Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 26, Issue 12, pp 3553–3559 | Cite as

Arthroscopic patellar release allows timely return to performance in professional and amateur athletes with chronic patellar tendinopathy

  • Jan M. PestkaEmail author
  • Gernot Lang
  • Dirk Maier
  • Norbert P. Südkamp
  • Peter Ogon
  • Kaywan Izadpanah



Return to sports rates in amateur and professional athletes with chronic patellar tendinopathy following arthroscopic patellar release are unpredictable. The present study aims to analyse the effectiveness of arthroscopic patellar release in professional compared to amateur athletes.


A total of 34 amateur and 20 professional athletes with chronic patellar tendinopathy, refractory to conservative treatment, were studied prospectively and underwent arthroscopic tendon release at the inferior patellar pole. Impact of grouped sports on clinical and functional outcome, subjective patient satisfaction and return to sports rates were assessed. Additionally, preoperative MRI-scans of the knee were evaluated and correlated with clinical outcome.


In 40 patients (74.1%) arthroscopic patellar release resulted in complete recovery and return to preinjury exercise levels. Full return to sports was achieved after a median of 3.0 (range 0.5–12.0) months. Functional outcome measures VISA-P (Victorian Institute of sport assessment for patella) and modified Blazina scores improved significantly from pre- to postoperatively (VISA-P: 48.8 vs. 94.0 pts., respectively, p < 0.0001; Blazina: 4.47 vs. 0.5, respectively, p < 0.0001).


As rapid recovery and timely return to sports are crucial for professional athletes, arthroscopic patellar release should be considered after failed conservative treatment.

Level of evidence



Anterior knee pain Patellar tendinitis Jumper’s knee Professional/amateur athletes Return to sports 


Author contributions

JMP: research hypothesis, data acquisition, analysis and interpretation of data, draft of manuscript. GL: data acquisition, analysis and interpretation of data, draft of manuscript. KI: study design, analysis and interpretation of data, revision of manuscript. DM: study design, analysis and interpretation of data, revision of manuscript. NPS: study design, analysis and interpretation of data, revision of manuscript. PO: research hypothesis and design of study, data acquisition, analysis and interpretation of data, draft of manuscript. All authors critically reviewed and approved the final manuscript.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

Jan M. Pestka, Gernot Lang, Dirk Maier, Norbert P. Südkamp, Peter Ogon and Kaywan Izadpanah have nothing to disclose and declare no conflicts of interest.

Ethical standards

The study was approved by our local institutional review board and informed consent was obtained from all patients before surgery. All studies have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Consent has been obtained to publish from the participant (or legal parent or guardian for children) to report individual patient data.


  1. 1.
    Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 85-A Suppl 2:58–69CrossRefGoogle Scholar
  2. 2.
    Culvenor AG, Cook JL, Warden SJ, Crossley KM (2011) Infrapatellar fat pad size, but not patellar alignment, is associated with patellar tendinopathy. Scand J Med Sci Sports 21:e405–e411CrossRefGoogle Scholar
  3. 3.
    Everhart JS, Cole D, Sojka JH, Higgins JD, Magnussen RA, Schmitt LC, Flanigan DC (2017) Treatment options for patellar tendinopathy: a systematic review. Arthroscopy 33:861–872CrossRefGoogle Scholar
  4. 4.
    Ferretti A, Conteduca F, Camerucci E, Morelli F (2002) Patellar tendinosis: a follow-up study of surgical treatment. J Bone Joint Surg Am 84-A:2179–2185CrossRefGoogle Scholar
  5. 5.
    Khan KM, Bonar F, Desmond PM, Cook JL, Young DA, Visentini PJ, Fehrmann MW, Kiss ZS, O’Brien PA, Harcourt PR, Dowling RJ, O’Sullivan RM, Crichton KJ, Tress BM, Wark JD (1996) Patellar tendinosis (jumper’s knee): findings at histopathologic examination, US, and MR imaging. Victorian Institute of Sport Tendon Study Group. Radiology 200:821–827CrossRefGoogle Scholar
  6. 6.
    Larsson MEH, Käll I, Nilsson-Helander K (2012) Treatment of patellar tendinopathy—a systematic review of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 20:1632–1646CrossRefGoogle Scholar
  7. 7.
    Lian ØB, Engebretsen L, Bahr R (2005) Prevalence of jumper’s knee among elite athletes from different sports: a cross-sectional study. Am J Sports Med 33:561–567CrossRefGoogle Scholar
  8. 8.
    Lohrer H, Nauck T (2011) Cross-cultural adaptation and validation of the VISA-P questionnaire for German-speaking patients with patellar tendinopathy. J Orthop Sport Phys Ther 41:180–190CrossRefGoogle Scholar
  9. 9.
    Longo UG, Franceschi F, Ruzzini L, Rabitti C, Morini S, Maffulli N, Denaro V (2008) Histopathology of the supraspinatus tendon in rotator cuff tears. Am J Sports Med 36:533–538CrossRefGoogle Scholar
  10. 10.
    Longo UG, Olivia F, Denaro V, Maffulli N, Maffulli N (2008) Oxygen species and overuse tendinopathy in athletes. Disabil Rehabil 30:1563–1571CrossRefGoogle Scholar
  11. 11.
    Longo UG, Rittweger J, Garau G, Radonic B, Gutwasser C, Gilliver SF, Kusy K, Zieliński J, Felsenberg D, Maffulli N (2011) Patellar tendinopathy in master track and field athletes: influence of impact profile, weight, height, age and gender. Knee Surg Sport Traumatol Arthrosc 19:508–512CrossRefGoogle Scholar
  12. 12.
    Maffulli N, Barrass V, Ewen SWB (2000) Light microscopic histology of achilles tendon ruptures. Am J Sports Med 28:857–863CrossRefGoogle Scholar
  13. 13.
    Maffulli N, Oliva F, Maffulli G, King JB, Del Buono A (2014) Surgery for unilateral and bilateral patellar tendinopathy: a seven year comparative study. Int Orthop 38:1717–1722CrossRefGoogle Scholar
  14. 14.
    Maier D, Bornebusch L, Salzmann GM, Südkamp NP, Ogon P (2013) Mid- and long-term efficacy of the arthroscopic patellar release for treatment of patellar tendinopathy unresponsive to nonoperative management. Arthroscopy 29:1338–1345CrossRefGoogle Scholar
  15. 15.
    Mani-Babu S, Morrissey D, Waugh C, Screen H, Barton C (2015) The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy. Am J Sports Med 43:752–761CrossRefGoogle Scholar
  16. 16.
    Mithoefer K, Williams RJ, Warren RF, Wickiewicz TL, Marx RG (2006) High-impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique. Am J Sports Med 34:1413–1418CrossRefGoogle Scholar
  17. 17.
    Ogon P, Izadpanah K, Eberbach H, Lang G, Südkamp NP, Maier D (2017) Prognostic value of MRI in arthroscopic treatment of chronic patellar tendinopathy: a prospective cohort study. BMC Musculoskelet Disord 18:146CrossRefGoogle Scholar
  18. 18.
    Ogon P, Maier D, Jaeger A, Suedkamp NP (2006) Arthroscopic patellar release for the treatment of chronic patellar tendinopathy. Arthroscopy 22:1–5CrossRefGoogle Scholar
  19. 19.
    Pascarella A, Alam M, Pascarella F, Latte C, Di Salvatore MG, Maffulli N (2011) Arthroscopic management of chronic patellar tendinopathy. Am J Sports Med 39:1975–1983CrossRefGoogle Scholar
  20. 20.
    Rodriguez-Merchan EC (2013) The treatment of patellar tendinopathy. J Orthop Traumatol 14:77–81CrossRefGoogle Scholar
  21. 21.
    Tom S, Parkinson J, Ilic MZ, Cook J, Feller JA, Handley CJ (2009) Changes in the composition of the extracellular matrix in patellar tendinopathy. Matrix Biol 28:230–236CrossRefGoogle Scholar
  22. 22.
    Visnes H, Bahr R (2007) The evolution of eccentric training as treatment for patellar tendinopathy (jumper’s knee): a critical review of exercise programmes. Br J Sports Med 41:217–223CrossRefGoogle Scholar
  23. 23.
    Williams GN, Taylor DC, Gangel TJ, Uhorchak JM, Arciero RA (2000) Comparison of the single assessment numeric evaluation method and the Lysholm score. Clin Orthop Relat Res 373:184–192CrossRefGoogle Scholar
  24. 24.
    Zwerver J, Bredeweg SW, van den Akker-Scheek I (2011) Prevalence of jumper’s knee among nonelite athletes from different sports. Am J Sports Med 39:1984–1988CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  • Jan M. Pestka
    • 1
    Email author
  • Gernot Lang
    • 1
  • Dirk Maier
    • 1
  • Norbert P. Südkamp
    • 1
  • Peter Ogon
    • 1
    • 2
  • Kaywan Izadpanah
    • 1
  1. 1.Department of Orthopedics and Trauma SurgeryUniversity Medical Center Freiburg, Faculty of Medicine, Albert-Ludwigs-University of FreiburgFreiburgGermany
  2. 2.Center of Orthopedic Sports Medicine FreiburgFreiburgGermany

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