Initial Management of Patellar Tendinitis in Children

Introduction to Patellar Tendinitis

The American Academy of Pediatrics and other medical societies recommend beginning treatment with relative rest, scheduled NSAIDs, and eccentric strengthening exercises for a child with patellar tendinitis 1

Implement relative rest by avoiding activities that reproduce pain while maintaining general activity to prevent deconditioning and muscle atrophy 1
Complete immobilization should be avoided as it leads to muscular weakness 1
Use scheduled NSAIDs (oral or topical) for pain relief during the acute phase, particularly to allow participation in physical therapy 1
Topical NSAIDs eliminate the gastrointestinal hemorrhage risk associated with oral formulations, making them preferable in pediatric patients 1
Eccentric strengthening exercises form the cornerstone of rehabilitation, reducing symptoms, increasing strength, and promoting tendon healing 1

Continue conservative management for 3-6 months before considering any advanced interventions 1, 5
Most patients (approximately 80%) achieve full recovery within this timeframe with appropriate conservative treatment 6

Ensure proper diagnosis: patellar tendinitis is uncommon at age 7; consider alternative diagnoses including apophysitis or inflammatory conditions 2, 3

Extracorporeal shock wave therapy is safe and noninvasive for chronic cases unresponsive to initial management 1
Corticosteroid injections should be used with extreme caution in children, as they may inhibit healing, reduce tensile strength, and predispose to spontaneous rupture 1
Surgery is reserved only for cases failing 3-6 months of conservative therapy and involves excision of abnormal tissue and longitudinal tenotomies 1, 5