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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 often results from sudden force and usually requires surgical repair.

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Things worth knowing about "Patellar tendon rupture"

A patellar tendon rupture is a complete or partial tear of the tendon below the kneecap. It often results from sudden force and usually requires surgical repair.

What is a Patellar Tendon Rupture?

A patellar tendon rupture is a complete or partial tear of the patellar tendon (ligamentum patellae), which connects the kneecap (patella) to the shinbone (tibia). This tendon is a key component of the knee extensor mechanism and transmits the force of the quadriceps muscle to the lower leg. A rupture of this tendon significantly impairs knee function and constitutes a serious orthopaedic injury.

Causes

A patellar tendon rupture is most commonly caused by a sudden, forceful load on the knee joint. Common causes include:

Abrupt deceleration or landing during sports activities (e.g., basketball, volleyball, football)
Direct trauma such as a fall onto the knee
Strong eccentric loading of the extensor mechanism

Certain pre-existing conditions and risk factors can increase the likelihood of a rupture:

Pre-existing tendinopathy (degenerative changes in the tendon)
Long-term use of corticosteroids or fluoroquinolone antibiotics
Metabolic conditions such as diabetes mellitus, chronic kidney disease, or gout
Systemic diseases such as rheumatoid arthritis or systemic lupus erythematosus
Older age (typically from around 40 years onwards)

Symptoms

The symptoms of a patellar tendon rupture are usually clear and appear immediately after the injury:

Sudden, severe pain below the kneecap
An audible or palpable popping or tearing sensation at the time of injury
Swelling and bruising (haematoma) around the knee joint
High-riding kneecap (patella alta) due to the pull of the quadriceps muscle
Inability to actively extend the knee or perform a straight leg raise
A palpable gap or defect in the tendon just below the kneecap
Inability to walk or bear weight

Diagnosis

Diagnosis is based on clinical examination and imaging studies:

Physical examination: Assessment of active knee extension, palpation of the tendon for a defect, and evaluation of the kneecap position
X-ray: May reveal a high-riding patella (patella alta) as an indirect sign of rupture
Ultrasound: A quick and cost-effective method to visualise the tendon tear
Magnetic resonance imaging (MRI): The gold standard for accurately assessing the extent of the tear and planning surgical repair

Treatment

Conservative Treatment

Non-surgical management is only appropriate for incomplete partial tears without significant loss of function. It involves immobilisation, pain management, and intensive physiotherapy.

Surgical Treatment

A complete rupture requires surgical repair, ideally within the first few weeks following the injury. The standard procedure is a primary tendon repair, in which the torn tendon ends are sutured back together. To protect the repair, a cerclage wire or tendon augmentation is often used as an additional measure.

Rehabilitation

After surgery, a structured rehabilitation programme is essential:

Immobilisation of the knee in a brace or orthosis for several weeks
Gradual increase in weight-bearing under physiotherapeutic supervision
Progressive restoration of muscle strength, coordination, and range of motion
Return to full sporting activity typically after 6 to 12 months

Prognosis

With timely surgical repair and consistent rehabilitation, the prognosis for a patellar tendon rupture is generally good. Most patients regain full or near-full knee function. However, delayed treatment may result in permanent weakness of the extensor mechanism and a poorer functional outcome.

References

Insall & Scott: Surgery of the Knee, 5th Edition. Churchill Livingstone, 2011.
Siwek CW, Rao JP. Ruptures of the extensor mechanism of the knee joint. Journal of Bone and Joint Surgery, 1981; 63(6):932-937. Available via PubMed.
Rodriguez-Merchan EC. Repair of acute and chronic patellar tendon ruptures. The American Journal of Orthopedics, 2014; 43(1):12-16. Available via PubMed.

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