Treatment options for patellar tendinopathy: critical review.

Patellar tendinopathy is a painful knee injury due to overuse common among jumping athletes. Because rest from sport is neither a feasible nor an effective treatment for patellar tendinopathy in elite athletes, active treatment options are needed. Treatment may be conservative, injection-based, or surgical. This review synthesizes findings from 32 studies of varying quality published between 2001 and 2011. Painful eccentric squats using a 25°-decline board is supported as a first-line treatment. Extracorporeal shock wave therapy is no more effective than placebo. Sclerosing injections seem to be effective, but the evidence is not definitive. Shaving of abnormal tissue via arthroscopic surgery with real-time ultrasound guidance is superior to sclerosing injections. Steroid injections are inferior to exercise interventions and are not recommended. Injections of autologous blood, platelet-rich plasma, and hyperosmolar dextrose are unproven and experimental. Clinicians need to have a comprehensive knowledge of the evidence in the literature, as well as training and experience, when treating patellar tendinopathy.