Testa V, Capasso G, Maffulli N, Bifulco G. (1999) Ultrasound guided percutaneous longitudinal tenotomy for the management of patellar tendinopathy. Med Sci Sports Exerc. 31:1509–1515. Most patients with jumper's knee are managed through medical and rehabilitative treatment in the initial stages of the disease. [22]Early recognition and diagnosis of jumper's knee are vital as they can have a progressive course. Although non-steroidal anti-inflammatory drugs were used traditionally, these have recently become less judicious as more physicians have come to realize that the disease is not inflammatory. Hence, NSAIDs may not provide a significant long-term benefit in tendinopathy. [4]Corticosteroid injections are contraindicated as they bear a risk of patellar tendon rupture.

Martens M, Wouters P, Burssens A, Mulier JC. (1982) Patellar tendonitis: pathology and results of treatment. Acta Orthop Scand 53:445–450.Shrier I, Matheson GO, Kohl HW. (1996) Achilles tendonitis: are corticosteroid injections useful or harmful. Clin J Sport Med. 6:245–250. Levy M, Goldstein J, Rosner M. (1987) A method of repair for quadriceps ten-don or patellar ligament (tendon) ruptures without cast immobilization: preliminary report. Clin Orthop. 218:297–301. Kannus P, Józsa L. (1991) Histopathological changes preceding spontaneous rupture of a tendon: a controlled study of 891 patients. J Bone Joint Surg. (Am) 73:1507–1525. Yu JS, Petersilge C, Sartoris DJ, et al. (1994) MR imaging of injuries of the extensor mechanism of the knee. Radiographics. 14:541–551. Curwin S, Stanish WD. (1984) Tendinitis: Its Etiology and Treatment. Lexington, NY: Collamore Press.

Rees JD, Lichtwark GA, Wolman RL, Wilson AM (2008) The mechanism for efficacy of eccentric loading in Achilles tendon injury; an in vivo study in humans. Rheumatology 47:1493–1497 Khan KM, Bonar F, Desmond PM, Cook JL, Young DA, Visentini PJ, et al. (1996) Patellar tendinosis (jumper’s knee): findings at histopathologic examination, US and MR imaging. Radiology. 200:821–827. Cook JL, Khan KM, Harcourt PR, Kiss ZS, Fehrmann MW, Griffiths L, et al. (1998) Patellar tendon ultrasonography in asymptomatic active athletes reveals hypoechoic regions: a study of 320 tendons. Clin J Sport Med. 8:73–77.

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Schiavone-Panni A, Tartarone M, Maffulli N. (2000) Patellar tendinopathy in athletes. Outcome of nonoperative and operative management. Am J Sports Med. 28:392–397. Multiple theories have been proposed for the pathogenesis of patellar tendinopathy, mechanical, vascular, and impingement related. However, the chronic overload theory is the most commonly reported. Repetitive overload on the knee extensor tendons will cause it to weaken progressively, eventually leading to failure. Microscopic failure occurs within the tendon at high loads and eventually leads to alterations at the cellular level, which 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 will ensue. [10]

Miniaci A, Dowdy PA, Willits KR, Vellet AD. (1995) Magnetic resonance imaging evaluation of the rotator cuff tendons in the asymptomatic shoulder. Am J Sports Med. 23:142–145. Hägglund M, Zwerver J, Ekstrand J (2011) Epidemiology of patellar tendinopathy in elite male soccer players. Am J Sports Med 39(9):1906–1911, Epub 2011 Jun 3 Leadbetter WB. (1993) Tendon overuse injuries: diagnosis and treatment. In: Renstrom PAFH, ed. Sports Injuries: Basic Principles of Prevention and Care. London: Oxford; 449–476. Khan KM, Visentini PJ, Kiss ZS, Desmond PM, Coleman BD, Cook JL, et al. (1999) Correlation of US and MR imaging with clinical outcome after open patellar tenotomy: prospective and retrospective studies. Clin J Sport Med. 9:129–137. Sharma P, Maffulli N (2005) Tendon Injury and tendinopathy: healing and repair. J Bone Joint Surg Am 87:187–202

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Currently, there is no widely accepted gold standard diagnostic technique. [17]Ultrasound offers several advantages; it is time and cost-saving, non-invasive, repeatable, and accurate, and provides a dynamic image of the knee structures. [2]Both ultrasound and magnetic resonance imaging (MRI) can be used to detect abnormalities in the patellar tendon itself. Imaging can also be used to guide clinicians as to the severity of the pathology. [18]

Cook JL, Khan KM, Harcourt PR, Grant M, Young DA, Bonar SF (1997) A cross sectional study of 100 athletes with jumper’s knee managed conservatively and surgically. The Victorian Institute of Sport Tendon Study Group. Br J Sports Med 31(4):332–336 Eccentric training has been suggested to play a key role in rehabilitating a jumper's knee. [25] [26] [2]Eccentric training has been shown to have equally efficacious resultsas surgical treatment. It is recommended that eccentric training should be tried for twelve weeks before offering surgical treatment. [27]According to Rodriguez-Merchan eccentric training appears to be the treatment of choice for patients suffering from patellar tendinopathy. [28] Khan KM, Maffulli N. (1998) Tendinopathy: an Achilles’ heel for athletes and clinicians. Clin J Sport Med. 8:151–154. Magra M, Maffulli N (2005) Matrix metalloproteases: a role in overusetendinopathies. Br J Sports Med 39:789–791 Coleman BD, Khan KM, Kiss ZS, Bartlett J, Young DA, Wark JD. (2000) Outcomes of open and arthroscopic patellar tenotomy for chronic patellar tendinopathy: a retrospective study. Am J Sports Med. 28:183–190.

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Davies SG, Baudouin CJ, King JD, et al. (1991) Ultrasound, computed tomography and magnetic resonance imaging in patellar tendinitis. Clin Radiol. 43:52–56. Fredberg U. (1997) Local corticosteroid injection in sport: a review of literature and guidelines for treatment. Scand J Med Sci Sport. 7:131–139. Patellar tendinopathy is mainly a clinical diagnosis made through a detailed history and meticulous physical examination. Appropriate questions which will cue in the diagnosis: Sport practiced, schedule of practice and competition, which position the athlete plays, and level of performance. The patient will usually complain of well-localized pain and tenderness on the inferior tip of the patella. [12] [2]