Patellar tendinopathy in athletes - Outcome of nonoperative and operative management

We report the results of nonoperative and operative management of patellar tendinopathy in 42 athletes with Blazina stage 2 (26 patients) or stage 3 ( 16 patients) patellar tendinopathy, All patients were initially managed non operatively with nonsteroidal antiinflammatory drugs, physical therapy, and a progressive rehabilitation program based on isometric exercises, stretch ing, and eccentric exercises. After 6 months, 33 patients showed symptomati c improvement and were able to resume their sports, In nine patients with B lazina stage 3 tendinopathy, nonoperative measures failed, and surgery was performed. Operative treatment consisted of removal of the degenerated area s of the tendon, multiple longitudinal tenotomies, and drilling of the lowe r pole of the patella at the site of tendon attachment. Histologic examinat ion of the excised tendon tissue showed areas of necrosis and mucoid degene ration, and alterations of the bone-tendon junction. After a mean follow-up of 4.8 years, clinical results were excellent or good in all patients. In the group treated nonoperatively, results were better in the patients who h ad stage 2 tendinopathy than in those with stage 3.