Evidence to Practice Review: Best Practices in Patellar Tendinopathy Management

Abstract

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 we have evidence to support the prevalence of this injury, we do not have a clear understanding of the contributing factors and pathophysiology that lead the pain and disability reported in athletes with PT. The purpose of this evidence to review manuscript was to review and 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 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 sclerosing treatments were found to be ineffective treatments, and corticosteroid injections were labeled as contraindicated against in patients with PT. This review has shown 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 treatments and lack of consistency 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.