilles tendinopathy: a randomized study of 70 patients. Acta Orthop Scand 1992; 63: 631–4
Lecomte J, Buyse H, Taymans J, et al. Treatment of tendinitis and bursitis: a comparison of nimesulide and naproxen sodium in a double-blind parallel trial. Eur J Rheumatol Inflamm 1994; 14: 29–32
Dreiser RL, Ditisheim A, Charlot J, et al. A double blind, placebo controlled study of niflumic acid gel in the treatment of acute tendinitis. Eur J Rheumatol Inflamm 1991; 11: 38–45
Vogel HG. Mechanical and chemical properties of various connective tissue organs in rats as influenced by non-steroidal antirheumatic drugs. Connect Tissue Res 1977; 5: 91–5
Almekinders LC. The efficacy of nonsteroidal anti-inflammatory drugs in the treatment of ligament injuries. Sports Med 1990; 9: 137–42
Fredberg U. Local corticosteroid injection in sport: review of literature and guidelines for treatment. Scand J Med Sci Sports 1997; 7: 131–9
Shrier I, Matheson GO, Kohl III HW. Achilles tendonitis: are corticosteroid injections useful or harmful? Clin J Sport Med 1996; 6: 245–50
Kennedy JC, Willis RB. The effects of local steroid injections on tendons: a biomechanical and microscopic correlative study. Am J Sports Med 1976; 4: 11–21
Stahl S, Kaufman T. The efficacy of an injection of steroids for medial epicondylitis: a prospective study of sixty elbows. J Bone Joint Surg Am 1997; 79: 1648–52
Klaiman MD, Shrader JA, Danoff JV, et al. Phonophoresis versus ultrasound in the treatment of common musculoskeletal conditions. Med Sci Sports Exerc 1998; 30: 1349–55
Penderghest CE, Kimura IF, Gulick DT. Double-blind clinical efficacy study of pulsed phonophoresis on perceived pain associated with symptomatic tendinitis. J Sport Rehabil 1998; 1: 9–19
Capasso G, Testa V, Maffulli N, et al. Aprotinin, corticosteroids and normosaline in the management of patellar tendinopathy in athletes: a prospective randomized study. Sports Exerc Injury 1997; 3: 111–5
Smidt N, van der Windt DAWM, Devillé WLJM, et al. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled study. Lancet 2002; 359: 657–62
Jarvinen M, Jozsa L, Kannus P, et al. Histopathological findings in chronic tendon disorders. Scand J Med Sci Sports 1997; 7: 86–95
Fredberg U, Bolvig L. Jumper’s knee: review of the literature. Scand J Med Sci Sports 1999; 9: 66–73
Paavola M, Kannus P, Jarvinen TA, et al. Treatment of tendon disorders: is there a role for corticosteroid injection? Foot Ankle Clin 2002; 7: 501–13
Jozsa L, Kannus P. Human tendons: anatomy, physiology and pathology. Champaign (IL): Human Kinetics, 1997
Rivenburgh DW. Physical modalities in the treatment of tendon injuries. Clin Sports Med 1992; 11: 645–59
MacAuley D. Do textbooks agree on their advice on ice? Clin J Sport Med 2001; 11: 67–72
Reddy GK, Gum S, Stehno-Bittel L, et al. Biochemistry and biomechanics of healing tendon, part II: effects of combined laser therapy and electrical stimulation. Med Sci Sports Exerc 1998; 30: 794–800
Gum SL, Reddy GK, Stehno-Bittel L, et al. Combined ultrasound, electrical stimulation, and laser promote collagen synthesis with moderate changes in tendon biomechanics. Am J Phys Med Rehabil 1997; 76: 288–96
Enwemeka CS. The effects of therapeutic ultrasound on tendon healing: a biomechanical study. Am J Phys Med Rehabil 1989; 68: 283–7
Bouter LM. Insufficient scientific evidence for efficacy of widely used electrotherapy, laser therapy, and ultrasound treatment in physiotherapy [in Dutch]. Ned Tijdschr Geneeskd 2000; 144: 502–5
Chung B, Wiley JP. Extracorporeal shockwave therapy: a review. Sports Med 2002; 32: 851–65
Rompe JD, Buch M, Gerdesmeyer L, et al. Musculoskeletal shock wave therapy: current database of clinical research [in German]. Z Orthop Ihre Grenzgeb 2002; 140: 267–74
Rompe JD, Kullmer K, Vogel J, et al. Extracorporeal shock-wave therapy: experimental basis, clinical application [in German]. Orthopade 1997; 26: 215–28
Lohrer H, Scholl J, Arentz S. Achilles tendinopathy and patellar tendinopathy: results of radial shockwave therapy in patients with unsuccessfully treated tendinoses [in German]. Sportverletz Sportschaden 2002; 16: 108–14
Vara FJ, Garzon N, Ortega N. Treatment of the patellar tendinitis with local application of extracorporeal shock wave: selected abstracts from the 4th Congress of the International Society for Musculoskeletal ShockWave Therapy; 2000 Jun 1; Naples
Steinacker T, Steuer M. Use of extracorporeal shockwave therapy (ESWT)in sports orthopedics [in German]. Sportverletz Sportschaden 2001; 15: 45–9
Peers K. Extracorporeal shock wave therapy in chronic Achilles and patellar tendinopathy [dissertation]. Belgium: Leuven Universtity Press, 2003
Alfredson H, Pietila T, Jonsson P, et al. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med 1998; 26: 360–6
Silbernagel KG, Thomee R, Thomee P, et al. Eccentric overload training for patients with chronic Achilles tendon pain: a randomised controlled study with reliability testing of the evaluation methods. Scand J Med Sci Sports 2001; 11: 197–206
Jensen K, Di Fabio RP. Evaluation of eccentric exercise in treatment of patellar tendinitis. Phys Ther 1989; 69: 211–6
Cannell LJ, Taunton JE, Clement DB, et al. 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 2001; 35: 60–4
Kjaer M, Langberg H, Skovgaard D, et al. In vivo studies of peritendinous tissue in exercise. Scand J Med Sci Sports 2000; 10: 326–31
Cook JL. Conservative treatment of patellar tendinopathy. Phys Ther Sport 2001; 2: 54–65
Stanish WD, Rubinovich RM, Curwin S. Eccentric exercise in chronic tendinitis. Clin Orthop 1986; 208: 65–8
Panni AS, Tartarone M, Maffulli N. Patellar tendinopathy in athletes: outcome of nonoperative and operative management. Am J Sports Med 2000; 28: 392–7
Maffulli N, Binfield PM, Leach WJ, et al. Surgical management of tendinopathy of the main body of the patellar tendon in athletes. Clin J Sport Med 1999; 9: 58–62
Griffiths GP, Selesnick FH. Operative treatment and arthroscopic findings in chronic patellar tendinitis. Arthroscopy 1998; 14: 836–9
Popp JE, Yu JS, Kaeding CC. Recalcitrant patellar tendinitis: magnetic resonance imaging, histologic evaluation, and surgical treatment. Am J Sports Med 1997; 25: 218–22
Verheyden F, Geens G, Nelen G. Jumper’s knee: results of surgical treatment. Acta Orthop Belg 1997; 63: 102–5
Pierets K, Verdonk R, De Muynck M, et al. Jumper’s knee: postoperative assessment: a retrospective clinical study. Knee Surg Sports Traumatol Arthrosc 1999; 7: 239–42
Cook JL, Khan KM, Harcourt PR, et al. 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 1997; 31: 332–6
Binfield PM, Maffulli N. Surgical management of common tendinopathies of the lower limb. Sports Exerc Injury 1997; 3: 116–22
Raatikainen T, Karpakka J, Puranen J, et al. Operative treatment of partial rupture of the patellar ligament: a study of 138 cases. Int J Sports Med 1994; 15: 46–9
Orava S, Osterback L, Hurme M. Surgical treatment of patellar tendon pain in athletes. Br J Sports Med 1986; 20: 167–9
Scranton Jr PE, Farrar EL. Mucoid degeneration of the patellar ligament in athletes. J Bone Joint Surg Am 1992; 74: 435–7
Karlsson J, Lundin O, Lossing IW, et al. Partial rupture of the patellar ligament: results after operative treatment. Am J Sports Med 1991; 19: 403–8
Karlsson J, Kalebo P, Goksor LA, et al. Partial rupture of the patellar ligament. Am J Sports Med 1992; 20: 390–5
King JB, Perry DJ, Mourad K, et al. Lesions of the patellar ligament. J Bone Joint Surg Br 1990; 72: 46–8
Zini R, Coari GC. Arthroscopic management of patellar tendinitis. J Sports Traumatol Rel Res 1997; 19: 75–82
Johnson DP. Arthroscopic surgery for patellar tendonitis. Arthroscopy 1998; 14 Suppl. 1: S44
Mariani PP, Puddu G, Ferretti A. Jumper’s knee. Ital J Orthop Traumatol 1978; 4: 85–93
Biedert R, Vogel U, Friederich NF. Chronic patellar tendinitis: a new surgical treatment. Sports Exerc Injury 2003; 3: 150–4
Testa V, Capasso G, Maffulli N, et al. Ultrasound-guided percutaneous longitudinal tenotomy for the management of patellar tendinopathy. Med Sci Sports Exerc 1999; 31: 1509–15
Leadbetter WB, Mooar PA, Lane GJ, et al. The surgical treatment of tendinitis: clinical rationale and biologic basis. Clin Sports Med 1992; 11: 679–712
Williams IF, Nicholls JS, Goodship AE, et al. Experimental treatment of tendon injury with heparin. Br J Plast Surg 1986; 39: 367–72
Tatari H, Kosay C, Baran O, et al. Effect of heparin on tendon degeneration: an experimental study on rats. Knee Surg Sports Traumatol Arthrosc 2001; 9: 247–53
Chan BP, Fu S, Qin L, et al. Effects of basic fibroblast growth factor (bFGF) on early stages of tendon healing: a rat patellar tendon model. Acta Orthop Scand 2000; 71: 513–8
Gerich TG, Kang R, Fu FH, et al. Gene transfer to the rabbit patellar tendon: potential for genetic enhancement of tendon and ligament healing. Gene Ther 1996; 3: 1089–93
Gerich TG, Fu FH, Robbins PD, et al. Prospects for gene therapy in sports medicine. Knee Surg Sports Traumatol Arthrosc 1996; 4: 180–7
Goomer RS, Maris TM, Gelberman R, et al. Nonviral in vivo gene therapy for tissue engineering of articular cartilage and tendon repair. Clin Orthop 2000; 379 Suppl.: S189–200
Hart DA, Evans CH. Orthopaedic gene therapy: ligament and tendon. Clin Orthop 2000; 379 Suppl.: S260–1
Hildebrand KA, Jia F, Woo SL. Response of donor and recipient cells after transplantation of cells to the ligament and tendon. Microsc Res Tech 2002; 58: 34–8
Lou J, Tu Y, Burns M, et al. BMP-12 gene transfer augmentation of lacerated tendon repair. J Orthop Res 2001; 19: 1199–202
Maffulli N, Moller HD, Evans CH. Tendon healing: can it be optimised? Br J Sports Med 2002; 36: 315–6
Acknowledgements
The authors declare that no funding was used to assist in the preparation of the manuscript and that no conflicts of interest exist relevant to the contents of the manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Peers, K.H.E., Lysens, R.J.J. Patellar Tendinopathy in Athletes. Sports Med 35, 71–87 (2005). https://doi.org/10.2165/00007256-200535010-00006
Published:
Issue Date:
DOI: https://doi.org/10.2165/00007256-200535010-00006