**7. Management**

Unfortunately the management used for chronic tendon disorders has a very little scientific backdrop and varies considerably among the surgeons and across countries. Thus the treatments listed below are at best empirical.

### **7.1 Rest**

*Tendons*

**6. Imaging**

**6.1 Roentgenogram**

**6.2 Ultrasonography**

Role of ultrasound:

**6.3 Role of MRI**

Appearance in MRI:

cases of patellar tendinopathy.

**Stage Symptoms** 0 No pain

to be of some prognostic value [30, 31].

Ultrasonographic appearance:

1.Detect preclinical lesion in athletes

intratendinous calcification may be present.

2.Detect patellar tendon pathology and assess its severity

Anteroposterior, lateral and tangential views of patella may show radiolucency over involved pole in early stage, while in prolonged stage, the involved pole may appear elongated. In chronic cases tendon calcification and periosteal reaction over anterior aspect of patella ("tooth sign") may be evident. While in long standing cases the stress fracture or disruption of extensor mechanism may occur.

Ultrasound and MRI is the main modality of investigation for jumper's knee. Although CT scan can image patellar tendon, it does not offer any significant advantage over the above mentioned investigations. However studies have shown CT scan

Patellar tendons in patients suffering from jumper's knee have decreased echogenicity, containing either a sonolucent region or diffuse hypoechogenicity [31–33]. The tendon envelope is irregular, and there may be erosion of patellar tip and

1.Identification of exact location and the extension of the tendon involvement

3.Quantification of the size of patellar tendon to be excised during surgery

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

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

2 Pain at the beginning and after sports activity, still able to perform at a satisfactory level 3 Pain during sports activity, increasing difficulty in performing at a satisfactory level 4 Pain during sports activity, unable to participate in sports at as satisfactory level

1 Pain only after intense sports activity, no undue functional impairment

5 Pain during daily activity, unable to participate in sport at any level

2.Exclusion of other condition such as bursitis, chondromalacia

**60**

This modality is useful in athletes presenting for the first time with patellar pain but becomes a concern in individuals involved in competitive sports.

### **7.2 Straps, braces and exercises**

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 most popular non-operative treatment involves eccentric exercise.
