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To compare the outcome of chronic patellar tendinopathy treated surgically and by extracorporeal shock wave therapy.Cross-sectional outcome analysis.University Hospital Pellenberg, Leuven, Belgium.Of a total of 27 patients (28 knees) with chronic patellar tendinopathy, 13 were treated surgically, and 14 (15 knees) received extracorporeal shock wave therapy.Functional outcome questionnaire: Victorian Institute of Sport Assessment score, Visual Analog Scale, and Roles and Maudsley classification.At an average of 6 months of follow-up, the mean Victorian Institute of Sport Assessment and Visual Analog Scale scores for the extracorporeal shock wave therapy group were 78.8 ± 28.7 and 9 ± 2, respectively, which improved to 83.9 ± 28.6 and 9 ± 2, respectively, at 22.1 months. The surgery group scored 70.7 ± 22.2 points on the Victorian Institute of Sport Assessment at an average of 26.3 months of follow-up (p = 0.41 and p = 0.18) and 8 ± 3 on the Visual Analog Scale (p = 0.14). In the extracorporeal shock wave therapy group, 5 (33%) patients rated their pain status at 22.1 months as excellent, 5 (33%) as good, 2 (13%) as fair, and 2 (13%) as poor. In the surgery group, 4 (33%) evaluated the result as excellent, 3 (25%) as good, 3 (25%) as fair, and 2 as poor (17%).Extracorporeal shock wave therapy shows a comparable functional outcome to surgery in a cross-sectional analysis of patients with chronic proximal patellar tendinopathy resistant to conservative treatment.