Patellar tendinopathy is characterised by pain around the distal pole of the patella and is based on a degenerative lesion (a tendinosis) localised at the posterior proximal aspect of the patellar tendon. Patellar tendinopathy can be a serious problem, as it often become chronic and has a high rate of reoccurrence. Elite tennis players may be forced to retire prematurely. The causes of the problem are frequently repeated jumping actions, as well as deceleration, quick stopping and cutting actions. The symptoms are pain that interferes with activity and a dull ache after strenuous activities. There is a localised tenderness at the inferior pool of the patella when the knee is fully extended and the quadriceps relaxed. The diagnosis is supported and verified by ultrasound or MRI. This tendon lesion is not inflammatory but due to the degenerative changes in the tendon. Exercise is therefore the most important treatment modality. Eccentric exercise is effective, as tendons respond favourably to tension and motion. The highest tension occurs with eccentric actions, compared to isometric and isotonic contractions. Eccentric exercise can be executed as a drop squat, standing with approximately 100 degrees of knee flexion. Jumping activities can be used as rehabilitative exercise. The pain can be used as a guide. Tendons take a long time to heal, as they have a slow metabolic rate and the tenocyte producing collagen has a turnover time of more than 50 to 100 days. If conservative treatment fails, surgery may be effective (with an 80% success rate), usually allowing a return to competitive tennis in four to six months. Tendon ruptures in young players most commonly result from cortico-steroid injections. The management of tendinopathy constitutes one of the most difficult and least studied areas of orthopaedic sports medicine. The treatment varies from country to country, from clinic to clinic and from physician to physician, and always presents a challenge.
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