Research Summary

Most Athletes Recover From Patellar Tendinopathy After 5 Years of Physical Therapy, Residual Pain Persists

Anthony Calabro, MA

Key Highlights

  • At 5-year follow-up, 76% of athletes with patellar tendinopathy reported feeling recovered.
  • Pain during sports decreased from a median of seven to two points, and VISA-P scores improved significantly.
  • 71% returned to their desired sport; however, only 25% reported being completely pain-free during sports.
  • No baseline prognostic factors were significantly associated with long-term self-perceived recovery.

Among athletes with patellar tendinopathy (PT) who underwent a structured physical therapy program, 76% reported feeling recovered at 5 years, and 71% had returned to their desired sport. While improvements in pain and function were substantial, complete resolution of symptoms was uncommon, with only 25% reporting being completely pain-free during sports activity.

Patellar tendinopathy is a common and debilitating condition in jumping athletes, often impairing sports performance and quality of life. Previous studies on long-term outcomes have been limited by narrow populations, outdated treatment protocols, or inadequate outcome measures. The current study aimed to provide a contemporary, patient-centered evaluation of PT prognosis using standardized metrics and a diverse athletic cohort.

The current prospective cohort study followed up on athletes previously enrolled in a randomized trial comparing progressive tendon-loading and eccentric exercises. All participants had received education, load management guidance, and exercise therapy. Five years after enrollment, 58 of 76 eligible athletes completed an online survey assessing self-perceived recovery using a global rating of change, along with pain levels, VISA-P scores, and current sports participation. Return to sport was categorized according to consensus criteria. Logistic regression analyses were conducted to explore prognostic factors.

The median pain score during sports declined from seven to two, and median VISA-P scores improved from 57 to 82 points (both P < .001). Clinically meaningful improvements were observed in 61% for pain during daily activities, 67% for sports-related pain, and 71% for VISA-P scores.

While 41 athletes (71%) returned to their preinjury sport—28 at or above prior performance levels—five (9%) had ceased all sports activity. Those who did not feel recovered reported significantly higher pain, greater disability, and lower likelihood of returning to performance. Despite initial associations in univariable analyses, no baseline variables (eg, BMI, symptom duration, quadriceps strength) remained statistically significant predictors of long-term recovery.

This study has several limitations. For example, the original cohort came from a randomized trial with strict inclusion criteria, potentially affecting generalizability. Pain assessment tools differed between baseline and follow-up, and most participants received various co-interventions over time. Additionally, the modest sample size may have limited the ability to detect significant prognostic factors.

“Athletes with PT after physical therapy can expect a generally acceptable long-term prognosis,” the authors concluded. “However, almost one-quarter did not feel recovered and perceived worse patient-reported outcomes. Clinicians treating athletes with PT may use these findings to estimate the average prognosis.”

References
Deng J, Oosterhof JJ, Eygendaal D, Breda SJ, Oei EHG, de Vos RJ. Long-term prognosis of athletes with patellar tendinopathy receiving physical therapy: patient-reported outcomes at 5-year follow-up. Am J Sports Med. 2025;53(7):1568-1576. doi:10.1177/03635465251336466