title: Treatment Options for Patellar Tendinopathy: A Systematic Review.
abstract: OBJECTIVE
  To compare the efficacy of common invasive and noninvasive patellar tendinopathy (PT) treatment strategies.
  
  
  METHODS
  A systematic search was performed in PubMed, Google Scholar, CINAHL, UptoDate, Cochrane Reviews, and SPORTDiscus. Fifteen studies met the following inclusion criteria: (1) therapeutic outcome trial for PT, and (2) Victorian Institute of Sports Assessment was used to assess symptom severity at follow-up. Methodological quality and reporting bias were evaluated with a modified Coleman score and Begg's and Egger's tests of bias, respectively.
  
  
  RESULTS
  A total of 15 studies were included. Reporting quality was high (mean Coleman score 86.0, standard deviation 9.7), and there was no systematic evidence of reporting bias. Increased duration of symptoms resulted in poorer outcomes regardless of treatment (0.9% decrease in improvement per additional month of symptoms; P = .004). Eccentric training with or without core stabilization or stretching improved symptoms (61% improvement in the Victorian Institute of Sports Assessment score, 95% confidence interval [CI] 53% to 69%). Surgery in patients refractory to nonoperative treatment also improved symptoms (57%, 95% CI 52% to 62%) with similar outcomes among arthroscopic and open approaches. Results from shockwave (54%, 95% CI 22% to 87%) and platelet-rich plasma (PRP) studies (55%, 95% CI 5% to 105%) varied widely though PRP may accelerate early recovery. Finally, steroid injection provided no benefit (20%, 95% CI -20% to 60%).
  
  
  CONCLUSIONS
  Initial treatment of PT can consist of eccentric squat-based therapy, shockwave, or PRP as monotherapy or an adjunct to accelerate recovery. Surgery or shockwave can be considered for patients who fail to improve after 6 months of conservative treatment. Corticosteroid therapy should not be used in the treatment of PT.
  
  
  METHODS
  Level IV, systematic review of Level II-IV studies.
authors.affiliation: Department of Orthopaedics, The Ohio State University, Columbus, Ohio, U.S.A.; College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Everhart
authors.affiliation: College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A.
authors.forename: Devon
authors.initials: D
authors.lastname: Cole
authors.affiliation: College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A.
authors.forename: John H
authors.initials: JH
authors.lastname: Sojka
authors.affiliation: College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A.
authors.forename: John D
authors.initials: JD
authors.lastname: Higgins
authors.affiliation: Department of Orthopaedics, The Ohio State University, Columbus, Ohio, U.S.A.; College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Magnussen
authors.affiliation: Department of Orthopaedics, The Ohio State University, Columbus, Ohio, U.S.A.; College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A.; Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, U.S.A.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Schmitt
authors.affiliation: Department of Orthopaedics, The Ohio State University, Columbus, Ohio, U.S.A.; College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A.; Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, U.S.A.; Cartilage Restoration Center, The Ohio State University, Columbus, Ohio, U.S.A.. Electronic address: david.flanigan@osumc.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Flanigan
mesh_terms: D005081:Exercise Therapy / Q000379:methods; D019220:High-Energy Shock Waves / Q000627:therapeutic use; D006801:Humans; D017847:Patellar Ligament; D017713:Platelet Transfusion / Q000379:methods; D053657:Platelet-Rich Plasma; D052256:Tendinopathy / Q000628:therapy*