Patellar Tendinopathy | Jumper’s Knee

Dr. David Woznica ProlotherapistDavid Woznica, MD

In this article we will examine research and clinical observations of various treatments for “Jumper’s Knee,” medically referred to as patellar tendinopathy, a degeneration process of the knee cap tendon. We will also look at the connection between patellar tendinopathy, knee ligament damage, and total knee instability.

Understanding points: People will often come into the office with confusion because they have been diagnosed with patellar tendinosis or with patellar tendinitis. 

Supportive Research

An October 2017 study in the Clinical Journal of Sports Medicine from the Center for Sports Medicine at the University Medical Center Groningen in the Netherlands opens with this statement:

Currently, no treatments exist for patellar tendinopathy that guarantee quick and full recovery.(1)

Then the researchers went on to assess which treatment option provides the best chance of clinical improvement and to assess the influence of patient and injury characteristics on the clinical effect of these treatments.

These were the treatments they tested:

Participants were divided into 5 groups:

The results:

NO CLEAR BENEFIT to any of these treatments. We do find that eccentric exercise training offered some degree of relief, however the more exercise the less benefit (not what an athlete wants to hear), the longer the patient had the symptoms and the patients age also presented problems.

Take away points:

The research above continues the work from researchers at the University of Groningen. Earlier the University medical researchers investigated the impact patellar tendinopathy has on a patient’s sports and work performance. Their findings?

The Dutch researchers concluded that the impact of Patellar Tendinopathy on sports and work performance is substantial and stresses the importance of developing preventive measures.(2) We will discuss our preventative and reparative options below.

If the doctor tells you you have patellar tendinopathy

If the doctor tells you you have patellar tendinopathy, you have a problem of the tendon that passes from the quadriceps muscle (the large muscle at the front of the thigh) over the kneecap (patella) to connect to the shinbone (tibia).

Patellar Tendinopathy

It is common among athletes who play “jumping” sports such as basketball and volleyball, but can also occur in athletes involved in soccer, aerobics, track and field or any sport that involves excessive running and jumping. For this reason your doctor may tell you you have “Jumper’s Knee.”

Researchers in Chile have published recommendations and guidelines for treatment in a paper from December 2016, here is what they say:

As far as the surgical technique goes, doctors from the Department of Orthopedic Surgery and the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Florida State University and the Florida State University College of Medicine, published their findings in the journal Orthopedics. They found open surgery and arthroscopic techniques achieved similar satisfactory results in 81% of patients, respectively. Average time to return to play was 5.6 months and 5 months, respectively.(4)

The unappealing aspects of Patellar Tendinopathy surgery

The problem with surgery for the athlete are three-fold,

This is what a paper from the University of Salerno and the University of London suggested in the journal Sports medicine and arthroscopy review.

  1. Many patients respond well to conservative treatment, but about 10% of them do not.
  2. In these cases, surgery is indicated.
  3. In a small percentage of patients surgery is unsuccessful. This group of patients presents a major challenge, as options are limited.(5)

Non-surgical bio-treatments Prolotherapy and PRP Therapy

However, many doctors are confident suggesting the surgery because they feel the athlete has no other options.

Other doctors do feel there are options Here is what New York University doctors wrote in the Bulletin of the Hospital for Joint Diseases.

“Due to its common refractory response (non-responsive or difficult to treat) to conservative treatment, a variety of new treatments have emerged recently that include dry-needling, sclerosing injections (Prolotherapy), platelet-rich plasma therapy, arthroscopic surgical procedures, surgical resection of the inferior patellar pole (cutting away tendon tissue at the knee cap), extracorporeal shock wave treatment (as discussed in the other studies cited here), and hyperthermia thermotherapy (exposing the knee to high temperature) in addition to physical therapy.”(6)

Obviously, the list includes treatments that we offer at Caring Medical, Prolotherapy and Platelet Rich Plasma.

Non-surgical solutions to the problem of chronic and recurrent Patellar Tendinopathy

In Germany, doctors supported the New York University findings. Writing in the medical journal Der Unfallchirurg (English: The trauma surgeon), the German researchers suggested that treatment with platelet-rich plasma showed a significantly better outcome when used correctly. Additionally, treatments such as Extracorporeal shockwave therapy, operative treatment and sclerotherapy (Prolotherapy) have also shown positive effects. Treatment with corticosteroid injections and with oral non-steroidal anti-inflammatory drugs (NSAID) showed positive short-term effects.(7)

Prolotherapy can treat various knee disorders including problems of the tendons. Prolotherapy Injections of a dextrose solution directed at the weakened tendons and involved ligaments. This causes a mild, localized inflammatory response at the injured area which stimulates a string of healing events, which include an increase of blood supply, an influx of reparative cells, and the deposition of collagen cells. When the collagen matures, it will strengthen and tighten the damaged tendons and ligaments.

The most important finding  is that PRP injections are statistically better than the control group (ESWT and dry needling) at longer term (6 months or more) follow-up suggesting that PRP is an effective and worthwhile treatment for Patellar Tendinopathy.

Doctors at the University of Pittsburgh writing in the Journal of knee surgery say athletes and doctors are turning to biomaterials, that is stem cells and blood platelets (PRP therapy). In fact, “They are becoming the mainstay of nonoperative therapy in the high-demand athletic population. The most well-studied agents include platelet-rich plasma (PRP) and stem cells-both of which have shown promise in the treatment of various conditions. Animal and clinical studies have demonstrated improved outcomes for patients with chronic patellar tendinopathy. “(8)

In a one-year study of patients who decided on non-surgical PRP treatments to get them back to their sport, European doctors found that all 20 patients in their study benefited from one injection of PRP coupled with a standardized eccentric rehabilitation (exercise). They concluded: “This study confirms that a local injection of PRP coupled with a program of eccentric rehabilitation for treating a chronic jumper’s knee, improves pain symptoms and the functionalities of the subjects’ knee up to 1 year after injection.”(9)

The most important finding in our meta-analysis is that PRP injections are statistically better than the control group (ESWT and dry needling) at longer term (6 months or more) follow-up suggesting that PRP is an effective and worthwhile treatment for Patellar Tendinopathy.

Doctors in the United Kingdom writing in the journal Knee surgery and related disease released their study in which they state: “The most important finding in our meta-analysis is that PRP injections are statistically better than the control group (ESWT and dry needling) at longer term (6 months or more) follow-up suggesting that PRP is an effective and worthwhile treatment for Patellar Tendinopathy.”(10)

 

Patellar Tendinopathy and ACL Weakness

Comprehensive Prolotherapy used in some cases with Platelet Rich Plasma Therapy and Stem Cells works at the root of the problem of patella tendinopathy and knee instability.

A series of injections are placed at the tender and weakened areas of the patella tendon and knee ligaments. These injections contain a proliferant to stimulate the body to repair and heal by inducing a mild inflammatory reaction. The body heals by inflammation, and Prolotherapy stimulates this healing. As the ligaments tighten and the patella tendon heals, the knee structures function normally rather than moving out of place. When the knee functions normally, the pain goes away.

If you have a question about Patellar Tendinopathy, you can get help and information from our Caring Medical staff

1 van Rijn D, van den Akker-Scheek I, Steunebrink M, Diercks RL, Zwerver J, van der Worp H. Comparison of the Effect of 5 Different Treatment Options for Managing Patellar Tendinopathy: A Secondary Analysis. Clin J Sport Med. 2017 Oct 10 [Google Scholar]

2 De Vries AJ, Koolhaas W, Zwerver J, Diercks RL, Nieuwenhuis K, Van Der Worp H, Brouwer S, Van Den Akker-Scheek I. The impact of patellar tendinopathy on sports and work performance in active athletes. Research in Sports Medicine. 2017 Apr 9:1-3. [Google Scholar]

3 Figueroa D, Figueroa F, Calvo R. Patellar Tendinopathy: Diagnosis and Treatment. J Am Acad Orthop Surg. 2016 Dec;24(12):e184-e192. [Google Scholar]

4 Stuhlman CR, Stowers K, Stowers L, Smith J. Current Concepts and the Role of Surgery in the Treatment of Jumper’s Knee. Orthopedics. Nov 1 2016;39(6):e1028-e1035. doi: 10.3928/01477447-20160714-06. [Google Scholar]

5 Maffulli N, Giai Via A, Oliva F. Revision Surgery for Failed Patellar Tendinopathy Exploration. Sports Med Arthrosc. 2017 Mar;25(1):36-40. [Google Scholar]

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

7. Horstmann H, Clausen JD, Krettek C, Weber-Spickschen TS. Evidence-based therapy for tendinopathy of the knee joint : Which forms of therapy are scientifically proven? Unfallchirurg. 2017 Mar;120(3):199-204.  [Google Scholar]

8. Kopka M, Bradley JP. The Use of Biologic Agents in Athletes with Knee Injuries. J Knee Surg. 2016 Jul;29(5):379-86. doi: 10.1055/s-0036-1584194. Epub 2016 May 20. [Google Scholar]

9 Kaux JF, Bruyere O, Croisier JL, Forthomme B, Le Goff C, Crielaard JM. One-year follow-up of platelet-rich plasma infiltration to treat chronic proximal patellar tendinopathies. Acta Orthop Belg. 2015 Jun;81(2):251-6. [Google Scholar]

10 Dupley L, Charalambous CP. Platelet-Rich Plasma Injections as a Treatment for Refractory Patellar Tendinosis: A Meta-Analysis of Randomised Trials. Knee surgery & related research. 2017 Sep;29(3):165. [Google Scholar]

 

Our Facebook Reviews
Our Facebook Reviews
Celebrating 25 years of Prolotherapy! Are you a good Prolotherapy candidate?
How Can We Help You?
First Name:
Last Name:
Phone:
Email:
Question:

Enter code:
captcha

SEARCH
for your symptoms

Prolotherapy, an alternative to surgery

Were you recommended SURGERY?
Get a 2nd opinion now!

WHY TO AVOID:
★ ★ ★ ★ ★We pride ourselves on 5-Star Patient Service!Come see why patients travel from all
over the world to visit our clinics.
Current Patients
Become a New Patient

Chicagoland Office
715 Lake St., Suite 600
Oak Park, IL 60301
(708) 393-8266 Phone
(855) 779-1950 Fax
Southwest Florida Office
9738 Commerce Center Ct.
Fort Myers, FL 33908
(239) 303-4069 Phone
(855) 779-1950 Fax Fort Myers, FL Office
We are an out-of-network provider.
© 2017 | All Rights Reserved | Disclaimer
National Prolotherapy Centers specializing in Comprehensive Prolotherapy,
Stem Cell Therapy, and Platelet Rich Plasma.

Meet our Prolotherapy Doctors and check out our Prolotherapy research.