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Patellar Tendon Rupture: Causes, Symptoms & Treatment
A patellar tendon rupture is a complete or partial tear of the tendon below the kneecap. It causes severe pain and inability to walk or straighten the leg.
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A patellar tendon rupture is a complete or partial tear of the tendon below the kneecap. It causes severe pain and inability to walk or straighten the leg.
What is a Patellar Tendon Rupture?
A patellar tendon rupture is a complete or partial tear of the patellar tendon (ligamentum patellae), the tendon that connects the kneecap (patella) to the shinbone (tibia). This tendon is a key component of the knee extensor mechanism and is essential for straightening and stabilising the leg. A rupture results in significant loss of function in the affected leg and represents a serious orthopaedic emergency requiring prompt medical attention.
Causes
Patellar tendon ruptures most commonly occur due to a sudden, forceful stress on the knee joint. Typical causes include:
- Sports injuries: Abrupt jumping or landing movements, particularly in sports such as basketball, football, or volleyball
- Direct trauma: A fall onto the knee or a direct blow to the patellar tendon
- Pre-existing tendon damage: Chronic inflammation (e.g., patellar tendinopathy), corticosteroid injections, or systemic conditions such as chronic kidney disease, rheumatoid arthritis, or diabetes mellitus can weaken the tendon structure
- Age-related degeneration: The load-bearing capacity of tendons decreases with age, making ruptures more common in middle-aged and older adults
Symptoms
A patellar tendon rupture typically presents with the following signs and symptoms:
- Sudden, severe pain below the kneecap
- High-riding patella (known as patella alta), as the kneecap is pulled upward by the quadriceps muscle
- A visible or palpable gap or hollow below the kneecap
- Inability to actively extend the knee or straighten the leg
- Swelling and bruising around the knee
- Difficulty or inability to walk or bear weight
Diagnosis
Diagnosis is typically established through a combination of clinical examination and imaging studies:
- Physical examination: Assessment of active knee extension, palpation of the tendon (gap, high-riding patella)
- X-ray: Detection of patella alta and exclusion of bony injuries
- Ultrasound: Rapid bedside evaluation of tendon integrity
- Magnetic Resonance Imaging (MRI): The gold standard for accurately determining the extent of the tear and identifying associated injuries
Treatment
Surgical Treatment
A complete patellar tendon rupture almost always requires surgical repair. The torn tendon is reattached to the bone using specialised sutures and anchor systems. Early surgical intervention is associated with better outcomes. In chronic or delayed cases, tendon reconstruction using a graft may be necessary.
Conservative Treatment
Partial tears without complete loss of extensor function may be managed conservatively in selected cases, using a knee brace in full extension, physiotherapy, and a gradual rehabilitation programme.
Rehabilitation
Surgical repair is followed by an intensive rehabilitation programme that can span several months and typically includes:
- Physiotherapy to restore muscle strength and range of motion
- Gradual, progressive weight-bearing
- Sport-specific training before return to athletic activity
Full recovery generally takes between 6 and 12 months, depending on the severity of the injury and the patient's overall health.
References
- Rajasekhar R, Ahmed I, Bhatt R. - Patellar tendon rupture: a review. - EFORT Open Reviews, 2021; 6(11): 956-963. PubMed.
- Longo UG et al. - Epidemiology, genetics and biological factors of patellar tendinopathy. - Disability and Rehabilitation, 2008; 30(20-22): 1664-1668. PubMed.
- Browner BD et al. - Skeletal Trauma: Basic Science, Management, and Reconstruction. 5th Edition. Elsevier Saunders, 2015.
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