Patellar Tendinopathy: What Landing Mechanics Can’t Predict

Landing mechanics can change. What they cannot yet do is reliably predict who will develop patellar tendinopathy.

That distinction matters for basketball players, volleyball athletes, runners who add plyometrics, and anyone told that a stiff ankle or a knee-dominant landing explains their tendon pain. The most comprehensive review of this question found cross-sectional associations between landing patterns and patellar tendinopathy, but no prospective evidence showing that those patterns came first or caused the condition. In other words, biomechanics may describe how athletes move once they have pain; they do not yet provide a validated injury forecast.

The missing studies change the conclusion

Tayfur et al.'s 2022 systematic review and meta-analysis examined landing kinematics and kinetics in jumping athletes with and without patellar tendinopathy. It covered initial-contact angles, joint range of motion, joint moments, ground-reaction forces, tendon force, and muscle-activation patterns.

The review found limited or very limited evidence for almost every variable. Ankle dorsiflexion-plantarflexion range of motion and trunk-flexion strategies had relatively stronger support, but even that evidence remained limited. Most included studies also carried a high risk of bias on QUADAS-2 assessment.

The larger problem was design. Every included study was cross-sectional or case-control. None followed athletes with different landing profiles over time to see who later developed patellar tendinopathy. Without that sequence, a study cannot tell whether a movement pattern increased risk, emerged after pain began, or reflected a third factor such as training load, tissue capacity, or prior injury.

That is not a minor technicality. It is the difference between a risk factor and a symptom response.

Pain may be moving the athlete, not just the tendon

A 2025 study by Ortega-Cebrián et al. gives reverse causation a real foothold. The researchers assessed landing dynamics alongside tendon structural alignment in athletes with and without patellar tendinopathy. Pain presence had a greater effect on landing dynamics than tendon structural alignment.

Pain can alter motor output as an athlete unconsciously redistributes force away from a symptomatic area. That makes altered landing mechanics in a painful athlete hard to interpret as an original cause. It may be an adaptation to symptoms.

This does not prove that mechanics never contribute to tendon problems. It means the existing cross-sectional comparisons cannot separate predisposition from pain-driven adaptation. Calling a single landing variable a patellar-tendon screening test gets ahead of the evidence.

Ankle dorsiflexion is a useful target, with an unproven tendon story

Restricted ankle dorsiflexion is the most consistent biomechanical correlate in this literature. Martinez et al. (2022) confirmed an association between restricted dorsiflexion range of motion and patellar tendinopathy in jumping athletes.

The proposed explanation sounds reasonable: if the ankle does not move enough during landing, the athlete may absorb force differently at the knee or trunk, increasing demand on the knee-extensor mechanism. But Martinez and colleagues explicitly noted that the mechanism connecting limited dorsiflexion to knee-level overload remains unknown. A plausible chain of events is still a hypothesis.

Assessing and improving restricted ankle mobility can make sense for broader lower-limb function. It is modifiable, and it may help an athlete execute the movements they need. The evidence does not show that restoring dorsiflexion prevents patellar tendinopathy or recurrence.

More load is not the whole explanation

The simple model says repeated high tendon load causes tendon pathology. Load matters in tendon rehabilitation and training, but the available biomechanics data do not support a one-variable explanation.

Pietrosimone et al. compared landing loading in male athletes with and without patellar tendon structural abnormality. The athletes with abnormal tendons did not share one loading profile: both overloading and underloading patterns appeared. Underloading may reflect a protective strategy, but the finding also shows why external movement measures cannot capture the whole biology of tendon change.

Tendon pathology develops in a context that includes training exposure and tissue capacity. A clinical review by Catapano et al. describes patellar and quadriceps tendinopathy across reactive, dysrepair, and degenerative stages. That framework places biomechanics among several contributors rather than assigning every tendon problem to a flawed squat, landing, or pair of ankles.

Feedback training improves movement, not proven tendon outcomes

There is a more encouraging, narrower finding. Ashrafizadeh et al. (2025) randomized 34 male recreational athletes with documented motor-control deficits to an eight-week feedback-augmented jump-training program or a control condition. The study reported significant improvements in reactive strength index during both drop vertical jumps and countermovement jumps (p=0.001 for each outcome), along with kinematic improvements across the movement phases assessed.

That is useful evidence for coaching and performance work. Feedback-based training can alter landing mechanics and stretch-shortening-cycle performance in this specific population.

It is not evidence that the program protects the patellar tendon. The trial did not measure patellar tendon pain, VISA-P scores, tendon ultrasound, or patellar tendinopathy incidence. It also enrolled men who already had selected motor-control deficits, so its findings do not automatically extend to elite jump athletes, female athletes, or athletes without those deficits.

Mechanics improved. Tendon health was never tested. Those are different endpoints, and the gap between them matters.

What has better support when the tendon already hurts

For established patellar tendinopathy, progressive tendon loading has stronger clinical support than landing-mechanics correction alone. Deng et al. (2025) used causal mediation analysis to examine whether physical and imaging changes explained the benefit of progressive tendon-loading exercise. Those changes explained treatment effectiveness only partially.

The result does not identify a single complete mechanism, but it reinforces a practical point: recovery involves more than producing a prettier landing pattern or a different ultrasound image. A structured loading program aims to build tolerance and function, while sensible progression helps avoid abrupt increases in training stress.

Landing assessment can help guide movement coaching. It cannot yet tell you whether your landing mechanics caused patellar tendinopathy, or whether changing them will prevent it.

The practical verdict

Fix a meaningful mobility restriction. Use feedback training when it improves movement quality or jump performance. Do not sell either intervention as a proven patellar-tendon shield.

If you have patellar tendon pain, prioritize a progressive loading plan with a qualified clinician or sports professional and manage training progression alongside it. The key unanswered research question is straightforward: do athletes with particular landing patterns develop patellar tendinopathy more often, and does changing those patterns reduce that risk? The prospective studies needed to answer it have not been done.