Purpose: Patellar tendinopathy is a frequent pathology which generally heals well after functional treatment if managed early.

Material and methods: We report a retrospective analysis of thirteen high-level athletes who underwent surgery for chronic patellar tendinopathy. The disease was demonstrated by ultrasound, MRI, and plain radiographs. Four patients had insertion tendiopathies and nine had tendinopathies involving the tendon body. Six patients also presented a femoropatellar impingement demonstrated by arthroscan. The indication for surgery was total sports disability (Blazina stage III-b) after failure of functional treatment. Surgery consisted in systematic combing of the tendon after resection of degenerative tissue. Resection of the patellar apex was performed in the four patients with insertion tendinopathy. Lateral release was performed in patients with femoropatellar impingement and one patient with severe impingement required advancement of the anterior tibial tuberosity.

Results: Outcome was very good in eight patients and good in five at 36 months (mean follow-up).

Discussion: Ultrasonography was often the only exploration performed for chronic patellar tendinopathy. It is essential for diagnosis and postoperative surveillance. MRI should be reserved for surgical cases or if the diagnosis is doubtful. The beneficial effect of surgical treatment is undeniable if the indication is well founded. For us it is logical and necessary to treat any femoropatellar impingement during the same operation.