Patellar Tendon Tear / Disruption

with Rehab

A patellar tendon tear or disruption is a complete tear of the tendon below the kneecap. The patellar tendon attaches the thigh muscle (quadriceps) to the shinbone (tibia). These muscles are responsible for bending the knee and flexing the hip. A tear in the patellar tendon results in a disability to perform these actions.

SYMPTOMS

  • A "pop" or tear felt in the knee or under the kneecap, at the time of injury.

  • Pain, tenderness, swelling, warmth, or redness over and around the patellar tendon.

  • Pain that gets worse when trying to forcefully straighten the knee or bend the knee.

  • Inability to straighten the knee when seated.

  • Crackling sound (crepitation) when the tendon is moved or touched.

  • Bruising (contusion) around the knee within 48 hours of injury.

  • Loss of firm fullness when pushing on the area where the tendon ruptured (a defect between the ends of the tendon where they separated from each other).

CAUSES

The patellar tendon tears when a force is placed on it that is greater than it can handle. Common causes of injury include:

  • A stressful incident, such as with jumping, hurdling, or starting a sprint.

  • Direct hit (trauma) to the knee.

RISK INCREASES WITH:

  • Sports that require sudden, explosive muscle contraction, such as those involving jumping or quick starts.

  • Running or contact sports.

  • Poor strength and flexibility.

  • Previous patellar tendon injury.

  • Untreated patellar tendinitis.

  • Corticosteroid injection into the patellar tendon. (Corticosteroid injections weaken tendons.)

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow for adequate recovery between workouts.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Protect the knee with taping, protective strapping, or elastic compression bandage during activity.

PROGNOSIS

If treated properly, patellar tendon tears usually heal, with a return to sports within 6 to 9 months after injury.

RELATED COMPLICATIONS

  • Weakness of the thigh (quadriceps) muscles, especially if the tear is left untreated.

  • Re-rupture of the tendon after treatment.

  • Prolonged disability.

  • Risks of surgery: infection, injury to nerves (numbness, weakness, or paralysis), bleeding, knee stiffness, knee weakness, pain when sitting for long periods, pain when getting up from a seated position and when kneeling or squatting, pain going up or down stairs or hills, and knee giving way or buckling.

TREATMENT

Treatment first involves resting from any activities that aggravate the symptoms. The use of ice and medicine will help reduce pain and inflammation. Applying a compression bandage and elevating the knee above the level of the heart will also help reduce inflammation. Definitive treatment for patellar tendon tears is surgery, because contraction of the quadriceps tendon prevents healing of the tendon. Surgery often involves using stitches (sutures) to sew the ends of the tendon back together. Surgery is followed by restraint of the knee, to allow for healing. After restraint, it is important to perform strengthening and stretching exercises to help regain strength and a full range of motion. These exercises may be completed at home or with a therapist.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given, if your caregiver thinks they are needed. Use only as directed and only as much as you need.

COLD THERAPY

Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

SEEK MEDICAL CARE IF:

  • Pain increases, despite treatment.

  • Cast discomfort develops.

  • Any of the following occur after surgery: signs of infection, including fever, increased pain, swelling, redness, drainage of fluids, or bleeding in the affected area.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Patellar Tendon Tear/Disruption

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

RANGE OF MOTION - Knee Flexion and Extension, Active-Assisted

  • Sit on the edge of a table or chair with your thighs firmly supported. It may be helpful to place a folded towel under the end of your right / left thigh.

  • Flexion (bending): Place the ankle of your healthy leg on top of the other ankle. Use your healthy leg to gently bend your right / left knee until you feel a mild tension across the top of your knee.

  • Hold for __________ seconds.

  • Extension (straightening): Switch your ankles so your right / left leg is on top. Use your healthy leg to straighten your right / left knee until you feel a mild tension on the backside of your knee.

  • Hold for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION - Knee Flexion, Active

  • Lie on your back with both knees straight. (If this causes back discomfort, bend your healthy knee, placing your foot flat on the floor.)

  • Slowly slide your heel back toward your buttocks until you feel a gentle stretch in the front of your knee or thigh.

  • Hold for __________ seconds. Slowly slide your heel back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING EXERCISES - Patellar Tendon Tear/Disruption

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided by your caregiver.

STRENGTH - Quadriceps, Isometrics

  • Lie on your back with your right / left leg extended and your opposite knee bent.

  • Gradually tense the muscles in the front of your right / left thigh. You should see either your kneecap slide up toward your hip or increased dimpling just above the knee. This motion will push the back of the knee down toward the floor, mat, or bed on which you are lying.

  • Hold the muscle as tight as you can without increasing your pain for __________ seconds.

  • Relax the muscles slowly and completely between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Quadriceps, Straight Leg Raises

Quality counts! Watch for signs that the quadriceps muscle is working, to be sure you are strengthening the correct muscles and not "cheating" by substituting with healthier muscles.

  • Lay on your back with your right / left leg extended and your opposite knee bent.

  • Tense the muscles in the front of your right / left thigh. You should see either your kneecap slide up or increased dimpling just above the knee. Your thigh may even shake a bit.

  • Tighten these muscles even more and raise your leg 4 to 6 inches off the floor. Hold for __________ seconds.

  • Keeping these muscles tense, lower your leg.

  • Relax the muscles slowly and completely between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Hip Abductors, Straight Leg Raises

Be aware of your form throughout the entire exercise, so that you exercise the correct muscles Poor form means that you are not strengthening the correct muscles.

  • Lie on your side so that your head, shoulders, knee and hip line up. You may bend your lower knee to help maintain your balance. Your right / left leg should be on top.

  • Roll your hips slightly forward, so that your hips are stacked directly over each other and your right / left knee is facing forward.

  • Lift your top leg up 4-6 inches, leading with your heel. Be sure that your foot does not drift forward or that your knee does not roll toward the ceiling.

  • Hold this position for __________ seconds. You should feel the muscles in your outer hip lifting. (You may not notice this until your leg begins to tire.)

  • Slowly lower your leg to the starting position. Allow the muscles to fully relax before beginning the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Hip Extensors, Straight Leg Raises

  • Lie on your stomach on a firm surface.

  • Tense the muscles in your buttocks to lift your right / left leg about 4 inches. If you cannot lift your leg this high without arching your back, place a pillow under your hips.

  • Keep your knee straight. Hold __________ seconds.

  • Slowly lower your leg to the starting position and allow it to relax completely before starting the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Hip Adductors, Straight Leg Raises

  • Lie on your side so that your head, shoulders, knee and hip line up. You may place your upper foot in front, to help maintain your balance. Your right / left leg should be on the bottom.

  • Roll your hips slightly forward, so that your hips are stacked directly over each other and your right / left knee is facing forward.

  • Tense the muscles in your inner thigh and lift your bottom leg 4-6 inches. Hold this position for __________ seconds.

  • Slowly lower your leg to the starting position. Allow the muscles to fully relax before beginning the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.