Eccentric Exercise Protocols for Patella Tendinopathy: Should we Really be Withdrawing Athletes from Sport? A Systematic Review

Adnan Saithna*, 1, Rajiv Gogna 2, Njalalle Baraza 1, Chetan Modi 1, Simon Spencer 1
1 Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Walsgrave, Coventry, CV2 2DX, UK
2 Trauma and Orthopaedic Surgery, Derby Hospitals NHS Foundation Trust, Uttoxeter Road, Derby, DE22 3NE, UK

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© Saithna et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Walsgrave, Coventry, CV2 2DX, UK; Tel: 02476 964000; Fax: 02476 964000; E-mail:


The 2007 review by Visnes and Bahr concluded that athletes with patella tendinopathy should be withdrawn from sport whilst engaging in eccentric exercise (EE) rehabilitation programs. However, deprivation of sport is associated with a number of negative psychological and physiological effects. Withdrawal from sport is therefore a decision that warrants due consideration of the risk/benefit ratio. The aim of this study was to determine whether sufficient evidence exists to warrant withdrawal of athletes from sport during an eccentric exercise rehabilitation program. A systematic review of the literature was performed to identify relevant randomised trials. Data was extracted to determine whether athletes were withdrawn from sport, what evidence was presented to support the chosen strategy and whether this affected the clinical outcome. Seven studies were included. None of these reported high quality evidence to support withdrawal. In addition, three studies were identified in which athletes were not withdrawn from sport and still benefited from EE. This review has demonstrated that there is no high quality evidence to support a strategy of withdrawal from sport in the management of patella tendinopathy.

Keywords: Eccentric exercises, jumper’s knee, patella, rehabilitation, tendinopathy, sport withdrawal.