**6.3 Role of MRI**


Appearance in MRI:

The abnormal patellar tendon contains an oval to round area of high signal intensity in T1- and T2-sequence at the tendon attachment site or focal zones of high signal intensity in the deeper zones of the tendon [34, 35]. The T2-weighted sequences (particularly the T2\*-weighted GRE sequences) have greater sensitivity than the T1-weighted protocols. However, the T1-weighted signal can image most cases of patellar tendinopathy.

Ferrati et al. [36] classified jumper's knee into six stages according to symptoms:


**61**

*Patellar Tendinopathy: "Jumper's Knee" DOI: http://dx.doi.org/10.5772/intechopen.84642*

**7.2 Straps, braces and exercises**

**7.3 Cryotherapy and physical modalities**

**7.4 Remedial massage**

required to warrant its use [39].

was outlined by Stanish et al. [40] outlined in **Table 1**.

**7.5 Rehabilitation**

Unfortunately the management used for chronic tendon disorders has a very little scientific backdrop and varies considerably among the surgeons and across

This modality is useful in athletes presenting for the first time with patellar pain

One approach to help in healing of the tendon tissues is unloading. This can be achieved either by the modification of the activities for e.g. decreasing the number of jumps or landing on the ground with proper orientation of the foot, or use of knee braces and straps such as chopart straps that share and alter the load on the tendon. Chopart strap [10] is a tape attached just proximal to tibial tendon. The

Cryotherapy helps in controlling initial tissue response to the injury. It is thought to act by decreasing the blood flow and metabolic rate, thereby decreasing the rate of inflammation. Electrical modalities that have been used in patellar tendinopathy include ESWT, ultrasound, heat, interferential therapy, magnetic fields, pulsed magnetic and electromagnetic fields, transcutaneous electrical nerve stimulation (TENS), and laser [10, 37, 38]. The true effects of the above mentioned modalities

It tends to treat the tendon tissue by having an effect on the muscle stretch and direct effect on the tendon cells. Muscle belly massage is thought to increase the compliance of the muscle and decrease the load on the muscle. Deep friction massage is thought to activate the mesenchymal cells to stimulate the healing response. "Fibrolysis", a form of deep frictional massage originally developed in Finland, has been successful in Achilles tendinopathy. However a controlled study failed to provide any evidence of healing in patellar tendinopathy and further evidence is

The key treatment nowadays to chronic tendinopathy is the stretching and strengthening programme of the whole muscle tendon unit. A staged program for tendinopathy corresponding to the stages of worsening severity of the condition [1]

Drop squat forms one of the key exercise for this condition in which patients are asked to sit to about 100–120° of knee flexion from a standing position and are advised to perform three sets consisting of 10 repetitions per session. It was observed that this regimen brought about complete relief in 30% of patients with reduction in the symptoms in further 64% of the patients [41]. Worsening symptoms were seen in the remaining 6% of patients. Cannell [42] observed that eccentric squats were better as compared to leg curl/extension exercises in treatment of the condition.

still remain unknown and further studies are required to support their use.

countries. Thus the treatments listed below are at best empirical.

but becomes a concern in individuals involved in competitive sports.

most popular non-operative treatment involves eccentric exercise.

**7. Management**

**7.1 Rest**
