Fortunately, patellar tendon ruptures are not all that common. But when they do happen, it can be debilitating. The injury usually happens in jumping athletes where there are high loads on the tendon as the athlete lands, such as the case with Leevan Sands. The injury can also occur in basketball players, due to the repetitive impact on the knee. From a functional and anatomical perspective, the patellar tendon is part of a system that straightens the knee.
The quadriceps muscle at the front of the thigh attaches to the kneecap (patella), which glides down and up as the knee bends and straightens. The patellar tendon then attaches the kneecap to the shin (tibia). When an athlete lands following a jump, the patellar tendon is quickly loaded with a force several times his body weight. The force can be so great that it exceeds the tensile strength of the tendon, causing it to break. This is a painful condition that often requires surgical repair in order to return the knee to a fully functioning status.
Types of injury
Complete Tear: Also called a patellar tendon rupture. This is where the patellar tendon is torn throughout, breaking it into two pieces. The injured athlete will not be able to straighten the knee due to the broken connection between the kneecap and shin. Treatment for this injury is almost always surgical repair. In surgery, an orthopedic surgeon will suture the broken tendon back together. The patient will then be placed in a brace for several weeks before starting physical therapy.
Partial Tear: This injury involves tearing of the patellar tendon, but not a complete severance. The treatment for this injury is based on the extent of the tear. Minor tears that are considered by the physician to be stable may be treated with a period of immobilization, followed by physical therapy to strengthen the quadriceps and surrounding musculature. Partial tears in which significant tensile strength of the tendon has been lost, and which the physician feels may be at risk for rupturing completely are usually treated surgically.
For those that present to the emergency department or their primary care doctor with a suspected patellar tendon tear, a referral to an orthopedic surgeon is generally the rule. The surgeon will make a definitive diagnosis based on the how the injury occurred, as well as clinical factors such as the location of pain, strength and mobility of the knee, and the patient’s ability to bear weight and walk. Complete tears may also be diagnosed with X-Ray, showing a “high riding patella” that is located above the knee joint rather than centered on top of it.
A patellar tendon tear is generally considered an acute injury, meaning that it was caused by a specific and sudden event. However, there are some risk factors that could lead to a tear, including chronic tendonitis of the patellar tendon. Commonly referred to as “jumper’s knee”, patellar tendonitis is an inflammation of the tendon but may also include small micro tears within the tendon fibers. This leaves the tendon weaker and more prone to further tearing during athletic maneuvers. Patellar tendonitis can be painful and is much more common than the significant tears described above.
Those affected will have pain directly over the tendon, from the bottom of the kneecap to the top of the shin. Standing from a low seated position, squatting, and of course jumping will intensify symptoms. Athletes are still the usual suspects here, but those who climb ladders or perform a considerable amount of squatting while at work may also be susceptible. Should you become affected with jumper’s knee, your physician may prescribe anti-inflammatory medications in addition to activity modification and possible bracing.
Cases that do not respond well to these treatments may be treated with local steroid injection, usually cortisone that should further reduce inflammation. However, steroid treatment does tend to weaken the tendon, increasing the likelihood of a patellar tendon tear. Therefore, physicians are very selective about who may qualify for this treatment. If a patient does physical labor as an occupation and is unable to take time off or be put on restricted duty, then they are not appropriate for this treatment. Likewise, athletes will be sidelined for the remainder of the season after receiving a cortisone injection.
We all have heard the axiom “A stitch in time saves nine.” That is a good rule of thumb to follow here. Get your knee pain treated before it gets out of control. A mild case of tendonitis is easy to manage with rest, medication, and physical therapy. As damage starts to accumulate, it becomes increasingly difficult.