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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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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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