Physiotherapy management of patellar tendinopathy (jumper's knee).

Patellar tendinopathy (jumper’s knee) is a clinical diagnosis of pain and dysfunction in the patellar tendon. It most commonly affects jumping athletes from adolescence through to the fourth decade of life. This condition affects health and quality of life by limiting sports and activity participation for recreational athletes and can be career-ending for professional athletes. Once symptoms are aggravated, activities of daily living are affected, including stairs, squats, stand to sit, and prolonged sitting. Patellar tendinopathy clinically presents as localised pain at the proximal tendon attachment to bone with high-level tendon loading, such as jumping and changing direction. Tendon pain at the superior patellar attachment (quadriceps tendinopathy) and at the tibial attachment occurs less frequently, but the diagnosis and management are similar to jumper’s knee. It is commonly clinically diagnosed in conjunction with imaging (ultrasound or magnetic resonance, often to exclude differential diagnoses such as patellofemoral pain), where structural disruptions on the scans represent areas of tendon pathology. Importantly, there is a disconnection between pathology on imaging and pain; it is common to have abnormal tendons on imaging in people with pain-free function. The term tendinopathy will be used in this review to mean painful tendons. The term tendon pathology will be used to indicate abnormal imaging or histopathology without reference to pain. Treatment of patellar tendinopathy may involve prolonged rehabilitation and can ultimately be ineffective. Management is limited by a poor understanding of how this condition develops, limited knowledge of risk factors and a paucity of time-efficient, effective treatments. Many treatment protocols are derived from evidence about other tendinopathies in the body and applied to the patellar tendon; however, the differences in tendons at a structural and clinical level may invalidate this transfer between tendons. This review discusses the prevalence of patellar tendinopathy, associated and risk factors, assessment techniques and treatment approaches that are based on evidence where possible, supplemented by expert opinion.