Patellar Tendinopathy Treatment London | Private Ultrasound Diagnosis & Injections

Patellar Tendinopathy Explained

Patellar Tendon Anatomy

The patellar tendon functions to transfer load from the quadriceps muscle via the patella (kneecap) to the upper shin bone (tibia).

What Causes Patellar Tendinopathy?

The patellar tendon must withstand significant tensile load during normal function. It has a thick fibrous structure, which can be demonstrated clearly on ultrasound.

Unfortunately, due to age-related changes and the high forces placed through the patellar tendon during:

• Running

• Squatting

• Lunging

• Sport-specific movements (such as deceleration)

...the patellar tendon can become a site of degenerative change or develop focal tears within the patellar tendon fibres as a result of repetitive loading or acute injury.

Diagnosing Patellar Tendinopathy 

Ultrasound imaging is the diagnostic imaging modality of choice when evaluating anterior knee pain suspected to originate from the patellar tendon.

On ultrasound, the patellar tendon may demonstrate:

• Focal tears, particularly near the patella

• Regions of tendinopathy (described as degenerative changes in the patellar tendon structure)

Pain may also arise from the patellar tendon insertion onto the tibial tuberosity of the shin bone. Ultrasound can reliably detect bony cortical irregularities at this site, which may contribute to symptoms.

Other causes of pain around the patellar tendon region that ultrasound can reliably diagnose include:

• Bursitis

• Hoffa’s fat pad irritation

Ultrasound Guided Injections for Patellar Tendinopathy

How is a Patellar Tendon Injection Administered?

The mainstay of treatment for patellar tendinopathy is a systematic programme of patellar tendon loading exercises. These focus on gradually strengthening both the quadriceps muscle and the patellar tendon over time.

This exercise-based approach encourages tenocyte cells within the patellar tendon to regenerate new tendon tissue.

When a conservative rehabilitation programme has been attempted but has not succeeded, an ultrasound-guided prolotherapy series of injections may be considered as the next course of action.

This involves — under local anaesthetic — placing the needle directly into the region of tendinopathy, repeatedly stimulating a microbleed. The healing properties within the blood — specifically platelets — are released to stimulate tissue repair.

Further rehabilitation can be resumed following this procedure.

What to Do After Your Knee Ultrasound Guided Injection

After the Injection
Following your patellar tendinopathy injection, your post-injection symptoms will depend on the technique used. If one of the bursae around the patellar tendon was injected, symptoms are usually minimal. If an ultrasound-guided prolotherapy-style injection or a higher-volume steroid injection around the tendon itself was performed, some aggravation of symptoms is expected as part of the treatment process.

Needle Path & Post-Injection Pain
For tendon-targeted procedures, it is common to feel some discomfort for a few days as the tissue responds to the treatment. This is normal and typically settles as healing progresses. 

Wound Care & Infection Risk
Avoid exposing the injection site to dirty or public water (e.g., swimming pools, hot tubs) for 2–3 days due to the small infection risk. Monitor the area for redness, swelling, or discharge and contact me immediately if these occur.

Activity Guidance
Avoid loading activities, including running, jumping, or squatting, for two weeks following the injection. After this period, begin a graded return to activity and rehabilitation, focusing on progressive tendon loading exercises as advised by your physiotherapist.

Follow-Up
If you experience unusual pain, swelling, redness, or any concerns following your injection, please contact me immediately.

Other Treatments for Patellar Tendinopathy

Stretches for Patellar Tendinopathy

Mobilisations for Patellar Alta

Progressive Decline Squat Exercises for Patellar Tendinopathy

Progressive Loading Exercises for Patellar Tendinopathy

Patellar Tendinopathy | Evidence base

There is a strong body of evidence, including randomized controlled trials, supporting progressive tendon loading as the gold-standard treatment for patellar tendinopathy. Eccentric training protocols (e.g., decline squats) have traditionally been used, but newer studies show that combined concentric-eccentric and isometric loading programs are equally effective and may be better tolerated. Corticosteroid injections are discouraged due to their catabolic effects on tendon tissue and poor long-term outcomes. Regenerative injections like PRP and prolotherapy have shown mixed results, and while used in clinical practice, are not consistently supported by high-quality evidence. Surgery is a last resort and may offer benefit for carefully selected, chronic cases, but rehabilitation remains the cornerstone of care.

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