Introduction
The patellar tendon connects the kneecap to the shinbone. Injuries to this tendon can occur during high-impact sports like running or jumping, as well as due to conditions such as tendonitis, chronic diseases, or steroid use. While minor partial tears may heal with non-surgical approaches, most cases of patellar tendon tears necessitate surgical intervention followed by physical rehabilitation.
Anatomy
The knee joint comprises three primary bones: the femur (thighbone), the tibia (larger bone in the lower leg), and the patella (kneecap). The patellar tendon attaches to the lower side of the kneecap and connects to the anterior tibial tubercle at the top of the tibia. This strong tissue plays a crucial role in stabilizing the kneecap and enabling knee extension.
Causes
Patellar tendon tears can be either complete or partial. Complete tears typically occur at the kneecap and are often caused by sudden, forceful impacts or during athletic activities involving jumping and running. In contrast, partial tears generally develop in the tendon’s midsection due to factors like patellar tendonitis, chronic conditions, or the use of steroids. Tendons that are inflamed or weakened are more susceptible to tearing, with middle-aged individuals being particularly at risk.
Symptoms
Patients may experience a popping sensation at the moment of the tear, followed by significant pain and swelling. The kneecap may also appear elevated. Common symptoms associated with a patellar tendon tear include:
- Bruising around the knee
- Cramping in the knee
- Buckling of the knee
- Difficulty walking
- Inability to fully straighten the knee
Diagnosis
Diagnosis of a patellar tendon tear typically involves a comprehensive medical history review, a physical examination of the knee, and imaging studies. Your physician may order X-rays or an MRI to assess the condition of the knee's bones and soft tissues, confirming the diagnosis.
Treatment
Treatment strategies for patellar tendon tears are personalized based on factors such as the patient's age, activity level, and the severity of the tear. Smaller tears may be treated conservatively, with recommendations for a knee immobilizer and the use of crutches for three to six weeks. Physical therapy will focus on strengthening the quadriceps and gradually increasing activity as healing progresses.
Surgery
Surgical intervention is often required for most individuals with patellar tendon tears, where the tendon is reattached to the kneecap. This procedure typically necessitates an overnight hospital stay but may sometimes be done on an outpatient basis, depending on the specific case. The surgery is performed under regional (spinal) or general anesthesia. The surgeon makes an incision over the kneecap to reattach the tendon using sutures or surgical hardware, ensuring proper alignment and tension.
Recovery
Post-surgery, pain management will be prescribed, along with recommendations for ice application. Initially, a brace or cast will be necessary, and crutches will be used to minimize weight on the knee. As recovery progresses, physical therapists will guide the patient through strengthening exercises, with gradual increases in mobility according to medical advice. Full recovery may take between 6 to 12 months, contingent upon the injury's severity and the surgical procedure performed.
