The quadriceps muscle and tendon and the patella and the patellar tendon allow the ability to extend the leg. A rupture of the either tendon is a rare and debilitating injury that almost always requires surgery to restore knee function.
The patellar tendon attaches the bottom of the kneecap to the shinbone or tibia. The patella is also attached at the top by the quadriceps tendon. Tendons are strong, flexible tissues that move the bones.
About tendon tears
A tear may be partial or complete. Small or partial tears can impair walking and the ability to perform daily activities. A large complete tear is disabling. A complete tear often occurs where the tendon attaches at the kneecap, and frequently also breaks off a piece of kneecap bone. When either tendon is completely torn the patient will be unable to straighten their knee or bear weight on the knee.
Small tears can be treated without surgery. However, to regain knee function, surgery is necessary to reattach the complete tendon rupture. Surgery works best when performed soon after the injury.
- The knee tendons are commonly injured in middle age from trauma during running and jumping sports, a fall, an awkward landing from a jump, and direct impact to the front of the knee.
- Ruptures of the quadriceps tendon are rare and more common in men over age 40.
- Patellar tendon ruptures are even more rare and more frequent in men under age 40 usually due to tendon weakness.
- Tendon weakness can predispose to a tear. Tendon weakness can be caused by patellar tendinitis which is common in runners and people who participate in jumping sports.
- Steroid injections, and certain diseases such as diabetes, kidney disease, infection, metabolic disease, and high cholesterol increase the risk of a tear. Prior knee surgery including total knee arthroplasty can also increase the risk of a knee tendon tear.
- pain with activity
- pain and swelling
- difficulty walking
- knee buckling
- a popping sound or sensation
Dr. Petrigliano will review your medical history including a history of conditions that can predispose to a tear. He will ask whether you have tendonitis, whether and how you injured your knee and when knee pain began and ask about your symptoms.
He will examine the knee, perform a knee extension test, and test range of motion. Imaging studies include x-rays to evaluate the bones and an MRI to evaluate the soft tissues including the tendons.
Treatment options depend on the size of the tear, your age and activity level.
- Small partial tears respond well to conservative nonsurgical management including bracing and crutches to prevent weight bearing for a month or more. Pain management will include over the counter and prescription pain medications. Physical therapy will begin when pain and swelling calm down.
- Complete tears of the patellar or quadriceps tendon always require prompt diagnosis and early surgery to reattach the tendon to the kneecap to prevent scarring. Surgery may be performed as an outpatient or in hospital for one night. An acute tear can be repaired with reattachment. However, a chronic tear, older than 3 weeks, may require tendon reconstruction.
The tendon is reattached to the bone with sutures. However, if the tendon is degenerated tendon reconstruction with an allograft or autograft graft will be necessary. Results are good to excellent.
Most patients can return to their preoperative level of sport with a low risk of rerupture. The overall return to play after both PT and QT repair is high.
Why choose Dr. Petrigliano?
Dr. Frank Petrigliano is an orthopaedic surgeon who was fellowship trained in sports medicine and shoulder surgery at the prestigious Hospital for Special Surgery where he provided care to athletes of all ages. He currently serves as the head team physician for the LA Kings hockey team and associate team physician for USC Athletics. Dr. Petrigliano is a renowned orthopaedic surgeon and researcher who employs state of the art treatments and procedures to get you back to your active life and back to sport. He always treats his patients with compassion and respect. Dr. Petrigliano is located in El Segundo California, and serves greater Los Angeles, Beverly Hills, the South Bay, and the Santa Clarita Valley. Contact Dr. Petrigliano to schedule a consultation today.
At a Glance
Dr. Frank Petrigliano
- Associate Professor of Orthopaedic Surgery at USC
- Chief of the Epstein Family Center for Sports Medicine
- Team physician for the LA Kings and USC Athletics
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