Patellar Tendinopathy Treatment in Bellingham, WA

The evidence is mixed depending on how PRP is used. A well-cited double-blind trial (Scott et al., AJSM 2019) found PRP no better than saline when used as a standalone injection — but that trial did not standardize a loading program alongside treatment. The current understanding is that PRP works best as a complement to structured loading, not a replacement for it.

When combined with an eccentric exercise program, a separate randomized trial (Dragoo et al., AJSM 2017) found that PRP plus dry needling accelerated return to sport compared with exercise alone. And a 2024 study found that combining PRP with shockwave produced superior outcomes to PRP alone. The honest summary: PRP is not a magic fix for this tendon, but as part of a well-structured plan it has clear randomized support.

Progressive loading — eccentric exercises and heavy-slow resistance training — has the strongest and most consistent evidence for patellar tendinopathy, and is the starting point for nearly every case. It builds the tendon's capacity to handle load, which is the core problem.

For chronic cases that have genuinely plateaued after several months of good loading, shockwave therapy and PRP are the most evidence-backed next steps. Shockwave is non-invasive and has strong support for chronic patellar tendinopathy. PRP works best when combined with continued loading rather than used alone. Cortisone injections are not recommended for this tendon — guidelines advise against them because the condition is degenerative rather than inflammatory, and repeated steroid use around tendons carries rupture risk.

Many cases respond to a single ultrasound-guided PRP injection combined with a structured loading program. A second injection may be considered depending on how the tendon responds over the following six to eight weeks.

Because patellar tendinopathy is a failed-healing problem in the tendon tissue, the goal is to provide a biological stimulus the tendon can respond to — not to repeat injections indefinitely. Dr. Borys uses diagnostic ultrasound to track tendon changes and determine whether a repeat injection is warranted.

Patellar tendinopathy is characteristically slow to recover. Most patients following a structured loading program begin seeing meaningful improvement over three to six months, with full return to sport often taking longer in high-load athletes.

PRP and shockwave do not shorten recovery to weeks, but they can accelerate progress in tendons that have stalled. The most important variable is consistency with loading: stopping the program as soon as pain eases is the most common reason for relapse.

Yes — shockwave has good evidence for chronic patellar tendinopathy. Focused extracorporeal shockwave therapy (ESWT) stimulates the tendon's own repair response, and controlled trials support its use for cases that have not responded to conservative care. It is non-invasive, performed in office, and can be used as a standalone treatment or combined with PRP, where a 2024 study found the combination superior to PRP alone.

The initial evaluation is a standard office visit that may be covered depending on your insurance plan. PRP injections and shockwave therapy are generally not covered by insurance and are paid out of pocket, as most plans still classify them as investigational.

Dr. Borys treats patellar tendinopathy in Bellingham, WA, serving athletes and active adults throughout Whatcom County. Pricing and treatment options are reviewed at your initial visit.