Patellar Tendon Tear
What is it?
The patellar tendon stretches between the kneecap and the front part of the tibia (shinbone), and a tear is the partial or complete rupture of this connective tissue.
How does it get hurt/damaged?
A patellar tendon tear is a serious injury for elite athletes and can be career threatening if not treated right away. Often, when a patellar tendon tear occurs, it is due to an abnormal amount of stress going through the tendon. Even though the patellar tendon goes through a lot of stress day-to-day, an excess of stress like landing from a jump or large height, such as while playing basketball, can cause the tendon to rupture.
How common is a patellar tendon tear?
Patellar tendon tears aren’t as common, only occurring about 5,000 times per year in the United States.
When should you be worried about a patellar tendon tear and what should you do initially?
A patellar tendon tear can cause a problem for an elite athlete if not seen by a medical care provider immediately after the injury. For the elite athlete, if not handled immediately, there will be a much more difficult road to recovery. Other patients who might experience a patellar tendon tear include those with diabetes and kidney problems, and those who take fluoroquinolone antibiotics.
Patellar tendon tears will present themselves generally as knee pain, swelling, difficulty with weight bearing, instability, and a popping sound at the time of injury. Any of these symptoms should warrant a visit to your primary care provider, when available, or a trip to the emergency room, if the pain isn’t manageable.
What is the severity of the injury and the treatment options?
In practice, patellar tendon injuries can be classified as acute (a mild to moderate tears) or a chronic rupture. Patients with an acute patellar tendon rupture will have decreased range of motion of the knee due to pain and a lack of ability to use the knee’s extender mechanism. There will also be a loss of knee extension ability, but are usually amenable to light repair.
A chronic patellar tendon tear, however, indicates that a total reconstruction is needed. Often chronic ruptures will start to present six weeks after the date of injury. In practice, doctors have seen some shredded patellar tendons that are almost impossible to repair. In these circumstances, a more extensive surgery that involves using a hamstring tendon graft through tunnels in the tibial tubercle and kneecap may be necessary, especially to get athletes back to high-level activities.
What is my recovery timeline and the anticipated outcome?
Patellar tendon tears that are classified as acute involve minor disruptions of the patellar tendon and may be able to be treated without surgical repair. Complete tears typically need a surgical repair. The usual surgical treatment is to repair the patellar tendon back to the patella with sutures drilled across it. For severe tears, with significant damage, a hamstring tendon reconstruction graft to reconstitute the tendon may be necessary.
Most athletes get back to 85-90% of their normal strength on the same side. Patellar tendon repairs can be very delicate. Therefore, patients will need to be on crutches and completely non-weight bearing for at least six weeks. They can usually start driving at about 7-8 weeks after surgery. A complete return to normal activities is usually anticipated between 5-7 months postoperatively.
