Surgical Technique: Jumper's Knee—Arthroscopic Treatment of Chronic Tendinosis of the Patellar Tendon  Matthias Brockmeyer, M.D., Alexander Haupert, M.D., Dieter Kohn, M.D., Olaf Lorbach, M.D.  Arthroscopy Techniques  Volume 5, Issue 6, Pages e1419-e1424 (December 2016) DOI: 10.1016/j.eats.2016.08.010 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 (A) Chronic patellar tendinosis is often associated with a prominent lower patellar pole. A preoperative radiograph (lateral view) of the left knee shows a long, prominent, bony lower patellar pole (arrow). (B) Safe identification of the bony tip of the patella. An intraoperative fluoroscopic picture of the left knee (lateral view) shows the lower bony patellar pole marked by a needle (arrow). Arthroscopy Techniques 2016 5, e1419-e1424DOI: (10.1016/j.eats.2016.08.010) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 Step-by-step surgical technique for arthroscopic treatment of chronic patellar tendinosis. Arthroscopy Techniques 2016 5, e1419-e1424DOI: (10.1016/j.eats.2016.08.010) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 Arthroscopic view from a high anterolateral standard portal showing debridement of inflamed soft tissue with an electrocautery device through an anteromedial accessory working portal beneath the patella directly next to the patellar tendon and identification of the lower patellar pole (X). (A left knee is shown with the patient in the supine position; regarding orientation, left is distal and top is ventral.) Arthroscopy Techniques 2016 5, e1419-e1424DOI: (10.1016/j.eats.2016.08.010) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 Arthroscopic view from a high anterolateral standard portal of the lower bony patellar pole marked by a needle. The asterisk indicates the articular-sided distal patellar pole; the X indicates the non-articular-sided lower patellar pole; and the pound sign indicates the proximal patellar tendon. (A left knee is shown with the patient in the supine position; regarding orientation, left is distal and top is ventral.) Arthroscopy Techniques 2016 5, e1419-e1424DOI: (10.1016/j.eats.2016.08.010) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 Arthroscopic view from a high anterolateral standard portal of step-by-step resection of the lower patellar pole (X) using a 4.0-mm burr through an anteromedial accessory working portal beneath the patella directly next to the patellar tendon. (A left knee is shown with the patient in the supine position; regarding orientation, left is lateral and top is ventral.) Arthroscopy Techniques 2016 5, e1419-e1424DOI: (10.1016/j.eats.2016.08.010) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 6 Final arthroscopic control of the extent of bony resection of the lower patellar pole: arthroscopic view from a high anterolateral standard portal of the resection area at the lower bony patellar pole (X) and the debrided proximal patellar tendon (pound sign). (A left knee is shown with the patient in the supine position; regarding orientation, left is proximal and top is ventral.) Arthroscopy Techniques 2016 5, e1419-e1424DOI: (10.1016/j.eats.2016.08.010) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 7 Treatment algorithm for chronic patellar tendinosis (jumper's knee). (NSAIDs, nonsteroidal anti-inflammatory drugs.) Arthroscopy Techniques 2016 5, e1419-e1424DOI: (10.1016/j.eats.2016.08.010) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions