Treatment Options for Patellar Spurs

Initial Conservative Management

The American Academy of Family Physicians recommends exercise therapy, particularly eccentric strengthening exercises, as the primary treatment approach for patellar spurs, reducing symptoms, increasing strength, and promoting tendon healing 1
Exercise therapy should focus on eccentric strengthening exercises for the quadriceps, as well as both open and closed chain exercises with progressive loading modified based on pain response, with a focus on hip and knee targeted exercise therapy 3
Relative rest to prevent ongoing damage while allowing activities that don't worsen pain is recommended, with complete immobilization avoided to prevent muscular atrophy and deconditioning 1
Cryotherapy, such as ice therapy, is effective for short-term pain relief, with applications of ice through a wet towel for 10-minute periods being most effective 1
NSAIDs, either oral or topical, are recommended for pain relief, especially during acute phases, with topical NSAIDs eliminating the increased risk of gastrointestinal hemorrhage associated with systemic NSAIDs 1, 5

Medially directed patellar taping can provide short-term relief of pain and improved function, while orthotic devices such as medially wedged insoles for lateral compartment issues and laterally wedged subtalar strapped insoles for medial compartment issues can also be beneficial 5
Manual therapy, including deep transverse friction massage, is recommended in combination with supervised exercise for pain reduction 5, 6

Intraarticular corticosteroid injections may be considered for pain relief, but caution is advised as corticosteroids may inhibit healing and reduce the tensile strength of the tissue, predisposing to spontaneous rupture 1, 5
Extracorporeal shock wave therapy is a safe, noninvasive option for pain relief in chronic cases 2

Surgery should be reserved for patients who have failed conservative therapy for 3-6 months, with surgical indications including persistent significant pain affecting quality of life and inability to return to desired activity level despite appropriate non-surgical management 6
Surgical techniques include excision of abnormal tendon tissue and longitudinal tenotomies to release areas of scarring and fibrosis 6

Most patellar tendinopathy cases represent chronic tendinosis rather than acute inflammation, and education should underpin all interventions, addressing inaccurate beliefs, building confidence, and explaining that pain doesn't necessarily correlate with damage 2, 3
For overweight patients, weight loss counseling should be included as part of the treatment plan, and diagnostic imaging such as ultrasonography or MRI may be helpful to confirm the diagnosis and assess the extent of the condition 1, 2, 5