The patellar tendon transfers forces from the quadriceps muscle, but repetitive mechanical stress from activities like jumping and landing can cause an overuse injury. This accumulated stress places tensile loads on the collagen fibres within the tendon.^1,4 Over time, this can lead to:

• Microscopic tears and degeneration of tendon fibrils¹
• Collagen disorganisation, with fibres appearing thinner and disorganised^1,4
• Tendon thickening, which is a common characteristic observed on imaging^1,4
• Significant pain and disability, which can limit or force an athlete to stop participating in sports^2-4

Current evidence suggests that patellar tendinopathy may be a degenerative condition.¹ Histopathological studies typically show structural degenerative changes rather than an acute inflammatory response; classic inflammatory cells are often absent.^1,4,5

Patellar tendinopathy is an overuse injury that results from repetitive mechanical stress and overload on the knee extensor mechanism.^1,3 This overload is often defined as activity above what the tendon has adapted to at that point in time.³ Common contributing factors include:

• Repetitive high-load activities, such as jumping, landing, acceleration, and deceleration^1,3,4
• Sudden increases in training volume or frequency^1,3,4
• Muscle tightness or inflexibility, particularly in the quadriceps and hamstrings^1-4
• Extrinsic factors, such as the hardness of a training surface and the shock absorption of surfaces or shoes^1,3
• Insufficient rest and recovery time between sessions^1,4

The condition is common in jumping sports, with a high prevalence reported in both elite and recreational athletes.¹ It is particularly frequent in sports like volleyball and basketball.^1,2,4

• Rest and activity modification: This involves relative rest (rather than complete immobilisation, to avoid muscle atrophy) and optimising training loads to reduce stress on the patellar tendon^1,4
• Physical therapy: This centres on progressive tendon-loading exercises (PTLE). Specific protocols may include eccentric training (such as decline squats), heavy slow resistance training, or isometric exercises^3,4
• Supportive taping or bracing: Using an infrapatellar strap or taping may help reduce patellar tendon strain and may help manage the sensation of discomfort during physical activity by providing external support to the tendon structure^1,4
• Shockwave therapy: Extracorporeal shockwave therapy (ESWT) is an emerging option for chronic cases and is often integrated into long-term management plans for those who have not responded to initial conservative measures^1,2

• Non-steroidal anti-inflammatory drugs (NSAIDs): While these may be used, they may not provide significant long-term benefit, as patellar tendinopathy is widely considered a degenerative condition (tendinosis) rather than an inflammatory one (tendinitis)^1,5
• Platelet-rich plasma (PRP): Injections of PRP have emerged as a targeted biological option for refractory cases where conservative approaches have failed^1,2,4
• Hyaluronic acid: Various injection protocols (such as single high-molecular-weight injections or a series of three) have been studied for their role in supporting the tendon environment, with observations noting their potential to assist in the management of symptoms and support functional activity levels⁶

Surgery is considered a last resort and is typically reserved for chronic, severe cases after conservative treatments (e.g. for 6 months) have failed^1,2,4