Abstract
Patellar tendinopathy is an overuse injury characterised by localised pain at the inferior pole of the patella during activities that mechanically load the tendon (Scott et al., Br J Sports Med 54:260–262, [1]). It is most common in young, athletic males participating in sports that place substantial demands on the knee extensors. Activities such as jumping or changing direction are often most provocative, as these tasks require large amounts of energy storage and release in the patellar tendon (Lian et al., Am J Sports Med 33:561–567, [2]).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Scott A, Squier K, Alfredson H, Bahr R, Cook JL, Coombes B, et al. Icon 2019: international scientific tendinopathy symposium consensus: clinical terminology. Br J Sports Med. 2020;54(5):260–2.
Lian ØB, Engebretsen L, Bahr R. Prevalence of jumper’s knee among elite athletes from different sports: a cross-sectional study. Am J Sports Med. 2005;33(4):561–7.
Malliaras P, Cook J, Purdam C, Rio E. Patellar tendinopathy: clinical diagnosis, load management, and advice for challenging case presentations. J Orthopaedic Sports Phys Therapy. 2015;45(11):887–98.
Cook J, Khan K, Harcourt P, Grant M, Young D, Bonar S. 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(4):332–6.
Kettunen JA, Kvist M, Alanen E, Kujala UM. Long-term prognosis for Jumper’s knee in male athletes: prospective follow-up study. Am J Sports Med. 2002;30(5):689–92.
Zwerver J, Bredeweg SW, van den Akker-Scheek I. Prevalence of Jumper’s knee among nonelite athletes from different sports: a cross-sectional survey. Am J Sports Med. 2011;39(9):1984–8.
Drakos MC, Domb B, Starkey C, Callahan L, Allen AA. Injury in the National Basketball Association: a 17-year overview. Sports Health. 2010;2(4):284–90.
Docking SI, Ooi CC, Connell D. Tendinopathy: is imaging telling us the entire story? J Orthopaedic Sports Phys Therapy. 2015;45(11):842–52.
van der Heijden RA, De Kanter JL, Bierma-Zeinstra SM, Verhaar JA, van Veldhoven PL, Krestin GP, et al. Structural abnormalities on magnetic resonance imaging in patients with patellofemoral pain: a cross-sectional case-control study. Am J Sports Med. 2016;44(9):2339–46.
Esculier J-F, Bouyer LJ, Dubois B, Leblond J, Brisson M, Chau L, et al. Predictors of clinical success in runners with patellofemoral pain: secondary analyses of a randomized clinical trial. J Sci Med Sport. 2018;21(8):777–82.
Rio E, Girdwood M, Thomas J, Garofalo C, Fortington LV, Docking S. Pain mapping of the anterior knee: injured athletes know best. Scand J Pain. 2018;18(3):409–16.
Hannington M, Docking S, Cook J, Edwards S, Rio E. Self-reported jumpers’ knee is common in elite basketball athletes–but is it all patellar tendinopathy? Phys Therapy Sport. 2020;43:58–64.
Alexander RM. Energy-saving mechanisms in walking and running. J Exp Biol. 1991;160(1):55–69.
Kujala UM, Sarna S, Kaprio J. Cumulative incidence of achilles tendon rupture and tendinopathy in male former elite athletes. Clin J Sport Med. 2005;15(3):133–5.
Cook J, Rio E, Purdam C, Docking S. Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? Br J Sports Med. 2016;50(19):1187–91.
Cook J, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009;43(6):409–16.
Docking S, Rosengarten S, Daffy J, Cook J. Treat the donut, not the hole: the pathological Achilles and patellar tendon has sufficient amounts normal tendon structure. J Sci Med Sport. 2014;18: e2.
Comin J, Cook JL, Malliaras P, McCormack M, Calleja M, Clarke A, et al. The prevalence and clinical significance of sonographic tendon abnormalities in asymptomatic ballet dancers: a 24-month longitudinal study. Br J Sports Med. 2013;47(2):89–92.
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(4):488–91.
Rudavsky A, Cook J, Docking S. Quantifying proximal patellar tendon changes during adolescence in elite ballet dancers, a 2-year study. Scand J Med Sci Sports. 2018;28(11):2369–74.
Docking SI, Rio E, Cook J, Carey D, Fortington L. Quantification of Achilles and patellar tendon structure on imaging does not enhance ability to predict self-reported symptoms beyond grey-scale ultrasound and previous history. J Sci Med Sport. 2019;22(2):145–50.
Rio E, Moseley L, Purdam C, Samiric T, Kidgell D, Pearce AJ, et al. The pain of tendinopathy: physiological or pathophysiological? Sports Med. 2014;44(1):9–23.
Docking SI, Rio E, Cook J, Orchard J, Fortington LV. The prevalence of Achilles and patellar tendon injuries in Australian football players beyond a time-loss definition. Scand J Med Sci Sports. 2018;28(9):2016–22.
Cook J, Khan K, Kiss Z, Griffiths L. 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(4):216–20.
Gisslén K, Gyulai C, Nordström P, Alfredson H. Normal clinical and ultrasound findings indicate a low risk to sustain jumper’s knee patellar tendinopathy: a longitudinal study on Swedish elite junior volleyball players. Br J Sports Med. 2007;41(4):253–8.
Ducher G, Cook J, Spurrier D, Coombs P, Ptasznik R, Black J, et al. Ultrasound imaging of the patellar tendon attachment to the tibia during puberty: a 12-month follow-up in tennis players. Scand J Med Sci Sports. 2010;20(1):e35–40.
Maffulli N, Longo UG, Spiezia F, Denaro V. Sports injuries in young athletes: long-term outcome and prevention strategies. Phys Sports Med. 2010;38(2):29–34.
Rio E, Kidgell D, Purdam C, Gaida J, Moseley GL, Pearce AJ, et al. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med. 2015;49(19):1277–83.
Malliaras P, Cook JL, Kent P. Reduced ankle dorsiflexion range may increase the risk of patellar tendon injury among volleyball players. J Sci Med Sport. 2006;9(4):304–9.
Kaufman KR, Brodine SK, Shaffer RA, Johnson CW, Cullison TR. The effect of foot structure and range of motion on musculoskeletal overuse injuries. Am J Sports Med. 1999;27(5):585–93.
Hägglund M, Zwerver J, Ekstrand J. Epidemiology of patellar tendinopathy in elite male soccer players. Am J Sports Med. 2011;39(9):1906–11.
Bahr MA, Bahr R. Jump frequency may contribute to risk of jumper’s knee: a study of interindividual and sex differences in a total of 11 943 jumps video recorded during training and matches in young elite volleyball players. Br J Sports Med. 2014;48(17):1322–6.
Janssen I, Brown N, Munro BJ, Steele JR. Variations in jump height explain the between-sex difference in patellar tendon loading during landing. Scand J Med Sci Sports. 2015;25(2):265–72.
Visnes H, Aandahl HÅ, Bahr R. Jumper’s knee paradox—jumping ability is a risk factor for developing jumper’s knee: a 5-year prospective study. Br J Sports Med. 2013;47(8):503–7.
Janssen I, Steele JR, Munro BJ, Brown NAT. Previously identified patellar tendinopathy risk factors differ between elite and sub-elite volleyball players. Scand J Med Sci Sports. 2015;25(3):308–14.
Cook JL, Khan K, Kiss ZS, Purdam CR, Griffiths L. Reproducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players. Br J Sports Med. 2001;35(1):65–9.
Purdam CR, Cook JL, Hopper DM, Khan KM, Group VTS. Discriminative ability of functional loading tests for adolescent jumper’s knee. Phys Therapy Sport. 2003;4(1):3–9.
Zwerver J, Bredeweg SW, Hof AL. Biomechanical analysis of the single-leg decline squat. Br J Sports Med. 2007;41(4):264–8.
Crossley KM, van Middelkoop M, Barton CJ, Culvenor AG. Rethinking patellofemoral pain: prevention, management and long-term consequences. Best Pract Res Clin Rheumatol. 2019;33(1):48–65.
Barton CJ, Levinger P, Menz HB, Webster KE. Kinematic gait characteristics associated with patellofemoral pain syndrome: a systematic review. Gait Posture. 2009;30(4):405–16.
Dragoo JL, Johnson C, McConnell J. Evaluation and treatment of disorders of the infrapatellar fat pad. Sports Med. 2012;42(1):51–67.
Baumbach SF, Lobo CM, Badyine I, Mutschler W, Kanz K-G. Prepatellar and olecranon bursitis: literature review and development of a treatment algorithm. Arch Orthopaedic Trauma Surg. 2014;134(3):359–70.
Schindler OS. ‘The Sneaky Plica’revisited: morphology, pathophysiology and treatment of synovial plicae of the knee. Knee Surg Sports Traumatol Arthrosc. 2014;22(2):247–62.
Sprague A, Epsley S, Silbernagel KG. Distinguishing quadriceps tendinopathy and patellar tendinopathy: Semantics or significant? J Orthopaedic Sports Phys Therapy. 2019;49(9):627–30.
Circi E, Atalay Y, Beyzadeoglu T. Treatment of Osgood-Schlatter disease: review of the literature. Musculoskeletal Surg. 2017;101(3):195–200.
Hernandez-Sanchez S, Hidalgo MD, Gomez A. Responsiveness of the VISA-P scale for patellar tendinopathy in athletes. Br J Sports Med. 2014;48(6):453–7.
Nickel B, Barratt A, Copp T, Moynihan R, McCaffery K. Words do matter: a systematic review on how different terminology for the same condition influences management preferences. BMJ Open. 2017;7(7): e014129.
Breda SJ, Oei EH, Zwerver J, Visser E, Waarsing E, Krestin GP, et al. Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial. Br J Sports Med. 2021;55(9):501–9.
Kubo K, Ishigaki T, Ikebukuro T. Effects of plyometric and isometric training on muscle and tendon stiffness in vivo. Physiol Rep. 2017;5(15): e13374.
Rio E, Purdam C, Girdwood M, Cook J. Isometric exercise to reduce pain in patellar tendinopathy in-season: is it effective “on the Road”? Clin J Sport Med. 2019;29(3):188–92.
Green LA, Gabriel DA. The cross education of strength and skill following unilateral strength training in the upper and lower limbs. J Neurophysiol. 2018;120(2):468–79.
Lee M, Carroll TJ. Cross education. Sports Med. 2007;37(1):1–14.
Rio E, Kidgell D, Moseley GL, Gaida J, Docking S, Purdam C, et al. Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review. Br J Sports Med. 2016;50(4):209–15.
Rosengarten SD, Cook JL, Bryant AL, Cordy JT, Daffy J, Docking SI. Australian football players’ Achilles tendons respond to game loads within 2 days: an ultrasound tissue characterisation (UTC) study. Br J Sports Med. 2015;49(3):183–7.
Zwerver J, Hartgens F, Verhagen E, van der Worp H, van den Akker-Scheek I, Diercks RL. No effect of extracorporeal shockwave therapy on patellar tendinopathy in jumping athletes during the competitive season: a randomized clinical trial. Am J Sports Med. 2011;39(6):1191–9.
van der Worp H, Zwerver J, Hamstra M, van den Akker-Scheek I, Diercks RL. No difference in effectiveness between focused and radial shockwave therapy for treating patellar tendinopathy: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2014;22(9):2026–32.
van Leeuwen MT, Zwerver J, van den Akker-Scheek I. Extracorporeal shockwave therapy for patellar tendinopathy: a review of the literature. Br J Sports Med. 2009;43(3):163–8.
de Vries A, Zwerver J, Diercks R, Tak I, van Berkel S, van Cingel 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):1217–24.
van Ark M, Zwerver J, van den Akker-Scheek I. Injection treatments for patellar tendinopathy. Br J Sports Med. 2011;45(13):1068–76.
Willberg L, Sunding K, Forssblad M, Fahlström M, Alfredson H. Sclerosing polidocanol injections or arthroscopic shaving to treat patellar tendinopathy/jumper’s knee? A randomised controlled study. Br J Sports Med. 2011;45(5):411–5.
Bahr R, Fossan B, Løken S, Engebretsen L. Surgical treatment compared with eccentric training for patellar tendinopathy (jumper’s knee): a randomized, controlled trial. JBJS. 2006;88(8):1689–98.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Kennedy, R., Cook, J. (2023). Patellar Tendinopathy: Risk Factors, Prevention, and Treatment. In: Sanchis-Alfonso, V. (eds) Anterior Knee Pain and Patellar Instability. Springer, Cham. https://doi.org/10.1007/978-3-031-09767-6_14
Download citation
DOI: https://doi.org/10.1007/978-3-031-09767-6_14
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-09766-9
Online ISBN: 978-3-031-09767-6
eBook Packages: MedicineMedicine (R0)