Patellar Tendinopathy
In most cases, patients respond to exercise therapy and progressive return to sport
Patellar Tendinopathy: Diagnosis and Treatment
Patellar tendinopathy, also known as jumper’s knee, is a common injury to the patellar tendon — the band connecting the kneecap to the shin bone. It mostly affects younger athletes in jumping and explosive sports such as volleyball, athletics, rugby, and football, though runners get it too. In most cases, patients respond to exercise therapy and a progressive return to sport.
Dr Masci diagnoses and treats patellar tendinopathy at his London clinics as a tendon specialist, and has co-authored published research on the condition. This guide covers the clinical essentials; for the full symptom and exercise detail, see our companion jumper’s knee guide.
What is patellar tendinopathy?
The patellar tendon transmits the force of the quadriceps to straighten the knee. Repetitive jumping and sprinting overload it, causing the tendon to thicken and its collagen to break down. The pain usually sits at the top of the tendon, where it attaches to the kneecap and bears the highest forces, though some cases occur at the lower end near the shin.
What are the typical features?
Pain appears at the tendon, just below the kneecap. It is classically “warm-up” pain — it eases during activity but worsens and lingers for hours afterwards. The tendon is tender and often swollen, and a single-leg squat or hop reproduces the pain.
Several factors raise the risk, and Dr Masci has co-authored studies on these: low tendon stiffness, thigh-muscle weakness, and ankle stiffness all feature.
How do we diagnose patellar tendinopathy?
Imaging confirms the diagnosis and excludes the mimics — kneecap arthritis, fat-pad impingement, and patellofemoral pain syndrome. Ultrasound and MRI both show the tendon thickening and collagen breakdown, but ultrasound is cheaper and can be done at the first consultation. Our jumper’s knee guide explains how to tell patellar tendinopathy apart from kneecap pain and a patellar stress fracture.
What is the treatment for patellar tendinopathy?
Progressive strengthening is the foundation. Gradually building strength in the quadriceps and surrounding muscles reduces the load on the tendon and drives collagen healing. Supervised programmes work best. Our jumper’s knee guide sets out the full exercise programme and strength goals.
When exercise isn’t enough
For cases that stall, the options are shockwave therapy, GTN patches, and collagen supplements — and the choice often comes down to preference for non-invasive versus faster-acting treatment.
A word on injections: avoid cortisone in the patellar tendon — it worsens outcomes. Dr Masci co-authored the review of injections in patellar tendinopathy and his own research shows PRP has little effect in high-level athletes, so injections are generally unrewarding here. The jumper’s knee guide explains the injection evidence in full.
Procedures for stubborn cases
When everything else fails, tendon scraping — a minimally invasive technique pioneered by Professor Hakan Alfredson that strips the painful nerves and vessels from the tendon surface — offers better results than traditional surgery, with a faster return to sport. The Tenex procedure is another minimally invasive option. Traditional open surgery, which cuts out the diseased tendon, has poor results (only 50% return to sport) and should be avoided.
Frequently asked questions about patellar tendinopathy
How long does patellar tendinopathy take to heal?
Months, not weeks — and recovery is famously slow. Consistent, progressive strengthening over 3–6 months (sometimes longer) is the route back. Most athletes recover without surgery.
Why shouldn’t I have a cortisone injection?
A study comparing cortisone with exercise and shockwave found the cortisone group did worse at 3–6 months. Cortisone also risks weakening the tendon. For the patellar tendon specifically, we advise against it.
Can I keep training with patellar tendinopathy?
Often, yes — at modified loads. Keep pain low (under about 3/10 during and after), avoid deep knee bends and jumping while it settles, and maintain the strengthening programme. Complete rest tends to deconditioning and a slower recovery.
Final word from Sport Doctor London about patellar tendinopathy
Patellar tendinopathy is common in young athletes in jumping and explosive sports, causing warm-up pain just below the kneecap. Exercise-based strengthening is the foundation of treatment, with shockwave, GTN patches, or collagen for stubborn cases. Avoid cortisone, and reserve tendon scraping or Tenex for cases that fail everything else.
To book a one-stop knee assessment with Dr Masci in London, contact his team here or call +44 (0) 203 488 0350.