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Patellar Tendon Rupture


Patellar tendon rupture is an rupture of the tendon that connects the patella to the tibia. The patellar tendon attaches to the tibial tubercle on the front of the tibia just below the front of the knee, and is connected to the bottom of the patella, above which are attached to the quadriceps tendon, followed by the quadriceps muscle, large muscles on the front of the thigh. This structure allows the knee to flex and extend, allowing use of basic functions such as walking and running.

When rupture occurs, the patella loses support from the tibia and moves toward the hip when the quadriceps muscle contract, hindering the leg's ability to extend. This means that those affected cannot stand, as their knee buckles and gives way when they attempt to.

Causes of Patellar Tendon Ruptures

  • Injury

    • A very strong force is required to tear the patellar tendon.

    • Falls. Direct impact to the front of the knee from a fall or other blow is a common cause of tears. Cuts are often associated with this type of injury.

    • Jumping. The patellar tendon usually tears when the knee is bent and the foot planted, like when landing from a jump or jumping up.

  • Tendon Weakness - A weakened patellar tendon is more likely to tear. Several things can lead to tendon weakness.

  • Patellar tendonitis. Inflammation of the patellar tendon, called patellar tendonitis, weakens the tendon. It may also cause small tears.

Patellar tendonitis is most common in people who participate in activities that require running or jumping. While it is more common in runners, it is sometimes referred to as "jumper's knee."

Corticosteroid injections to treat patellar tendonitis are typically avoided in or around the infrapatellar tendon. Injections around this articular tendon have been linked to increased tendon weakness and increased likelihood of tendon rupture.

Chronic disease. Weakened tendons can also be caused by diseases that disrupt blood supply. Chronic diseases which may weaken the tendon include:

  • Chronic renal failure

  • Hyper betalipoproteinemia

  • Rheumatoid arthritis

  • Systemic lupus erythmatosus (SLE)

  • Diabetes mellitus

  • Infection

  • Metabolic disease

  • Steroid use. Using medications like corticosteroids and anabolic steroids has been linked to increased muscle and tendon weakness.

Symptoms of patellar tendon rupture include:

  • Knee pain:

    • Pain worsens with movement of the knee

  • Knee swelling

  • Knee tenderness

  • Knee stiffness

  • Mild leg swelling (unilateral):

    • Located below the kneecap

  • Inability to straighten the leg at the knee

  • Difficulty walking:

    • Inability to walk

Knee X-rays are the first imaging studies that are obtained and can be very helpful. When the patellar tendon ruptures, the patella shifts superiorly because of muscle contraction of the quadriceps muscles. This shift in the patella position is called “patella alta.” X-rays also evaluate the knee for any other injuries that can present similarly to a patellar tendon rupture such as a fracture. If any doubt remains after physical examination and X-rays, an ultrasound or magnetic resonance imaging (MRI) can be performed.

 

Ultrasonography is a safe, inexpensive and rapid test that can detect a tendon tear. However, the test is technician dependent and in some facilities is not a reliable diagnostic test. MRI is also a safe test but is more expensive and takes longer to perform. In addition, availability of MRI’s can be limited in emergency rooms and a doctor’s office. However, an MRI can also evaluate any other potential problems in the knee such as ligament or cartilage injury. In the vast majority of athletes who have suffered a patellar tendon rupture, an MRI is not indicated as the diagnosis is made with X-rays and physical examination. However, in the case of partial tears, chronic tears or an unusual presentation, an MRI can be a useful diagnostic tool.

Surgical repair of the torn tendon is recommended. If the tear is treated non-operatively, the patient will rarely have the ability to extend the leg and ambulate normally without assistance. Surgical repair, while not an emergency, should be performed soon after the injury occurred. This allows for an easier repair before a significant accumulation of scar tissue. Most surgeons perform a direct repair of the tendon if it is torn in the middle. If the tendon is torn off of the bone, several different techniques can be utilized such as reattaching the tendon to the bone with a combination of sutures and bone tunnels. Regardless of technique, the goal of surgical repair is to re-approximate the tendon ends in a secure fashion to allow it to heal.

 

If the patellar tendon is not repaired soon after the injury (within 5-6 weeks), surgical repair can become more difficult and have suboptimal results. If the tendon cannot be repaired back to itself, a reconstruction can be performed with a graft from donor tissue (allograft) or tissue taken from another part of the patient’s body (autograft).

 

 

 

   

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