Pain at the front of the knee, right at the bottom tip of the kneecap, that hurts when you jump, run downhill, take stairs or stand up after sitting through a meeting. It is usually called patellar tendinitis or jumper’s knee. The name is wrong in a way that matters.
It is not inflammation, and that changes the treatment
“-itis” means inflammation. When persistent patellar tendon problems are examined under the microscope, what is found is not an inflammatory infiltrate. It is a degenerative, disorganised tendon: collagen fibres that have lost their tight parallel alignment, an increase in ground substance, and an ingrowth of new small blood vessels and nerve fibres that do not belong in healthy tendon. The accurate word is tendinopathy, or tendinosis.
Three practical consequences follow, and they explain most of the frustration people arrive with:
- Anti-inflammatories underperform, because there is not much inflammation to treat. They can take the edge off the pain. They do not change the tendon.
- Rest alone does not fix it. A degenerative tendon needs a stimulus to remodel. Complete rest removes the stimulus, the pain settles while you are doing nothing, and it returns the moment you load the tendon again. This is the single commonest reason people describe a problem that has recurred for years.
- Corticosteroid injection is the wrong tool here. It reliably produces short-term relief, and the medium-term results in tendinopathy are worse than doing very little. In a large load-bearing tendon there is also a rupture concern. It is not offered here for this problem.
Where the pain sits, and what else it could be
Classic patellar tendinopathy is tender in one very specific place: the deep surface of the tendon right at the inferior pole of the patella, the bottom tip of the kneecap. Patients can usually put a fingertip on it. Pain that is diffuse across the front of the knee, or that moves about, is usually something else.
- Quadriceps tendinopathy — same problem, above the kneecap instead of below it. Commoner in weightlifters and in older athletes.
- Patellofemoral pain — aching around and behind the kneecap rather than at a point on the tendon, worse on stairs and after prolonged sitting.
- Fat pad impingement — pain either side of the tendon rather than on it, often worse with the knee held straight and pushed back.
- Osgood-Schlatter — in a growing adolescent, tenderness at the bony bump on the shin where the tendon inserts, not at the kneecap.
- Sinding-Larsen-Johansson — the growth-plate equivalent at the lower pole of the kneecap in a younger adolescent.
- Patellofemoral arthritis — in an older knee, arthritis behind the kneecap presents with front-of-knee pain and is routinely mislabelled. It is covered on the knee arthritis page.
Getting this right is not academic. The treatment for a degenerative tendon and the treatment for an irritated fat pad have almost nothing in common.
Why this is a diagnosis ultrasound is unusually good at
The patellar tendon sits directly under the skin, which makes it close to an ideal structure for ultrasound. In the room, during the visit, it shows the tendon thickened, the disorganised hypoechoic area on its deep surface, and the new vessel ingrowth that tracks with symptoms — and it does so dynamically, with the knee moving and the tendon under load, which a static scan cannot.
It also means that when an injection is indicated it is placed under direct vision into the abnormal part of the tendon, rather than into the general area by feel. For a structure this small, that distinction is the procedure rather than a refinement of it.
MRI has a role for complex or atypical cases, but for a straightforward patellar tendinopathy it usually adds cost and delay rather than information.
The treatment that actually works, and why it usually has not been done
Progressive tendon loading is the primary treatment for patellar tendinopathy, and everything else on this page is an adjunct to it. Not stretching, not ultrasound therapy, not rest — graduated, measured load, applied for long enough.
The evidence supports both heavy slow resistance work and eccentric protocols, most classically a decline-board squat. Which one suits you depends on your sport, your season and what you will actually do. What matters more than the choice is the execution:
- Some pain during the exercise is acceptable and is part of the protocol. What is monitored is how the tendon feels the next morning, not how it feels during the set.
- The load has to keep going up. A programme performed at the same weight for eight weeks is not a loading programme.
- The timescale is months. Twelve weeks is a normal minimum for a tendon that has been sore for a year. Programmes are routinely abandoned at week four because nothing has changed yet, which is exactly when nothing should have changed yet.
When a patient says loading did not work, it has usually either been stopped early, never progressed, or been done alongside continued full training that kept the tendon overloaded.
Where PRP fits
Patellar tendinopathy is a reasonable indication for platelet-rich plasma, with a specific place in the sequence: for the tendon that has had a properly executed loading programme and has not responded. It is not a shortcut that lets you skip the rehabilitation, and any practice offering it as one is setting you up to be disappointed.
Two things about how it is done here:
- Placed under ultrasound guidance, into the degenerative region itself rather than around the tendon.
- The platelet dose is measured and recorded. Two syringes both labelled PRP can differ tenfold in what they actually deliver, depending on the kit, the spin protocol, the volume of blood drawn and your own platelet count. Dr. Buford’s published work is specifically on this question, and it is the thing worth asking any clinic you are comparing.
Afterwards the tendon is usually more sore for a few days — PRP works by provoking a repair response, so a period of increased ache is expected rather than a bad sign. Avoid anti-inflammatory medication during that window, because it blunts the response you have just paid for. Loading resumes on a defined schedule; the injection and the programme are one treatment, not two alternatives.
What is not offered for this problem
- Corticosteroid injection into the tendon. Short-term relief, worse medium-term outcomes, and a rupture concern in a load-bearing tendon.
- Any injectable stem cell product sourced from a donor — amniotic, umbilical cord, placental and “exosome” products are not legal for this use in the United States and are not offered here at any price.
- An injection instead of rehabilitation. Available on request nowhere in this practice.
When surgery comes into it
Rarely, and late. Surgical treatment of patellar tendinopathy is reserved for tendons that have failed a genuinely complete non-operative programme over a long period, typically at least six months of properly progressed loading, and it is a considerably longer recovery than most patients expect. The far commoner situation is a tendon that has never had the non-operative treatment done properly in the first place.
A complete patellar tendon rupture is a different and urgent problem: a sudden pop with inability to straighten the knee against gravity needs prompt surgical assessment, not an injection.
Common questions
Is patellar tendinitis actually inflammation?
Usually not. Persistent patellar tendon problems show degenerative change rather than inflammation — disorganised collagen, increased ground substance, and ingrowth of small vessels and nerve fibres. That is why the accurate term is tendinopathy or tendinosis, and it explains why anti-inflammatory medication and rest alone tend to disappoint. The tendon needs a remodelling stimulus, which means progressive load.
Why does my patellar tendon feel fine when I rest and hurt again as soon as I return to sport?
Because rest removes the symptom without changing the tendon. A degenerative tendon needs graduated loading to remodel; complete rest deconditions it further, so the pain returns at the first real load. This pattern — better with rest, worse on return, repeatedly — is the commonest history in the clinic and is the strongest argument for a properly progressed loading programme rather than another period off.
Should I have a cortisone shot for jumper's knee?
It is not offered here for this problem. Corticosteroid reliably relieves tendon pain in the short term, but medium-term outcomes in tendinopathy are worse than with far less aggressive treatment, and in a large load-bearing tendon like the patellar tendon there is a rupture concern on top of that. If something is going to be injected into this tendon, PRP is the better-reasoned choice.
Does PRP work for patellar tendinopathy?
It is a reasonable indication, with a specific place: the tendon that has completed a properly executed loading programme and has not responded. It is not a way of skipping the rehabilitation, and a clinic that offers it that way is setting you up to be disappointed. Here it is placed under ultrasound guidance into the degenerative part of the tendon itself, and the platelet dose delivered is measured and recorded.
How long does it take to get better?
Longer than most people are told. Twelve weeks of progressive loading is a normal minimum for a tendon that has been sore for a year, and improvement is judged on how the tendon feels the morning after loading rather than during it. Programmes are routinely abandoned at week four because nothing has changed — which is exactly when nothing should have changed yet.
I have pain at the front of my knee but not at one specific point. Is it still this?
Probably not. Classic patellar tendinopathy is tender at one identifiable spot, at the deep surface of the tendon right at the bottom tip of the kneecap, and patients can usually put a fingertip on it. Diffuse or moving front-of-knee pain is more often patellofemoral pain, fat pad irritation, or — in an older knee — arthritis behind the kneecap, which is treated quite differently.
