Background: Although the surgical treatment of patellar tendinopathy
(jumper's knee) is a common procedure, there have been no randomized,
controlled trials comparing this treatment with forms of nonoperative
treatment. The purpose of the present study was to compare the outcome of open
patellar tenotomy with that of eccentric strength training in patients with
patellar tendinopathy.
Methods: Thirty-five patients (forty knees) who had been referred
for the treatment of grade-IIIB patellar tendinopathy were randomized to
surgical treatment (twenty knees) or eccentric strength training (twenty
knees). The eccentric training group performed squats on a 25° decline
board as a home exercise program (with three sets of fifteen repetitions being
performed twice daily) for a twelve-week intervention period. In the surgical
treatment group, the abnormal tissue was removed by means of a wedge-shaped
full-thickness excision, followed by a structured rehabilitation program with
gradual progression to eccentric training. The primary outcome measure was the
VISA (Victorian Institute of Sport Assessment) score (possible range, 0 to
100), which was calculated on the basis of answers to a symptom-based
questionnaire that was developed specifically for patellar tendinopathy. The
patients were evaluated after three, six, and twelve months of follow-up.
Results: There was no difference between the groups with regard to
the VISA score during the twelve-month follow-up period, but both groups had
improvement (p < 0.001). The mean combined VISA score for the two groups
increased from 30 (95% confidence interval, 25 to 35) before the start of
treatment to 49 (95% confidence interval, 42 to 55) at three months, 58 (95%
confidence interval, 51 to 65) at six months, and 70 (95% confidence interval,
62 to 78) at twelve months. In the surgical treatment group, five knees had no
symptoms, twelve had improvement but were still symptomatic, two were
unchanged, and one was worse after twelve months (p = 0.49 compared with the
eccentric training group). In the eccentric training group, five knees did not
respond to treatment and underwent secondary surgery after three to six
months. Of the remaining fifteen knees in the eccentric training group, seven
had no symptoms and eight had improvement but were still symptomatic after
twelve months.
Conclusions: No advantage was demonstrated for surgical treatment
compared with eccentric strength training. Eccentric training should be tried
for twelve weeks before open tenotomy is considered for the treatment of
patellar tendinopathy.
Level of Evidence: Therapeutic Level I. See Instructions
to Authors for a complete description of levels of evidence.