Description:
<jats:p>High‐level patellar tendon strain may cause impairments of the tendon's micromorphological integrity in growing athletes and increase the risk for tendinopathy. This study investigated if an evidence‐based tendon exercise intervention prevents high‐level patellar tendon strain, impairments of micromorphology and pain in adolescent basketball players (male, 13–15 years). At three time points over a season (M1‐3), tendon mechanical properties were measured using ultrasound and dynamometry, proximal tendon micromorphology with a spatial frequency analysis and pain and disability using VISA‐P scores. The control group (CON, <jats:italic>n</jats:italic> = 19) followed the usual strength training plan, including sprint and change‐of‐direction drills. In the intervention group (INT, <jats:italic>n</jats:italic> = 14), three sessions per week with functional exercises were integrated into the training, providing repetitive high‐magnitude tendon loading for at least 3 s per repetition. The frequency of high‐level strain (ie, ≥9%) continuously decreased in INT, while tending to increase in CON since tendon force increased in both (<jats:italic>p </jats:italic>< 0.001), yet tendon stiffness only in INT (<jats:italic>p</jats:italic> = 0.004). In CON, tendon strain was inversely associated with tendon peak spatial frequency at all time points (<jats:italic>p </jats:italic>< 0.05), indicating impairments of tendon micromorphological integrity with higher strain, but not at M2 and M3 in INT. Descriptively, the fraction of asymptomatic athletes at baseline was similar in both groups (~70%) and increased to 100% in M3 in INT, while remaining unchanged in CON. We suggest that functional high‐load tendon exercises could reduce the prevalence of high‐level patellar tendon strain and associated impairments of its micromorphology in adolescent athletes, providing new opportunities for tendinopathy prevention.</jats:p>