Surgical Treatment of Patellar Tendinopathy

  • Gian Luigi CanataEmail author
  • Valentina Casale
  • Josè Huylebroek
  • Alberto Vascellari


Patellar tendinopathy is a common musculoskeletal disorder among recreational and professional athletes. It has an important impact on the athletes’ careers, because of its high prevalence, the resulting impairment of knee function, and its chronic clinical course Surgery is recommended in the presence of patellar tendinopathy only when the conservative treatment has failed. Both open and arthroscopic procedures are widely used, even if arthroscopy is preferred due to its shorter recovery times. The surgical rationale consists in the debridement of the damaged tissue, and performing apicectomy could be an option in case of bony protrusion. The mean time to return to sports activities is 3–6 months.The healing process requires time to avoid postoperative complications, thus the rehabilitation program should not be too aggressive.


Arthroscopic Procedure Arthroscopic Technique Patellar Tendinopathy Open Kinetic Chain Autologous Blood Injection 
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  1. Alaseirlis DA, Konstantinidis GA, Malliaropoulos N et al (2012) Arthroscopic treatment of chronic patellar tendinopathy in high-level athletes. Muscles Ligaments Tendons J 2(4):267–272PubMedGoogle Scholar
  2. Bahr R, Fossan B, Løken S et al (2006) Surgical treatment compared with eccentric training for patellar tendinopathy (jumper’s knee): a randomised controlled trial. J Bone Joint Surg Am 88(8):1689–1698PubMedGoogle Scholar
  3. Blazina ME, Kerlan RK, Jobe FW et al (1973) Jumper’s knee. Orthop Clin North Am 4(3):665–678PubMedGoogle Scholar
  4. Brockmeyer M, Diehl N, Schmitt C et al (2015) Results of surgical treatment of chronic patellar tendinosis (Jumper's Knee): a systematic review of the literature. Arthroscopy 31(12):2424–2429CrossRefPubMedGoogle Scholar
  5. Cenni MH, Silva TD, do Nascimento BF et al (2015) Patellar tendinopathy: late-stage results from surgical treatment. Rev Bras Ortop 50(5):550–555CrossRefPubMedPubMedCentralGoogle Scholar
  6. Coleman BD, Khan KM, Maffulli N et al (2000) Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group. Scand J Med Sci Sports 10(1):2–11CrossRefPubMedGoogle Scholar
  7. Cucurulo T, Louis ML, Thaunat M et al (2009) Surgical treatment of patellar tendinopathy in athletes. A retrospective multicentric study. Orthop Traumatol Surg Res 95(8 suppl 1):S78–S84CrossRefPubMedGoogle Scholar
  8. Ferretti A, Conteduca F, Camerucci E et al (2002) Patellar tendinosis: a follow-up study of surgical treatment. J Bone Joint Surg Am 84-A(12):2179–2185CrossRefPubMedGoogle Scholar
  9. Filardo G, Kon E, Della Villa S et al (2010) Use of platelet-rich plasma for the treatment of refractory jumper’s knee. Int Orthop 34:909–915CrossRefPubMedGoogle Scholar
  10. Fritschy D, Wallensten R (1993) Surgical treatment of patellar tendinitis. Knee Surg Sports Traumatol Arthrosc 1(2):131–133CrossRefPubMedGoogle Scholar
  11. Gill TJ 4th, Carroll KM, Hariri S (2013) Open patellar tendon debridement for treatment of recalcitrant patellar tendinopathy: indications, technique, and clinical outcomes after a 2-year minimum follow-up. Sports Health 5(3):276–280CrossRefPubMedPubMedCentralGoogle Scholar
  12. Housner JA, Jacobson JA, Misko R (2009) Sonographically guided percutaneous needle tenotomy for the treatment of chronic tendinosis. J Ultrasound Med 28(9):1187–1192CrossRefPubMedGoogle Scholar
  13. James SL, Ali K, Pocock C et al (2007) Ultrasound guided dry needling and autologous blood injection for patellar tendinosis. Br J Sports Med 41:518–521CrossRefPubMedPubMedCentralGoogle Scholar
  14. Johnson DP (1998) Arthroscopic surgery for patellar tendonitis. Arthroscopy 14(suppl. 1):S44Google Scholar
  15. Kaeding CC, Pedroza AD, Powers BC (2007) Surgical treatment of chronic patellar tendinosis: a systematic review. Clin Orthop Relat Res 455:102–106CrossRefPubMedGoogle Scholar
  16. Karlsson J, Lundin O, Lossing IW et al (1991) Partial rupture of the patellar ligament. Results after operative treatment. Am J Sports Med 19(4):403–408CrossRefPubMedGoogle Scholar
  17. Kelly DW, Carter VS, Jobe FW et al (1984) Patellar and quadriceps tendon ruptures–jumper’s knee. Am J Sports Med 12(5):375–380CrossRefPubMedGoogle Scholar
  18. Khan WS, Smart A (2016) Outcome of surgery for chronic patellar tendinopathy: a systematic review. Acta Orthop Belg 82(3):610–626Google Scholar
  19. Leadbetter WB, Mooar PA, Lane GJ et al (1992) The surgical treatment of tendinitis. Clinical rationale and biological basis. Clin Sports Med 11(4):679–712PubMedGoogle Scholar
  20. Lian OB, 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(4):561–567CrossRefPubMedGoogle Scholar
  21. Lorbach O, Diamantopoulos A, Paessler HH (2008) Arthroscopic resection of the lower patellar pole in patients with chronic patellar tendinosis. Arthroscopy 24(2):167–173CrossRefPubMedGoogle Scholar
  22. Maffulli N, Binfield PM, Leach WJ et al (1999) Surgical management of tendinopathy of the main body of the patellar tendon in athletes. Clin J Sport Med 9(2):58–62CrossRefPubMedGoogle Scholar
  23. Maffulli N, Oliva F, Maffulli G et al (2014) Surgery for unilateral and bilateral patellar tendinopathy: a seven year comparative study. Int Orthop 38:1717–1722CrossRefPubMedPubMedCentralGoogle Scholar
  24. Maier D, Bornebusch L, Salzmann GM et al (2013) Mid- and long-term efficacy of the arthroscopic patellar release for treatment of patellar tendinopathy unresponsive to nonoperative management. Arthroscopy 29(8):1338–1345CrossRefPubMedGoogle Scholar
  25. Marcheggiani Muccioli GM, Zaffagnini S, Tsapralis K et al (2013) Open versus arthroscopic surgical treatment of chronic proximal patellar tendinopathy. A systematic review. Knee Surg Sports Traumatol Arthrosc 21(2):351–357CrossRefPubMedGoogle Scholar
  26. Nichols CE (1992) Patellar tendon injuries. Clin Sports Med 11(4):807–813PubMedGoogle Scholar
  27. Ogon P, Maier D, Jaeger A et al (2006) Arthroscopic patellar release for the treatment of chronic patellar tendinopathy. Arthroscopy 22(4):462.e1–462.e5CrossRefGoogle Scholar
  28. Orava S, Osterback L, Hurme M (1986) Surgical treatment of patellar tendon pain in athletes. Br J Sports Med 20(4):167–169CrossRefPubMedPubMedCentralGoogle Scholar
  29. Pascarella A, Alam M, Pascarella F et al (2011) Arthroscopic management of chronic patellar tendinopathy. Am J Sports Med 39(9):1875–1983CrossRefGoogle Scholar
  30. Peers KH, Lysens RJ, Brys P et al (2003) Cross-sectional outcome analysis of athletes with chronic patellar tendinopathy treated surgically and by extracorporeal shock wave therapy. Clin J Sport Med 13(2):79–83CrossRefPubMedGoogle Scholar
  31. Pierets K, Verdonk R, De Muynck M et al (1999) Jumper’s knee: postoperative assessment. A retrospective clinical study. Knee Surg Sports Traumatol Arthrosc 7(4):239–242CrossRefPubMedGoogle Scholar
  32. Pinsornsak P, Naratrikun K, Chumchuen S (2014) The effect of infrapatellar fat pad excision on complications after minimally invasive TKA: a randomized controlled trial. Clin Orthop Relat Res 472(2):695–701CrossRefPubMedGoogle Scholar
  33. Popp JE, Yu JS, Kaeding CC (1997) Recalcitrant patellar tendinitis. Magnetic resonance imaging, histologic evaluation, and surgical treatment. Am J Sports Med 25(2):218–222CrossRefPubMedGoogle Scholar
  34. Raatikainen T, Karpakka J, Puranen J et al (1994) Operative treatment of partial rupture of the patellar ligament. A study of 138 cases. Int J Sports Med 15(1):46–49CrossRefPubMedGoogle Scholar
  35. Rodriguez-Merchan EC (2013) The treatment of patellar tendinopathy. J Orthopaed Traumatol 14(2):77–81CrossRefGoogle Scholar
  36. Ryan M, Wong A, Rabago D et al (2011) Ultrasound-guided injections of hyperosmolar dextrose for overuse patellar tendinopathy: a pilot study. Br J Sports Med 45(12):972–977CrossRefPubMedGoogle Scholar
  37. Santander J, Zarba E, Iraporda H et al (2012) Can arthroscopically tendinopathy reduce pain and restore function? Clin Orthop Relat Res 470:993–997CrossRefPubMedGoogle Scholar
  38. Sarimo J, Sarin J, Orava S et al (2007) Distal patellar tendinosis: an unusual form of jumper’s knee. Knee Surg Sports Traumatol Arthrosc 15(1):54–57CrossRefPubMedGoogle Scholar
  39. Shelbourne KD, Henne TD, Gray T (2006) Recalcitrant patellar tendinosis in elite athletes: surgical treatment in conjunction with aggressive postoperative rehabilitation. Am J Sports Med 34(7):1141–1146CrossRefPubMedGoogle Scholar
  40. Smillie IS (1946) Injuries of the knee joint, 3rd edn. E. & S, Livingstone, Edinburgh, ScotlandGoogle Scholar
  41. Stuhlman CR, Stowers K, Stowers L et al (2016) Current concepts and the role of surgery in the treatment of Jumper’s knee. Orthopedics 1:1–8Google Scholar
  42. Testa V, Capasso G, Maffulli N et al (1999) Ultrasound-guided percutaneous longitudinal tenotomy for the management of patellar tendinopathy. Med Sci Sports Exerc 31(11):1509–1515CrossRefPubMedGoogle Scholar
  43. Topol GA, Podesta LA, Reeves KD et al (2011) Hyperosmolar dextrose injection for recalcitrant Osgood-Schlatter disease. Pediatrics 128(5):e1121–e1128CrossRefPubMedGoogle Scholar
  44. Verheyden F, Geens G, Nelen G (1997) Jumper’s knee: results of surgical treatment. Acta Orthop Belg 63(2):102–105PubMedGoogle Scholar
  45. Willberg L, Sunding K, Forssblad M et al (2011) Sclerosing polidocanol injections or arthroscopic shaving to treat patellar tendinopathy/jumper's knee? A randomised controlled study. Br J Sports Med 45(5):411–415CrossRefPubMedGoogle Scholar
  46. Willberg L, Sunding K, Ohberg L et al (2007) Treatment of Jumper’s knee: promising short-term results in a pilot study using a new arthroscopic approach based on imaging findings. Knee Surg Sports Traumatol Arthrosc 15(5):676–681CrossRefPubMedGoogle Scholar
  47. Zhang B, Qu TB, Pan J et al (2016) Open patellar tendon tenotomy and debridement combined with suture-bridging double-row technique for severe patellar tendinopathy. Othop Surg 8(1):51–59CrossRefGoogle Scholar
  48. Zwerver J (2008) Patellar tendinopaty (jumper's knee): a common and difficult-to-treat sports inhjury. Ned Tijdschr Geneeskd 152(33):1831–1837PubMedGoogle Scholar
  49. Zwerver J, Hartgens F, Verhagen E et al (2011) No effect of extracorporeal shockwave therapy on patellar tendinopathy in jumping athletes during the competitive season: a randomized clinical trial. Am J Sports Med 39(6):1191–1199CrossRefPubMedGoogle Scholar

Copyright information

© ISAKOS 2017

Authors and Affiliations

  • Gian Luigi Canata
    • 1
    Email author
  • Valentina Casale
    • 1
  • Josè Huylebroek
    • 2
  • Alberto Vascellari
    • 3
  1. 1.Centre of Sports TraumatologyKoelliker HospitalTurinItaly
  2. 2.Sportsmed—Orthopaedic CentreParc Leopold HospitalBrusselsBelgium
  3. 3.Orthopaedic Unit Oderzo HospitalOderzoItaly

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