Patellar Tendonitis Treatment Options
Patellar tendonitis—often called jumper’s knee—is a condition involving pain and degeneration of the tendon that connects the kneecap (patella) to the shin bone (tibia). Despite the term “tendonitis,” this condition is typically more of a tendinosis, meaning the tendon has developed microscopic degeneration from repetitive overload rather than acute inflammation.
It is common in athletes who participate in sports involving repetitive jumping, sprinting, or rapid changes in direction, such as basketball, volleyball, and soccer. Treatment is usually stepwise, beginning with load management and rehabilitation before considering procedural or surgical options.
Yes—and this is often the most important first step.
Patellar tendon pain is usually driven by excessive load relative to the tendon’s capacity. Reducing high-impact activities such as jumping, sprinting, or deep squatting allows the tendon to calm down and begin to recover.
Activity modification does not mean complete rest in most cases. Instead, the goal is relative rest—maintaining general conditioning while temporarily reducing movements that provoke symptoms. Many athletes benefit from temporarily decreasing training volume and intensity while beginning a structured rehabilitation program.
Physical therapy is the cornerstone of treatment.
The primary focus is eccentric strengthening, which involves lengthening the tendon under controlled load (for example, slow, controlled decline squats). Eccentric loading has been shown to stimulate tendon remodeling and improve tolerance to stress over time.
In addition to eccentric exercises, therapy often includes:
- Heavy slow resistance training
- Hip and core strengthening
- Flexibility work for quadriceps and hamstrings
- Biomechanical assessment of landing and jumping mechanics
Most patients see meaningful improvement over 8–12 weeks with consistent, progressive strengthening.
A patellar tendon strap (counterforce strap) worn just below the kneecap can reduce strain on the tendon during activity. By altering force distribution across the tendon, these straps may decrease pain during sports or daily activities.
While straps do not directly heal the tendon, they can be helpful during the rehabilitation process, allowing patients to remain active with fewer symptoms.
When symptoms persist despite appropriate therapy and load management, adjunct treatments may be considered.
Shockwave Therapy
Extracorporeal shockwave therapy (ESWT) delivers focused mechanical pulses to the tendon. This treatment may stimulate a healing response in chronically degenerated tendon tissue. Shockwave therapy is typically performed in a series of sessions and may benefit patients who have not responded to structured strengthening alone.
Platelet-Rich Plasma (PRP)
PRP injections involve concentrating a patient’s own platelets and injecting them into the affected tendon. The goal is to promote tissue healing through growth factor release. Unlike cortisone injections—which are generally avoided in patellar tendinopathy due to potential tendon weakening—PRP is intended to support tendon recovery.
PRP is often considered when symptoms have persisted for several months despite appropriate rehabilitation. Improvement is usually gradual over weeks to months.
Surgery is reserved for patients with persistent, function-limiting pain after exhausting conservative treatments—typically after at least 6–12 months of structured rehabilitation and adjunct therapies.
Surgical options may include:
- Debridement of degenerative tendon tissue
- Removal of diseased portions of the tendon
- Addressing associated inferior pole patellar pathology
- Arthroscopic or open approaches depending on the location and extent of disease
The goal of surgery is to remove unhealthy tendon tissue and stimulate a healing response while preserving as much healthy tendon as possible.
Recovery after surgery requires a structured rehabilitation program. Return to sport often occurs gradually over several months, depending on healing and strength progression.
The majority of patients with patellar tendonitis improve without surgery when treatment focuses on load management and progressive strengthening. Adjunct treatments such as shockwave therapy or PRP may help in persistent cases, while surgery is reserved for those who do not respond to comprehensive nonoperative care.
Early evaluation can help tailor treatment to the individual athlete’s biomechanics, sport demands, and timeline for return to play.
Patellar tendonitis is a common but highly manageable condition. With appropriate activity modification and a structured strengthening program emphasizing eccentric loading, most patients can return to sport and activity without surgery. Adjunct treatments and, in rare cases, surgical intervention are available for persistent symptoms.
Patients experiencing persistent pain just below the kneecap—especially athletes involved in jumping sports—are encouraged to contact Dr. José Vega’s office in Cleveland to schedule a consultation. A thorough evaluation can help determine the most appropriate treatment plan and guide a safe return to activity.
References
- Challoumas D, Pedret C, Biddle M, et al. Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies. BMJ Open Sport Exerc Med. 2021;7(4):e001110.
- Cognetti DJ, Sheean AJ, Arner JW, Wilkerson D, Bradley JP. Surgical Management of Patellar Tendinopathy Results in Improved Outcomes and High Rates of Return to Sport: A Systematic Review. J Knee Surg. 2023;36(11):1171-1190.
- Dragoo JL, Wasterlain AS, Braun HJ, Nead KT. Platelet-rich plasma as a treatment for patellar tendinopathy: a double-blind, randomized controlled trial. Am J Sports Med. 2014;42(3):610-618.
- Everhart JS, Cole D, Sojka JH, et al. Treatment Options for Patellar Tendinopathy: A Systematic Review. Arthroscopy. 2017;33(4):861-872.
- de Vries A, Zwerver J, Diercks R, et al. Effect of patellar strap and sports tape on pain in patellar tendinopathy: A randomized controlled trial. Scand J Med Sci Sports. 2016;26(10):1217-1224.
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Dr. Jose Vega
- Board-certified orthopedic surgeon
- Fellowship-trained sports medicine specialist
- Author of industry leading peer reviewed publications
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