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Patellar tendinosis or “jumper’s knee” is a
common pathology in athletes with an incidence
of 13 to 20% in this group [1, 2]. This condition
affects athletes in many sports implying
jumping and heavy landing, rapid acceleration
or deceleration and kicking, such as basketball,
volleyball, soccer, tennis, long jump and high
jump [1, 2]. A recent epidemiological study
showed that the average duration of substantial
pain problems and reduced function is nearly
three years [3]. So, it has a tendency to be
chronic and, the incidence of retiring from
sport is as high as 53% for elite athletes [4].
Several studies demonstrate little or no inflam
mation in tendons exposed to overuse [5, 6, 7]
and the patellar tendon is not different [8].
Patellar tendinopathy appears to result from an
imbalance between the protective/regenerative
changes and the pathologic responses elicited
by tendon overuse. The net result is tendon
degeneration, weakness, tearing, and pain.
Many different treatment have been described
for patellar tendinopathy but no consensus exists
regarding the best way to treat this condition:
Eccentric training
Patellar tendinosis is typically managed con
servatively in the early stages. Non-operative
management includes activity restriction or
modification, ice, anti-inflammatory, drugs,
eccentric training, massage or taping. Bahr
et
al.
[9] performed a randomized controlled trial
comparing operative versus conservative
management of patellar tendinosis. They
concluded that although surgical treatment and
eccentric training can produce significant
improvement in terms of pain and function
scores, only about half of all patients will be
able to return to sport within one year after
treatment with each option, and fewer still will
have relief of all symptoms. No advantage was
demonstrated for surgical treatment compared
with eccentric training. Eccentric training
should be tried for twelve weeks before open
tenotomy is considered for treatment of patellar
tendinopathy.
Twelve weeks eccentric course of eccentric
strengthening exercises is more effective than a
traditional concentric strengthening program
for treating patellar tendinopathy in recreational
athletes [10].
Studies demonstrate statistically significant
better results in groups that performed eccentric
training compare to groups experiencing pulsed
ultra-sound and transverse friction [11], or
groups treated by corticosteroid injections
[12].
Patellar tendinosis :
Therapeutics options
R. Bastos-Filho, V.B. Duthon, R. Badet