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Treatments and drugs
By Mayo Clinic staffPatellar tendinitis treatment is a long process, no matter what type of treatment you've chosen. Recovery may take a few weeks or months if the injury isn't too severe, or as long as a year or more for people who undergo surgery.
Most people with patellar tendinitis find pain relief and improvement using conservative treatment — meaning treatments other than surgery. Surgery for chronic patellar tendinitis (often called patellar tendinopathy or patellar tendinosis) is rarely performed. However, if you have persistent signs and symptoms for over a year, you may want to discuss the potential benefits and risks of patellar tendon surgery with your doctor.
Conservative treatment
The conservative approach to treating patellar tendinitis aims to reduce the strain on your tendon and then gradually build up the tendon's strength. Your doctor may suggest several techniques to accomplish this, including:
- Rest. Rest doesn't mean giving up all physical activity, but avoid running and jumping. Your doctor can suggest other ways of staying active without stressing your damaged patellar tendon. It's especially important to avoid any activity that gives you pain.
- Adjusting your body mechanics. A physical therapist can help you learn to better distribute the force you exert during physical activity. For instance, an athlete who jumps frequently might learn proper takeoff and landing techniques.
- Stretching your muscles. Inflexible muscles, especially inflexible thigh muscles (quadriceps), contribute to the strain on your patellar tendon.
- Strengthening your tendon. A physical therapist may recommend specific exercises to strengthen your patellar tendon and the muscles around it. Exercises can also help strengthen your quadriceps. A specific type of exercise for strengthening the quadriceps called eccentric strengthening has been shown in some studies to help treat and prevent patellar tendinitis. This strengthening exercise involves lowering weight slowly after raising it, such as a seated knee extension exercise.
- Patellar tendon strap. A strap that applies pressure to your patellar tendon can help to distribute force away from the tendon itself and direct it through the strap instead. This may help relieve pain.
- Iontophoresis. This technique involves applying a topical corticosteroid medication to the area affected by tendinitis. A small device then uses an electrical charge to deliver the medication through your skin. Your physical therapist can assist you in the application of iontophoresis.
- Corticosteroid injection. An ultrasound-guided corticosteroid injection into the sheath around the patellar tendon can help relieve pain and make it possible to perform strength exercises that otherwise may be too painful. You'll need to follow activity restrictions for at least three weeks after the injection, including avoiding jumping or running activities.
- Massage. Massaging the patellar tendon may help encourage tendon healing.
If you've recently developed patellar tendinitis, you can expect at least several weeks or months of conservative therapy before you'll be able to fully resume physical activity, including jumping. If you've re-injured your patellar tendon, the time for healing may be even longer.
Surgery
You and your doctor may consider surgery for your patellar tendinopathy in select cases if more conservative approaches aren't helping after 12 months of treatment. There is little research into the best surgical techniques for patellar tendinitis, so the procedure you undergo often depends largely on your injury, as well as your surgeon's preferred method. Surgery may include repairing any tears in your tendon or removing any badly damaged parts of your tendon.
Most people who have had patellar tendinitis surgery are able to resume athletic training within about six months. In some cases, however, recovery may take up to 18 months.
Other approaches
Other types of therapy may provide relief from pain associated with patellar tendinitis. Though these methods haven't been thoroughly researched, your doctor might consider trying:
- Pain medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids may provide short-term relief from pain associated with patellar tendinitis. However, because the benefit of these drugs for patellar tendinitis don't outweigh the risks of associated side effects, they're not generally recommended for long-term pain management.
- Platelet-rich plasma (PRP). In this experimental approach, your own blood plasma is injected into the affected area. Although small studies have found this technique helpful in reducing the pain of patellar tendinitis, large, controlled studies are needed.
- Extracorporeal shock wave therapy. This form of therapy uses sound waves to promote healing of the tendon. Some research suggests this type of therapy may be effective in relieving the symptoms of patellar tendinitis.
- Other physical therapy treatments. This category includes treatments using ultrasound and laser stimulation. These can help to provide pain relief, though it's not known if these treatments can help heal the tendon.
- Hudgins TH. Jumper's knee. In: Frontera WR, et al. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.mdconsult.com/das/book/body/171922449-6/918424682/1678/67.html#4-u1.0-B978-1-4160-4007-1..50066-3--cesec4_1064. Accessed Nov. 18, 2009.
- Choi L. Overuse injuries. In. DeLee JC, et al. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa.: Saunders Elsevier; 2009. http://www.mdconsult.com/das/book/body/171922449-6/918424682/2079/17.html#4-u1.0-B978-1-4160-3143-7..10014-4--s0125_1247. Accessed Nov. 18, 2009.
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- Khan K, et al. Overview of the management of overuse (chronic) tendinopathy. http://www.uptodate.com/home/index.html. Accessed Nov. 18, 2009.
- Cucurulo T, et al. Surgical treatment of patellar tendinopathy in athletes. A retrospective multicentric study. Orthopaedics & Traumatology: Surgery & Research.2009;95:78.
- Rees JD. Management of tendinopathy. The American Journal of Sports Medicine. 2009;37:1855.
- James SLJ, et al. Ultrasound guided dry needling and autologous blood injection for patellar tendinosis. British Journal of Sports Medicine. 2007;41:518.
- Laskowski ER (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 23, 2009.
