Chronic patellar tendinopathy is highly prevalent among youth, amateur, and elite athletes, with rates reaching 30-40% in high-performance populations. Among current conservative treatments, platelet-rich plasma (PRP) injections and extracorporeal shockwave therapy (ESWT) have demonstrated promising clinical outcomes. However, high-quality randomized controlled trials comparing ESWT alone versus ESWT combined with different injection therapies remain lacking.
Objective:
To compare the clinical effectiveness of ESWT alone, ESWT combined with hyaluronic acid (HA), and ESWT combined with PRP in athletes with chronic patellar tendinopathy.
Methods:
A three-arm, single-blind randomized controlled trial will be conducted. Athletes participating in sports with repetitive jumping or explosive lower-limb loading will be enrolled and stratified by sport type. Inclusion criteria include typical anterior knee pain, a positive decline squat test, and ultrasonographic evidence of tendon thickening or hypoechoic changes. Calcified tendinopathy will be excluded.
Outcomes will be assessed at 1, 3, 6, 9, and 12 months, including VAS, VISA-P, SPORTS scale, sport-specific performance tests (vertical jump, single-leg hop, agility tests), and return-to-play (RTP) time.
Expected Impact:
This study aims to address three key clinical questions:
1. Is ESWT alone adequate as an initial treatment for chronic patellar tendinopathy in athletes?
2. If adjunctive injection is needed, does HA or PRP provide superior short- and long-term outcomes?
3. Which treatment strategy results in the fastest safe return to sport? The findings of this trial will provide evidence-based guidance for clinicians and contribute to the development of more precise treatment algorithms, ultimately enhancing performance longevity and protecting the careers of high-level athletes.