Quadriceps tendinopathy - a forgotten pathology for physiotherapists? A systematic review of the current evidence-base

Background: The evidence-base surrounding the pathophysiology and management of specific tendinopathies has evolved over the past 20 years. Recent research examining lower limb tendinopathies has focussed primarily on Achilles and patellar tendon injuries. However, on further examination of the different types of patella/knee tendinopathies, confusion has arisen surrounding the diagnosis and management of patellar compared to quadriceps tendinopathy. Objectives: The purpose of this paper was to critically examine the evidence-base surrounding the diagnosis and management of quadriceps tendinopathy. Methods: A systematic literature search of published and unpublished literature databases was conducted to identify literature pertaining to quadriceps tendinopathy. Data from each paper were extracted to examine four key areas related to quadriceps tendinopathy: nomenclature, prevalence, assessment, and management. Results: Twelve studies satisfied the eligibility criteria and were included in the review. On analysis, little literature has been published solely informing clinicians on the pathology, diagnosis, or management of quadriceps tendinopathy. The terms patellar tendinopathy and jumper's knee have been incorrectly used interchangeably with quadriceps tendinopathy. Activities such as repetitive squatting and prolonged knee flexion have been associated with the development of this tendinopathy. Sports such as football and volleyball have been cited as causative factors. Quadriceps tendinopathy's principal diagnostic feature is pain on palpation of the quadriceps/patella interface, and resisted knee extension with the knee hyperflexed. There are no clear recommendations on how to specifically treat quadriceps tendinopathy. Conclusion: Quadriceps tendinopathy is less commn than patellar tendinopathy. Possibly as a result of this, little is known about how to assess and manage this particular knee tendinopathy. Further research is required to determine the optimal management strategy for patients diagnosed with quadriceps tendinopathy, acknowledging the biomechanical and anatomical difference of the quadriceps compared to the patellar tendon.