This protocol applies to patients with patellar tendinopathy in whom a structured, progressive tendon-loading exercise program — conducted across multiple phases over an extended period — has not achieved the pain and functional targets required to return to activity.
The prior treatment was a progressive tendon-loading exercise program with load management. Escalation to this protocol is indicated when that program did not reach the required thresholds: visual analog scale (VAS) pain scores below the specified limits during and after exercise in the early phases, continued VAS improvement toward near-pain-free physical activity by week 12 onward, or a clinically meaningful gain of at least 13 points on the VISA-P functional score.
When these targets go unmet, a next-step intervention is warranted.
When the exercise-based program has not met the required clinical targets, the evidence supports consideration of a platelet-rich plasma (PRP)-based injection approach directed at the patellar tendon. The full protocol specifies the preparation type, the procedural guidance requirements, and further clinical details not shown here.
Reduction of anterior knee pain at the patellar tendon.
Leukocyte-rich PRP shows more promise than its leukocyte-poor counterpart. Leukocyte-rich PRP may be a viable option in patients who have failed to improve on other forms of conservative therapy. If PRP is determined to be appropriate, the injections should be performed under ultrasound guidance to identify the exact location of the tendinopathy. Approximately 80% of participants returned to their previous sporting activities after PRP treatments; results were poorer in patients who had a longer history of symptoms.
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