Continuing Education Activity

Patellar tendinopathy, commonly referred to as jumper’s knee, is a frequent cause of anterior knee pain in athletes exposed to repetitive high-load jumping and running activities. The condition is characterized by localized tenderness at the patellar tendon and activity-related pain that worsens with loading of the knee extensors. Patellar tendinopathy develops from cumulative microtrauma and small tendon tears associated with repetitive eccentric quadriceps loading. Patellar tendinopathy is particularly prevalent among athletes who require rapid speed and power generation, including volleyball, basketball, track-and-field jumping events, long-distance running, and skiing. The clinical presentation typically includes focal tenderness at the inferior pole, pain with squatting or jumping, and reduced tolerance for high-load activity. Although imaging may assist in selected cases, diagnosis is primarily clinical, guided by a thorough history and physical examination. Early recognition and appropriate load management are essential to prevent progression and prolonged functional limitation.

This continuing education activity provides clinicians with a practical, evidence-informed framework for evaluating and managing patellar tendinopathy. Participants review key historical features and examination findings that support accurate diagnosis and explore how sport-specific biomechanics contribute to tendon overload. Contemporary conservative management principles are emphasized, including load modification, progressive strengthening, and objective criteria for safe return to sport. The course reinforces patient education strategies that promote realistic expectations and adherence to rehabilitation. Collaboration within an interprofessional team, including primary clinicians, physical therapists, athletic trainers, and other healthcare professionals, enhances communication, coordinates load progression, and supports safe return-to-play decisions. Through structured assessment, standardized management strategies, and coordinated care, clinicians improve diagnostic confidence, functional recovery, and overall patient outcomes. 

Objectives:

• Identify and assess patellar tendinopathy using targeted history and examination, and screen sport-specific loading patterns that predispose to patellar tendon overload.
• Differentiate patellar tendinopathy from other causes of anterior knee pain, determine when imaging is appropriate, and interpret imaging findings in the context of the clinical presentation.
• Apply and develop an evidence-informed rehabilitation pathway centered on education, load modification, and progressive strengthening through return-to-sport conditioning.
• Evaluate progress, select escalation strategies for patellar tendinopathy when indicated, clearly communicate prognosis, and collaborate with the interprofessional healthcare team, including therapists and sports staff, to coordinate a safe return-to-play.

Introduction

Patellar tendinopathy, also called jumper's knee, is a painful condition of the knee, mainly activity-related, caused by small tears in the patellar tendon and most commonly seen in sports requiring strenuous jumping; this results in localized patellar tendon tenderness. The tears are typically caused by accumulated stress on the patellar or quadriceps tendon. As the name implies, the condition is common among athletes in jumping sports, where there is a high demand for the speed and power of the leg extensors.[1] These sports often involve high eccentric quadriceps loading, including volleyball, track and field (long jump and high jump), basketball, long-distance running, and skiing.

The condition is most common in men, with a higher incidence among adolescents and young adults. Contrary to traditional belief, a patellar tendinopathy does not involve inflammation of the knee extensor tendons. Studies dating back 40 years describe patellar tendinopathy as a degenerative condition. Patellar tendinopathy is a clinical diagnosis based on detailed history-taking and physical examination. Ultrasound can facilitate diagnosis because it is readily available and cost-effective. Treatment primarily involves conservative measures, such as reducing activities that load the knee. Once the pain subsides, functional restoration is achieved through physical therapy and exercise. Surgery usually remains the last resort for chronic refractory cases.

Etiology

Patellar tendinopathy is an overuse injury of the knee extensor mechanism caused by repetitive mechanical stress during athletic activities that involve jumping, landing, acceleration, deceleration, and cutting.[2] Micro-tearing of the knee extensor tendons can occur with repeated movements during a single exercise session or with insufficient rest between sessions. The component of the knee extensor mechanism most likely to be affected is the inferior pole of the patella, where the patellar tendon inserts.

Other less frequently involved regions of the knee are at the insertion of the quadriceps tendon to the superior pole of the patella and where the patellar tendon inserts into the tibial tuberosity.[3] For simplicity, and because most cases of patellar tendinopathy are due to a problem with the patellar tendon at its insertion into the inferior patella, the term patellar tendinopathy is used interchangeably. Patellar "tendinitis" is a misnomer, as many clinicians feel it is more tendinosis than tendinitis. In published studies, classic inflammatory cells are typically absent.[4]

There are several intrinsic factors of the knee that predispose to this pathology. These include ligamentous laxity, quadriceps and hamstring tightness, excessive Q-angle of the knee, abnormal patellar height, previous or ongoing knee inflammation, and excessive force on the knee. Other factors can also contribute to the development of patellar tendinopathy, including excessive training volume and frequency, the athlete's performance level, and the hardness of the surface on which the sport is practiced.[5] Study results show that the prevalence of patellar tendinopathy among athletes playing on concrete is 38%, compared with 20% on other surfaces.[6] Additional potential risk factors include body weight, body mass index, waist-to-hip ratio, leg-length discrepancy, foot arch height, quadriceps strength, and vertical jump performance, all of which may increase mechanical strain on the patellar tendon.[7]

Epidemiology

The exact incidence of patellar tendinopathy in the United States and globally is difficult to determine, as sports-related injuries are frequently underreported. Jumping sports such as volleyball, basketball, and long- and high-jumping are associated with a high prevalence of disease.[3] Study results indicate that patellar tendinopathy is substantially more common among elite than recreational athletes.[8][9] 

Patellar tendinopathy can occur in adolescent athletes and in individuals in their third decade and beyond.[10] Patellar tendinopathy occurs more often in men, possibly due to differences in the quadriceps' force-generating capacity between men and women.[1] Approximately 45% of elite jumping athletes and up to 14% of recreational jumping athletes have patellar tendinopathy symptoms at any point during their career.[1] 

Pathophysiology

Multiple theories have been proposed to explain the pathogenesis of patellar tendinopathy, including mechanical, vascular, and impingement-related causes. However, the chronic overload theory is the most commonly reported. Repetitive overload of the knee extensor tendons leads to progressive weakening, eventually resulting in failure. Microscopic failure within the tendon occurs under high loads and ultimately leads to cellular-level alterations that undermine its mechanical properties. Tendon micro-trauma may cause individual fibril degeneration due to stress across the tendon. As the fibril degeneration becomes ongoing, chronic tendinopathy ensues.[11]

Ultrasound evaluation of the patellar tendon typically demonstrates three pathologic stages. In the early stage, edema is present along the injured tendon fibers; the tendon appears swollen and thickened but remains relatively homogeneous. In the second stage, characterized by irreversible structural changes, the tendon exhibits a heterogeneous pattern with mixed hypoechoic and hyperechoic areas; edema is no longer evident, and granuloma formation may occur. In the final stage, the tendinous envelope becomes irregular and thickened, and the tendon fibers remain heterogeneous despite resolution of the initial swelling.[2]

Histopathology

Historically, the condition was considered inflammatory; however, a study from 2 decades ago reported the absence of inflammatory cells.[12] Patellar tendinopathy actually appears to be a degenerative condition. Histologic studies of specimens demonstrate degeneration, fibrinoid necrosis, pseudocyst change, randomized collagen with neovascularization, tenocyte infiltration, micro-tears of the tendinous tissue, focal degeneration near the bone-tendon insertion, hyaline degeneration, and metaplasia.[2] 

Repetitive microtrauma affects tenocytes, altering protein and enzyme production and deforming the nucleus. Loading of the tendon fibroblasts increases prostaglandin E2 and leukotriene B4, both of which contribute to tendinopathy. Results of in vitro studies have shown that vascular endothelial growth factor and matrix metalloproteinase activity are linked to tendon breakdown. In vivo studies suggest thatvascular endothelial growth factor may contribute to neovascularization. Although the results of several studies have shown neovascularization in tendinopathy, others have found no association between neovascularization. Diseased tendons also have a higher percentage of cells undergoing apoptosis, as well as multiple pro-apoptotic proteins and genes present.[11] 

History and Physical

Patellar tendinopathy is primarily a clinical diagnosis established through a detailed history and careful physical examination. Key historical elements include the athlete’s sport, training/competition schedule, playing position, and level of performance. Patients typically report well-localized pain and point tenderness at the inferior pole of the patella.[13] In early or mild cases, pain may occur only during athletic activity, whereas more advanced cases may involve discomfort with daily activities and, less commonly, at rest.[14] 

Patellar tendinopathy presents with signs and symptoms that overlap with other causes of anterior knee pain, including discomfort during prolonged sitting, squatting, and stair climbing. Patients may also report pain with sustained knee flexion, commonly referred to as the “movie theatre sign.”[15] Pain is typically load-related and increases during activities that require energy storage and release through the patellar tendon, particularly with higher demands on the knee extensors. Symptoms usually begin abruptly with loading and resolve shortly after the load is removed, and pain at rest is uncommon.[16]

Knee examination may reveal localized swelling over the patellar tendon with focal tenderness to palpation. Several clinical signs have been described. The Basset sign, also known as the passive extension–flexion sign, is performed by palpating the anterior knee in full extension to identify the point of maximal tenderness, typically at the inferior pole of the patella or proximal patellar tendon. The examination is then repeated at 90° of knee flexion; the sign is considered positive if tenderness is markedly reduced in the flexed position. The standing active quadriceps sign involves palpating the patellar tendon while the patient stands, then repeating the assessment with the patient bearing weight on the affected limb with the knee flexed to approximately 30°, thereby contracting the quadriceps.

A significant reduction in tenderness during quadriceps contraction constitutes a positive test. A cadaveric study supports the rationale for these findings, demonstrating that when the quadriceps is tensioned, such as at 90° of knee flexion, the deep fibers of the patellar tendon resist deformation during anterior palpation.[17] A thorough examination of the entire lower extremity is needed to identify relevant deficits at the hip, knee, and ankle/foot region. Malalignment of the foot, heel, or tibia can place excess stress on the knee extensor tendons, increasing the risk of tendinopathy.[16]

Evaluation

Currently, patellar tendinopathy is primarily a clinical diagnosis, and there is no widely accepted gold standard diagnostic technique.[18] However, imaging modalities such as ultrasound or magnetic resonance imaging (MRI) may be useful for detecting abnormalities in the patellar tendon and potentially indicating the severity of the pathology.[19] Ultrasound offers several advantages: it is time- and cost-saving, noninvasive, repeatable, accurate, and provides dynamic visualization of knee structures.[2] Results of a study found that increased patellar tendon thickness of 8 millimeters on ultrasound in the preseason was highly predictive of symptomatic patellar tendinopathy during the season.[20] Results of another study found that a patellar tendon thickness of at least 7 millimeters was an accurate predictor of patellar tendinopathy with a sensitivity of 81.3% and specificity 95.6% for ultrasound and a sensitivity of 100% and specificity of 89.4% for MRI.[21]

Radiographs, including anteroposterior, lateral, and skyline views, are recommended to exclude any acute bony injuries or pathologies. Radiographic changes in the tendon may be noted, including elongation of the involved patellar pole, calcification, an inferior traction spur (enthesophyte) in chronic cases, and increased density within the patellar tendon matrix. However, these changes are rare within the first 6 months of symptom onset. MRI scans would be indicated in chronic cases and for surgical planning. MRI can show thickening of the patellar tendon, which is more diagnostic than edema alone. Foci of increased signal intensity have been observed on both T1 and T2 images.

In chronic cases, MRI scans may reveal the absence of the posterior border of the fat pad. Often, the proximal part of the tendon is affected and thickened.[22] Although not routinely indicated, a bone scan may be used in the early stages of the disease. This test demonstrates increased blood pooling and localized tracer activity in the affected region.[23] Shear wave elastography is an emerging modality for detecting mechanical changes in the tendon and identifying earlier patellar tendon pathology, although further research is needed.[24]

The Victorian Institute of Sport Assessment score is a reliable tool for evaluating and quantifying the severity of symptoms in patellar tendinopathy.[25] This scale was specifically developed to assess symptom severity and functional limitations associated with the condition. This score demonstrates strong inter- and intra-observer reliability and comprises a questionnaire that assesses pain, performance on simple functional tasks, and sport-specific activity levels.[25]

Treatment / Management

Treatment and management of patellar tendinopathy include both nonoperative and operative options, with conservative measures often preferred as the initial approach.[26] Many individuals with patellar tendinopathy receive early treatment focused on medical and rehabilitative interventions.[27] Early recognition and diagnosis of patellar tendinopathy are vital, as the condition can progress.

The initial treatment for patellar tendinopathy includes pain management, which may include the use of medications such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs). Evidence regarding NSAIDs' effectiveness is unclear, as some studies demonstrate benefits in treating patellar tendinopathy.[28][29] However, NSAIDs may also have detrimental effects on tendon health in the long term due to their potentially harmful effects on the tendon.[30][31][32] Furthermore, the pathogenesis of patellar tendinopathy is not inflammatory; thus, there is controversy about treating a degenerative condition with an anti-inflammatory.[4] Thus, NSAIDs may not provide a significant long-term benefit in the treatment of tendinopathy.[4]

Patellar strapping is often used, although studies on its efficacy are conflicting: some indicate effectiveness, whereas others do not.[26] Strapping has been shown to reduce the strain across the patellar tendon.[33][34] These straps may be particularly useful for patients who must jump or make rapid directional changes, as they help manage symptoms and enable more effective physical therapy.[16] Rest is also essential for preventing tendon damage and allowing the tendon time to heal. Relative rest is preferred over complete immobilization to minimize tendon and muscle atrophy.[14][35] Activity modification may include avoiding excessive jumping or impact loading of the knee, which can aggravate the condition; an adequate warm-up; and physiotherapy focused on increasing quadriceps and hamstring flexibility. As the pain begins to subside, the intensity of rehabilitation therapy and sport-specific training can be slowly increased.[2] 

In training, eccentric training, in particular, has been suggested to play a key role in rehabilitation.[2][36][37] According to Rodriguez-Merchan, eccentric training appears to be the treatment of choice for patellar tendinopathy.[38] A systematic review by Larsson, Käll, and Nilsson-Helander provided strong evidence supporting the use of eccentric training in the management of patellar tendinopathy.[39] Examples of eccentric exercises include drop squats or decline squats. Results from a study found that athletes who followed an eccentric training program showed significant improvements compared with those who trained with a concentric program.[40] Eccentric training has been shown to be noninferior to open patellar tenotomy at 12 months; thus, it is recommended that eccentric training be tried for 12 weeks before offering surgical treatment.[41]

Eccentric training has recognized limitations. In a study, results showed that volleyball players who performed eccentric decline squats during the competitive season experienced a worsening of symptoms.[42] Another investigation reported an increased risk of injury and adverse effects when eccentric exercises were implemented in-season.[43] Moreover, because eccentric loading can be pain-provoking, some evidence suggests it may not confer additional benefit in certain clinical contexts.[44]

Alternative training protocols may include heavy slow resistance (HSR) exercises and progressive tendon-loading exercises. HSR exercises have been shown to be as effective as eccentric exercises in reducing pain and fiber remodeling, with the added benefit of significantly higher patient satisfaction.[45] Progressive tendon-loading exercises have also been shown to reduce symptom severity compared with eccentric exercises at the 24-week mark, although patient satisfaction remained the same.[46] 

Results from a 2024 meta-analysis evaluating eccentric, isometric, and HSR training for patellar tendinopathy found that all approaches were effective. The authors also found that progressive loading regimens that included either isometric exercises or HSR training were more effective than eccentric training alone, although eccentric training was more convenient because it does not require additional equipment and can be performed at various locations.[47] In contrast, another recent study compared strengthening exercises with no treatment, glucocorticoid injections, and surgery, and the results concluded that the exercises did not appear to affect function, pain, or the number of athletes returning to sport.[48]

There have been multiple rehabilitation proposals, with 1 article recommending a combined eccentric and concentric exercise regimen.[49] More recently, an author has proposed a 3-stage protocol with the stages as follows:

1. Modulation of pain and load management
2. Strengthening exercises and load progression
3. Functional strengthening and return to sports [50]

Treatment Options

Given the refractory response to many initial conservative treatments, new treatment options have been explored, including dry needling, corticosteroids, platelet-rich plasma (PRP) therapy, extracorporeal shock wave therapy, and surgical interventions.[49] 

• Dry needling, in conjunction with conventional physical therapy, has resulted in lower pain scores, improved function, and reduced tendon thickness compared with physical therapy alone.[51]
• Corticosteroid injections have also been used to treat patellar tendinopathy and have been shown to help with pain, swelling, and sonographic findings.[11][52] However, there are significant adverse effects with corticosteroid injections, including decreased tendon strength, tendon atrophy, and tendon rupture.[53][54][55] Due to these risks, corticosteroid injections are now being avoided in the treatment of patellar tendinopathy. 
• Cryotherapy may be used for short-term pain relief, although its use just prior to activity should be avoided as it may blunt the pain and increase the risk of re-injury or new injury.[11]
• Extracorporeal shockwave therapy (ESWT) may potentially be an option for treatment as it is fairly safe, simple, and does not cause pain.[56] Currently, there is no consensus on the efficacy of ESWT. Results of some trials have shown it to be superior to conservative or sham procedures, whereas others have found no difference compared with conservative or sham treatments.[57] 
• PRP injections have also gained popularity as a treatment for various musculoskeletal conditions, including patellar tendinopathy. However, the evidence for PRP is conflicting. A systematic review by Jeong et al suggests that PRP is effective for patellar tendinopathy; however, the evidence was weak because most studies were retrospective, case series, or not randomized controlled trials.[57][58] Results of another analysis showed that PRP was no different from other injections in pain improvement, functional outcomes, or quality of life, although PRP appeared superior to ESWT.[59] Because studies on PRP efficacy are limited, it is recommended that other evidence-based options be pursued before considering PRP.[57]
• Surgical treatment is typically recommended only after 6 months of nonsurgical methods have failed, as these methods are up to 90% effective.[60][61] Arthroscopic and open approaches may include removal of pathological tissue, tendon repair, debridement of degenerative tissue, or removal of the inferior pole of the patella.[62] Both arthroscopic and open approaches are feasible, with success rates of 91% and 87%, respectively.[62] However, the arthroscopic approach may be preferred because it is less invasive and allows a faster return to activity.[62] Ultimately, there appears to be no consensus on the optimal treatment for patellar tendinopathy. 

Differential Diagnosis

Patellar tendinopathy can be mistaken for other injuries or pathologies, including Osgood-Schlatter disease, meniscal injuries, patellofemoral syndrome, quadriceps injury, knee bursitis (superficial and deep infrapatellar bursae), osteochondritis dissecans, patellar subluxation, pathologies of the knee fat pad, chondromalacia, or patellar tracking problems.[8]

Staging

Blazina et al first described patellar tendinopathy in 1973 and proposed a staging system based on the timing of pain relative to physical activity.[63] This classification, along with subsequent modifications, remains widely used in clinical practice. The 4 stages are defined as follows:

1. Pain occurring after a sports activity
2. Pain at the beginning of activity; subsides with warm-up but may recur with fatigue
3. Pain present during activity and at rest, accompanied by declining performance
4. Complete tendon rupture

In addition to activity-based staging, symptom duration may also guide clinical categorization.[64] Tendinopathy is considered acute when symptoms persist for 0 to 6 weeks, subacute when symptoms persist for 6 to 12 weeks, and chronic when symptoms persist beyond 3 months.

Prognosis

Most cases of patellar tendinopathy resolve with nonoperative management.[11] Nevertheless, mild-to-moderate pain may persist for 15 years in adult athletes with patellar tendinopathy but does not appear to limit leisure-time physical activity.[65] Rudavsky and Cook say that the process of returning to sports play is slow. This process is often influenced by factors such as pain severity, degree of dysfunction, sport practiced, quality of rehabilitation, athlete's performance level, and intrinsic and extrinsic factors.[8] 

Results from a previous study using imaging to classify lesion severity reported that mild lesions might require 20 days for the patient to return to sport, whereas more severe lesions might require 90 days.[66] Other experts mention that athletes with severe dysfunction might need anywhere from 6 to 12 months to recover. Lang et al published a study analyzing patients who underwent surgical treatment (arthroscopic patellar release). The results showed that the mean time to return to play was 4.03 ± 3.18 months.[67]

Joshua et al conducted a systematic search of prior studies to compare the efficacy of commonly used invasive and noninvasive treatment options. The conclusion was that eccentric squat-based therapy, shockwave, or PRP could be used as monotherapies or adjunct therapies to accelerate recovery. Surgery or shockwave can be considered for patients who fail to improve after 6 months of conservative treatment. Since patellar tendinopathy is not inflammatory, corticosteroid injections should not be used.[61] 

Patellar tendinopathy may cause long-lasting symptoms that can lead to the athlete's early retirement from the sport. In a small prospective case-control study, Kettunen et al found that 53% of symptomatic subjects with patellar tendinopathy had quit their sport, compared with only 7% of asymptomatic subjects.[65] Although a variety of physical examination tests exist—assessing strength, flexibility, jump performance, or pain levels—they are often limited in their ability to serve as reliable prognostic indicators or to monitor treatment response.[68]

Complications

Athletes, clinicians, coaches, and athletic trainers should recognize that treatment for patellar tendinopathy can be a slow and sometimes frustrating process. There are multiple pitfalls to be aware of, including the failure to control pain. The athlete's beliefs about pain and pathology may influence the development and management of unresponsive tendinopathies.

Some athletes, having been informed that their tendons are weakened by tears or degeneration and are at increased risk of rupture, may develop fear-avoidant behaviors, which have been linked to poorer functional outcomes in individuals with lower-limb tendinopathy. Over-reliance on noninvasive therapies like shockwave therapy and injections instead of including rehabilitation exercises as part of the treatment plan can also lead to complications. Additionally, failing to retrain jump-landing mechanics can compromise outcomes; athletes should undergo targeted biomechanical retraining after sufficient rehabilitation to optimize tendon loading and reduce the risk of reinjury.[16]

Postoperative and Rehabilitation Care

For the first 2 weeks after surgery, patients are immobilized in full extension and encouraged to bear weight as tolerated. After this initial phase, the rehabilitation program gradually progresses to permit brace removal and increased range of motion as tolerated. As strength and function improve, activity advances in a stepwise manner toward safe return to sport.[69] 

Deterrence and Patient Education

There is currently insufficient evidence to support preventive interventions specific to patellar tendinopathy.[70] Commonly employed measures include static stretching, core stability training, foot orthotics, shock-absorbent insoles, and hormone replacement therapy for women.[70] Other proposed preventive measures include proprioception training, prophylactic eccentric training, stretching of the patellar tendon and lower-limb muscles, reducing training duration or frequency, and bracing or taping.[43] Results from a study of elite women soccer players showed that sport-specific balance training (protective training) was associated with a lower incidence of patellar tendinopathy, with a dose-response relationship between balance training duration and the reduction in injury incidence.[71]

Pearls and Other Issues

Rehabilitation exercises remain the cornerstone of management for patellar tendinopathy, with structured, progressive loading programs demonstrating the most consistent benefit in reducing pain and restoring function. The use of NSAIDs and corticosteroid injections should be discouraged, as patellar tendinopathy is primarily a degenerative condition, and these interventions provide only short-term relief without addressing underlying tendon pathology. Athletes and all individuals involved in training and medical care should understand that recovery is often prolonged and requires adherence to load modification and progressive rehabilitation. Clear communication among clinicians, therapists, coaches, and the athlete is essential for setting realistic expectations, supporting long-term tendon health, and reducing the risk of recurrence.

Enhancing Healthcare Team Outcomes

Patellar tendinopathy is best managed through coordinated care delivered by clinicians experienced in musculoskeletal and sports-related conditions. Sports medicine clinicians, physiatrists, and rheumatologists typically provide first-line assessment and nonoperative management, while orthopaedic surgeons are involved when symptoms are refractory to structured rehabilitation or when partial or complete extensor tendon tearing is suspected. Because the condition commonly affects athletes and is closely linked to training loads and biomechanics, optimal outcomes often depend on contributions from physical therapists, athletic trainers, sports biomechanists, and, when appropriate, sports psychologists. Orthopaedic specialty nurses frequently facilitate follow-up, continuity, and escalation when concerns arise, supporting safe progression and timely reassessment.

High-quality patient care requires clear role definition and consistent interprofessional communication. Clinicians should confirm the diagnosis, exclude red flags such as tendon rupture, educate patients on prognosis, and align treatment goals with sport demands and functional expectations. Advanced clinicians can support longitudinal monitoring, reinforce adherence, and standardize escalation thresholds. Physical therapists should deliver the core rehabilitation program, typically isometric and progressive eccentric loading, with progression toward plyometrics and sport-specific conditioning for return to performance; evidence indicates that eccentric training provides superior outcomes compared with concentric programs at 12 weeks.

Nurses coordinate appointments, monitor symptom trajectories and functional status, and communicate changes promptly, while pharmacists advise on safe analgesic strategies and medication risks that may affect tendon health. Athletic trainers and biomechanists guide training modifications and technique optimization, and sports psychologists may address fear avoidance and confidence in return to play. Shared documentation, regular updates, and agreed rehabilitation milestones improve patient-centered care, reduce treatment variability, enhance safety, and strengthen team performance.

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References

1.

Lian OB, Engebretsen L, Bahr R. Prevalence of jumper's knee among elite athletes from different sports: a cross-sectional study. Am J Sports Med. 2005 Apr;33(4):561-7. [PubMed: 15722279]

2.

Fredberg U, Bolvig L. Jumper's knee. Review of the literature. Scand J Med Sci Sports. 1999 Apr;9(2):66-73. [PubMed: 10220839]

3.

Ferretti A. Epidemiology of jumper's knee. Sports Med. 1986 Jul-Aug;3(4):289-95. [PubMed: 3738327]

4.

Khan KM, Cook JL, Kannus P, Maffulli N, Bonar SF. Time to abandon the "tendinitis" myth. BMJ. 2002 Mar 16;324(7338):626-7. [PMC free article: PMC1122566] [PubMed: 11895810]

5.

Tibesku CO, Pässler HH. [Jumper's knee--a review]. Sportverletz Sportschaden. 2005 Jun;19(2):63-71. [PubMed: 15918127]

6.

van der Worp H, van Ark M, Zwerver J, van den Akker-Scheek I. Risk factors for patellar tendinopathy in basketball and volleyball players: a cross-sectional study. Scand J Med Sci Sports. 2012 Dec;22(6):783-90. [PubMed: 21496108]

7.

van der Worp H, van Ark M, Roerink S, Pepping GJ, van den Akker-Scheek I, Zwerver J. Risk factors for patellar tendinopathy: a systematic review of the literature. Br J Sports Med. 2011 Apr;45(5):446-52. [PubMed: 21367808]

8.

Rudavsky A, Cook J. Physiotherapy management of patellar tendinopathy (jumper's knee). J Physiother. 2014 Sep;60(3):122-9. [PubMed: 25092419]

9.

Lian O, Engebretsen L, Ovrebø RV, Bahr R. Characteristics of the leg extensors in male volleyball players with jumper's knee. Am J Sports Med. 1996 May-Jun;24(3):380-5. [PubMed: 8734892]

10.

Durcan L, Coole A, McCarthy E, Johnston C, Webb MJ, O'Shea FD, Gissane C, Wilson F. The prevalence of patellar tendinopathy in elite academy rugby: a clinical and imaging study. J Sci Med Sport. 2014 Mar;17(2):173-6. [PubMed: 23838071]

11.

Schwartz A, Watson JN, Hutchinson MR. Patellar Tendinopathy. Sports Health. 2015 Sep-Oct;7(5):415-20. [PMC free article: PMC4547110] [PubMed: 26502416]

12.

Almekinders LC, Temple JD. Etiology, diagnosis, and treatment of tendonitis: an analysis of the literature. Med Sci Sports Exerc. 1998 Aug;30(8):1183-90. [PubMed: 9710855]

13.

Fornaciari P, Kabelitz M, Fucentese SF. [Jumper's Knee]. Praxis (Bern 1994). 2018 Apr;107(9-10):513-519. [PubMed: 29690843]

14.

Peers KH, Lysens RJ. Patellar tendinopathy in athletes: current diagnostic and therapeutic recommendations. Sports Med. 2005;35(1):71-87. [PubMed: 15651914]

15.

Dixit S, DiFiori JP, Burton M, Mines B. Management of patellofemoral pain syndrome. Am Fam Physician. 2007 Jan 15;75(2):194-202. [PubMed: 17263214]

16.

Malliaras P, Cook J, Purdam C, Rio E. Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations. J Orthop Sports Phys Ther. 2015 Nov;45(11):887-98. [PubMed: 26390269]

17.

Rath E, Schwarzkopf R, Richmond JC. Clinical signs and anatomical correlation of patellar tendinitis. Indian J Orthop. 2010 Oct;44(4):435-7. [PMC free article: PMC2947732] [PubMed: 20924486]

18.

Owoeye OBA, Wiley JP, Walker REA, Palacios-Derflingher L, Emery CA. Diagnostic Accuracy of a Self-report Measure of Patellar Tendinopathy in Youth Basketball. J Orthop Sports Phys Ther. 2018 Oct;48(10):758-766. [PubMed: 29703124]

19.

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. Patellar tendinosis (jumper's knee): findings at histopathologic examination, US, and MR imaging. Victorian Institute of Sport Tendon Study Group. Radiology. 1996 Sep;200(3):821-7. [PubMed: 8756939]

20.

Desai SS, Mueller JD, Wong TT, Thomopoulos S, Crockatt WK, Desai NN, Goldwaser EL, Popkin CA. Preseason Patellar Tendon Thickness Predicts Symptomatic Patellar Tendinopathy in Male NCAA Division I Basketball Players. J Bone Joint Surg Am. 2025 May 21;107(10):e51. [PubMed: 40100945]

21.

Nishida Y, Nishino T, Tanaka K, Onishi S, Kanamori A, Yamazaki M. An Objective Measure of Patellar Tendon Thickness Based on Ultrasonography and MRI in University Athletes. J Clin Med. 2021 Sep 10;10(18) [PMC free article: PMC8471213] [PubMed: 34575211]

22.

Johnson DP, Wakeley CJ, Watt I. Magnetic resonance imaging of patellar tendonitis. J Bone Joint Surg Br. 1996 May;78(3):452-7. [PubMed: 8636185]

23.

Kahn D, Wilson MA. Bone scintigraphic findings in patellar tendonitis. J Nucl Med. 1987 Nov;28(11):1768-70. [PubMed: 3668667]

24.

Götschi T, Franchi MV, Schulz N, Fröhlich S, Frey WO, Snedeker JG, Spörri J. Altered regional 3D shear wave velocity patterns in youth competitive alpine skiers suffering from patellar tendon complaints - a prospective case-control study. Eur J Sport Sci. 2023 Jun;23(6):1068-1076. [PubMed: 35699187]

25.

Visentini PJ, Khan KM, Cook JL, Kiss ZS, Harcourt PR, Wark JD. The VISA score: an index of severity of symptoms in patients with jumper's knee (patellar tendinosis). Victorian Institute of Sport Tendon Study Group. J Sci Med Sport. 1998 Jan;1(1):22-8. [PubMed: 9732118]

26.

Theodorou A, Komnos G, Hantes M. Patellar tendinopathy: an overview of prevalence, risk factors, screening, diagnosis, treatment and prevention. Arch Orthop Trauma Surg. 2023 Nov;143(11):6695-6705. [PMC free article: PMC10541843] [PubMed: 37542006]

27.

Martens M, Wouters P, Burssens A, Mulier JC. Patellar tendinitis: pathology and results of treatment. Acta Orthop Scand. 1982 Jun;53(3):445-50. [PubMed: 7090767]

28.

Dreiser RL, Ditisheim A, Charlot J, Lopez A. A double blind, placebo controlled study of niflumic acid gel in the treatment of acute tendinitis. Eur J Rheumatol Inflamm. 1991;11(2):38-45. [PubMed: 1365471]

29.

Andres BM, Murrell GA. Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clin Orthop Relat Res. 2008 Jul;466(7):1539-54. [PMC free article: PMC2505250] [PubMed: 18446422]

30.

Magra M, Maffulli N. Nonsteroidal antiinflammatory drugs in tendinopathy: friend or foe. Clin J Sport Med. 2006 Jan;16(1):1-3. [PubMed: 16377967]

31.

Almekinders LC. Anti-inflammatory treatment of muscular injuries in sport. An update of recent studies. Sports Med. 1999 Dec;28(6):383-8. [PubMed: 10623981]

32.

Vogel HG. Mechanical and chemical properties of various connective tissue organs in rats as influenced by non-steroidal antirheumatic drugs. Connect Tissue Res. 1977;5(2):91-5. [PubMed: 142610]

33.

de Vries AJ, van den Akker-Scheek I, Diercks RL, Zwerver J, van der Worp H. The effect of a patellar strap on knee joint proprioception in healthy participants and athletes with patellar tendinopathy. J Sci Med Sport. 2016 Apr;19(4):278-82. [PubMed: 26021817]

34.

Lavagnino M, Arnoczky SP, Dodds J, Elvin N. Infrapatellar Straps Decrease Patellar Tendon Strain at the Site of the Jumper's Knee Lesion: A Computational Analysis Based on Radiographic Measurements. Sports Health. 2011 May;3(3):296-302. [PMC free article: PMC3445162] [PubMed: 23016021]

35.

Wu F, Nerlich M, Docheva D. Tendon injuries: Basic science and new repair proposals. EFORT Open Rev. 2017 Jul;2(7):332-342. [PMC free article: PMC5549180] [PubMed: 28828182]

36.

Van der Worp H, de Poel HJ, Diercks RL, van den Akker-Scheek I, Zwerver J. Jumper's knee or lander's knee? A systematic review of the relation between jump biomechanics and patellar tendinopathy. Int J Sports Med. 2014 Jul;35(8):714-22. [PubMed: 24577862]

37.

Kountouris A, Cook J. Rehabilitation of Achilles and patellar tendinopathies. Best Pract Res Clin Rheumatol. 2007 Apr;21(2):295-316. [PubMed: 17512484]

38.

Rodriguez-Merchan EC. The treatment of patellar tendinopathy. J Orthop Traumatol. 2013 Jun;14(2):77-81. [PMC free article: PMC3667373] [PubMed: 23271268]

39.

Larsson ME, Käll I, Nilsson-Helander K. Treatment of patellar tendinopathy--a systematic review of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc. 2012 Aug;20(8):1632-46. [PubMed: 22186923]

40.

Jonsson P, Alfredson H. Superior results with eccentric compared to concentric quadriceps training in patients with jumper's knee: a prospective randomised study. Br J Sports Med. 2005 Nov;39(11):847-50. [PMC free article: PMC1725058] [PubMed: 16244196]

41.

Bahr R, Fossan B, Løken S, Engebretsen L. Surgical treatment compared with eccentric training for patellar tendinopathy (Jumper's Knee). A randomized, controlled trial. J Bone Joint Surg Am. 2006 Aug;88(8):1689-98. [PubMed: 16882889]

42.

Visnes H, Bahr R. The evolution of eccentric training as treatment for patellar tendinopathy (jumper's knee): a critical review of exercise programmes. Br J Sports Med. 2007 Apr;41(4):217-23. [PMC free article: PMC2658948] [PubMed: 17261559]

43.

Fredberg U, Bolvig L, Andersen NT. Prophylactic training in asymptomatic soccer players with ultrasonographic abnormalities in Achilles and patellar tendons: the Danish Super League Study. Am J Sports Med. 2008 Mar;36(3):451-60. [PubMed: 18079558]

44.

Visnes H, Hoksrud A, Cook J, Bahr R. No effect of eccentric training on jumper's knee in volleyball players during the competitive season: a randomized clinical trial. Clin J Sport Med. 2005 Jul;15(4):227-34. [PubMed: 16003036]

45.

Kongsgaard M, Kovanen V, Aagaard P, Doessing S, Hansen P, Laursen AH, Kaldau NC, Kjaer M, Magnusson SP. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scand J Med Sci Sports. 2009 Dec;19(6):790-802. [PubMed: 19793213]

46.

Breda SJ, Oei EHG, Zwerver J, Visser E, Waarsing E, Krestin GP, de Vos RJ. Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial. Br J Sports Med. 2021 May;55(9):501-509. [PMC free article: PMC8070614] [PubMed: 33219115]

47.

Li Y, Sun D, Fang Y, Lu Z, Shi F, Liu G, Gu Y. Mixed comparison of intervention with eccentric, isometric, and heavy slow resistance for Victorian Institute of Sport Assessment Patella Questionnaire in adults with patellar tendinopathy: A systematic review and network meta-analysis. Heliyon. 2024 Nov 15;10(21):e39171. [PMC free article: PMC11570476] [PubMed: 39559237]

48.

Lopes AD, Rizzo RR, Hespanhol L, Costa LO, Kamper SJ. Exercise for patellar tendinopathy. Cochrane Database Syst Rev. 2025 May 27;5(5):CD013078. [PMC free article: PMC12107522] [PubMed: 40421598]

49.

Christian RA, Rossy WH, Sherman OH. Patellar tendinopathy - recent developments toward treatment. Bull Hosp Jt Dis (2013). 2014;72(3):217-24. [PubMed: 25429390]

50.

Muaidi QI. Rehabilitation of patellar tendinopathy. J Musculoskelet Neuronal Interact. 2020 Dec 01;20(4):535-540. [PMC free article: PMC7716685] [PubMed: 33265081]

51.

Sharif F, Ahmad A, Gilani SA, Bacha R, Hanif A, Arif MA. Efficacy of ultrasound guided dry needling as an adjunct to conventional physical therapy for patients with jumper's knee: A randomized controlled trial. Front Surg. 2022;9:1023902. [PMC free article: PMC9672502] [PubMed: 36406368]

52.

Aicale R, Bisaccia RD, Oliviero A, Oliva F, Maffulli N. Current pharmacological approaches to the treatment of tendinopathy. Expert Opin Pharmacother. 2020 Aug;21(12):1467-1477. [PubMed: 32511031]

53.

Chen SK, Lu CC, Chou PH, Guo LY, Wu WL. Patellar tendon ruptures in weight lifters after local steroid injections. Arch Orthop Trauma Surg. 2009 Mar;129(3):369-72. [PubMed: 18575877]

54.

Hart L. Corticosteroid and other injections in the management of tendinopathies: a review. Clin J Sport Med. 2011 Nov;21(6):540-1. [PubMed: 22064721]

55.

Haraldsson BT, Langberg H, Aagaard P, Zuurmond AM, van El B, Degroot J, Kjaer M, Magnusson SP. Corticosteroids reduce the tensile strength of isolated collagen fascicles. Am J Sports Med. 2006 Dec;34(12):1992-7. [PubMed: 16902230]

56.

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 Mar;43(3):163-8. [PubMed: 18718975]

57.

Walton J, Kozina E, Woo F, Jadidi S. A Review of Patellar Tendinopathy in Athletes Involved in Jumping Sports. Cureus. 2023 Oct;15(10):e47459. [PMC free article: PMC10661584] [PubMed: 38022235]

58.

Jeong DU, Lee CR, Lee JH, Pak J, Kang LW, Jeong BC, Lee SH. Clinical applications of platelet-rich plasma in patellar tendinopathy. Biomed Res Int. 2014;2014:249498. [PMC free article: PMC4127290] [PubMed: 25136568]

59.

Barman A, Sinha MK, Sahoo J, Jena D, Patel V, Patel S, Bhattacharjee S, Baral D. Platelet-rich plasma injection in the treatment of patellar tendinopathy: a systematic review and meta-analysis. Knee Surg Relat Res. 2022 May 04;34(1):22. [PMC free article: PMC9066802] [PubMed: 35509070]

60.

Pećina M, Bojanić I, Ivković A, Brčić L, Smoljanović T, Seiwerth S. Patellar tendinopathy: histopathological examination and follow-up of surgical treatment. Acta Chir Orthop Traumatol Cech. 2010 Aug;77(4):277-83. [PubMed: 21059324]

61.

Everhart JS, Cole D, Sojka JH, Higgins JD, Magnussen RA, Schmitt LC, Flanigan DC. Treatment Options for Patellar Tendinopathy: A Systematic Review. Arthroscopy. 2017 Apr;33(4):861-872. [PubMed: 28110807]

62.

Brockmeyer M, Diehl N, Schmitt C, Kohn DM, Lorbach O. Results of Surgical Treatment of Chronic Patellar Tendinosis (Jumper's Knee): A Systematic Review of the Literature. Arthroscopy. 2015 Dec;31(12):2424-9.e3. [PubMed: 26248496]

63.

Blazina ME, Kerlan RK, Jobe FW, Carter VS, Carlson GJ. Jumper's knee. Orthop Clin North Am. 1973 Jul;4(3):665-78. [PubMed: 4783891]

64.

Kaux JF, Forthomme B, Goff CL, Crielaard JM, Croisier JL. Current opinions on tendinopathy. J Sports Sci Med. 2011 Jun 01;10(2):238-53. [PMC free article: PMC3761855] [PubMed: 24149868]

65.

Kettunen JA, Kvist M, Alanen E, Kujala UM. Long-term prognosis for jumper's knee in male athletes. A prospective follow-up study. Am J Sports Med. 2002 Sep-Oct;30(5):689-92. [PubMed: 12239003]

66.

Gemignani M, Busoni F, Tonerini M, Scaglione M. The patellar tendinopathy in athletes: a sonographic grading correlated to prognosis and therapy. Emerg Radiol. 2008 Nov;15(6):399-404. [PubMed: 18560913]

67.

Lang G, Pestka JM, Maier D, Izadpanah K, Südkamp N, Ogon P. Arthroscopic patellar release for treatment of chronic symptomatic patellar tendinopathy: long-term outcome and influential factors in an athletic population. BMC Musculoskelet Disord. 2017 Nov 22;18(1):486. [PMC free article: PMC5700547] [PubMed: 29166934]

68.

Deng J, Breda SJ, Eygendaal D, Oei EH, de Vos RJ. Association Between Physical Tests and Patients-Reported Outcomes in Athletes Performing Exercise Therapy for Patellar Tendinopathy: A Secondary Analysis of the JUMPER Study. Am J Sports Med. 2023 Nov;51(13):3523-3532. [PMC free article: PMC10623612] [PubMed: 37815096]

69.

Vitale JA, Banfi G, Belli E, Negrini F, La Torre A. A 9-month multidisciplinary rehabilitation protocol based on early postoperative mobilization following a chronic-degenerative patellar tendon rupture in a professional soccer player. Eur J Phys Rehabil Med. 2019 Oct;55(5):676-681. [PubMed: 30547493]

70.

Peters JA, Zwerver J, Diercks RL, Elferink-Gemser MT, van den Akker-Scheek I. Preventive interventions for tendinopathy: A systematic review. J Sci Med Sport. 2016 Mar;19(3):205-211. [PubMed: 25981200]

71.

Kraemer R, Knobloch K. A soccer-specific balance training program for hamstring muscle and patellar and achilles tendon injuries: an intervention study in premier league female soccer. Am J Sports Med. 2009 Jul;37(7):1384-93. [PubMed: 19567665]

Disclosure: Ahmed Mabrouk declares no relevant financial relationships with ineligible companies.

Disclosure: Chia-Yuan Lee declares no relevant financial relationships with ineligible companies.

Disclosure: Andrew Sherman declares no relevant financial relationships with ineligible companies.