One of the central pillars in the treatment of patellar tendinopathy is targeted physiotherapy. Eccentric training in particular is used to strengthen and stabilize the tendon.
Stretching the quadriceps and ischiocrural muscles also plays an important role. Special supports that center the kneecap and can thus reduce the pressure in the area of the patella tip can also support the treatment very well.
This can improve the healing of the inflamed tendon and the tendon insertion. This also leads to a reduction in pain and an improvement in mobility. We usually recommend 3-5 ACP treatments.
This is how ACP supports healing processes in the area of the patellar tendon:
Many injuries in the human body heal themselves. Behind these complex healing processes are growth factors from the blood.
During treatment with ACP, blood is taken from the patient with a small special syringe, similar to the way you would have a blood test at your GP.
This blood is then specially processed so that only the growth factors responsible for healing remain in a highly concentrated form.
The body's own active ingredient obtained in this way is then injected into the affected tendon. The body's healing mechanisms begin at the site of the injection. The inflammation and the associated swelling subside and the healing of the tendon is supported.
Cortisone is rarely used to treat patellar tendinopathy. However, 1-2 cortisone infiltrations can be useful in highly acute stages. The symptoms can usually be completely reduced in this way.
However, it is essential to rest after the injection to avoid damaging the patellar tendon.
In principle, only a very experienced doctor should administer cortisone infiltration in the area of patellar tendinopathy, as the injection into the tendon can cause extreme damage to the tissue.
Hyalate is often used to support cartilage damage. Hyaluronic acid is occasionally used directly in the area of the patellar tip to keep the tendon and surrounding tissue soft and supple.
Acupuncture is very successful for all chronic pain and of course also for patellar tendinopathy. Acupuncture can reduce pain and special trigger points can reduce the tension in the muscles and thus the tension on the patellar tendon.
Shockwave therapy can be used to improve blood circulation, reduce pain and improve mobility. Most patients notice a significant reduction in pain after just the 1st or 2nd shock wave therapy treatment. Mobility also improves noticeably after just 1-2 applications.
The symptoms of patellar tendinopathy can often be significantly reduced and improved after 5-6 applications. This naturally also leads to a reduction in swelling in the area of the tendon and therefore also to a reduction in symptoms in the area of the patellar tendon and the attachment to the bone.
Surgery can then still be performed if symptoms persist. The chances of success after prior shock wave therapy are not affected by this.
It is advisable to clarify the cost coverage by the health insurance company beforehand, as the coverage of shock wave therapy for patellar tendinopathy is an individual decision by the health insurance company. Most private health insurance companies cover the costs.
Our own surgical technique according to Ogon - special successes in competitive sport
Ogon's patellar tendon release procedure is an extremely gentle, arthroscopic procedure that is now used worldwide, especially in the field of competitive sport.
The surgical technique avoids large incisions and thus major tissue injuries. Tissue is also not removed from the bone or tendon, meaning that the patient can return to full weight-bearing very quickly.
Normal walking is possible on the first day after the operation without crutches. In most cases, the professional athletes we have treated have even been able to return to their highest level of performance before the injury.
The surgical procedure always begins with a diagnostic arthroscopy via the standardized anterolateral portal. Two cannulas are then inserted in the symptomatic region for precise intra-articular localization of the leading symptoms.
Using a second medial working portal, the synovitis that is always present in this area is first removed using state-of-the-art electrothermal instruments, the paratenon is relieved and then the lower bony patellar pole is denervated.
Neitherbone nor tendon material is removed during the entire procedure.
In most cases, all competitive athletes who have undergone surgery using this technique have been able to return to their original high level of performance postoperatively, even without the removal of bone and tendon components.
The postoperative treatment regimen allows immediate full weight-bearing and free movement of the operated knee joint, depending on pain and swelling. This means that the frequently affected athlete is able to return to their initial performance level at a very early stage.
In a separate study, a total of 15 patients suffering from grade 3 and 4 chronic patellar tendinopathy (according to Blazina classification) were surgically treated using the technique described above and prospectively followed up.
A total of 14 patients were able to successfully return to their initial sporting activity, while the Blazina score was reduced to an average of 0.4 points 41 months after the operation. 13 of the 15 patients were completely symptom-free just 3 months after the procedure.
The operation usually takes between 30 and 60 minutes.
The operation can be performed on an outpatient or inpatient basis. In most cases, we recommend a short inpatient stay (one night) in order to avoid direct postoperative stress and thus swelling in the surgical area.
Normal walking is possible again in almost all cases 1-2 days after the operation. Major strain should be avoided for approx. 3 months in order to prevent the inflammation from flaring up again.
Light sports, such as cycling or walking, can usually be resumed a few days after the operation without any pain. You should wait 3 months after the operation before engaging in competitive sports.
Even non-athletes can suffer chronic inflammation in the area of the patellar tendon and, in the worst case, a complete rupture of the patellar tendon. For this reason, we also recommend surgical treatment for non-athletes, depending on the symptoms, if conservative treatment does not work.
The patellar tendon can become chronically inflamed and, in the worst case, even rupture.
In the case of chronic patellar tendinopathy, normal sporting activity is often no longer possible and there may even be pain at rest and at night.
As with any operation, in the worst case an infection can occur, which must then be treated with antibiotics.
However, this is extremely rare with modern arthroscopic procedures, partly due to the constant flushing with irrigation fluid.
Fortunately, major, permanent damage has not yet occurred with our gentle, arthroscopic procedure.
