Patellar tendinopathy is a common, yet misunderstood pathoetiology afflicting a variety of patient populations. This lack of unified understanding affects the capability of clinicians to provide effective treatment interventions. Patients with tendinopathy often report long-term and low to moderate levels of pain, diminished flexibility, and strength, as well as decreased physical function. Load-management strategies combined with exercise regimens focused on progressive tendon loading are the most effective treatment option for patients with patellar tendinopathy. This review will provide an evidence-based approach to patellar tendinopathy, including its pathoetiology, evaluation, and treatment strategies.

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Patellar tendinopathy (PT) is a degenerative condition that is common in sporting populations due to the loads placed on the tendon during dynamic activity. PT often occurs in overtraining situations; however, it may also occur in conjunction with and/or worsen through poor biomechanics, persistent inflammation, and altered movement patterns. Although sports medicine practitioners have evidence to support the prevalence of this injury, we do not have a strong base of evidence surrounding the contributing factors and pathophysiology that lead the pain and disability reported in patients with PT. The purpose of this evidence to practice review was to summarize a systematic review on interventions to treat PT. The authors aimed to include any randomized controlled trial that treated patients with PT and used the Victorian Institute of Sport Assessment Patellar Tendon Questionnaire (VISA-P) as an outcome measure. Seven different PT interventions were described and summarized by the authors in this review. On the conservative end of the treatment spectrum, eccentric loading programs and extracorporeal shockwave therapy were found to be effective at reducing pain. More invasive approaches often utilized after failed conservative treatment, such as platelet-rich plasma injections and arthroscopic tenotomy, were also deemed effective. Therapeutic ultrasound and sclerotherapy were found to be ineffective treatments, and corticosteroid injections are contraindicated in patients with PT. The review highlights that both conservative and invasive treatment approaches can reduce pain in patients with PT. However, there is still no consensus on the optimal treatment protocols for patients with PT due to the variability in in protocols. Thus, we recommend utilizing an individualized approach and appropriate clinical judgement to guide treatments derived from a thorough patient history and physical/biomechanical examination to identify interventions with the highest likelihood of resolving symptoms.