Patellar Tendon Tear
Patellar tendon tears can happen for many reasons and affect many different people. It can occur from chronic overuse or may arise from sudden traumatic incidents. It can be the result of accidents around the home. Often, athletes suffer from this painful condition that can prevent them from participating in athletic competitions or doing the sport they love. While painful, it’s possible to restore range of motion and strengthen the knee, that is, with the right orthopedic surgeon like those at Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado.
OVERVIEW
The knee is one of the most complex joints in the body, comprised of muscles, tendons, ligaments, and cartilage that work together to provide stability, support, and movement. Not surprisingly, the knee is susceptible to injury because of the many roles it plays. The patellar tendon attaches the bottom of the kneecap (patella) to the top of the shinbone (tibia). The patella is attached to the quadriceps muscles by the quadriceps tendon. Working together, the quadriceps muscles, quadriceps tendon, and patellar tendon straighten the knee.
WHAT IS A PATELLAR TENDON TEAR?
There are three principal types of patellar tendon tears which are graded 1-3.
Grade 1: Stretching of the patellar tendon fibers. Also referred to as a sprain.
Grade 2: Partial-thickness tear. A portion of the patellar tendon is torn, but the surrounding fibers are intact.
Grade 3: Complete tear. The tear has extended across all the patellar tendon fibers, and the tendon ruptures. A rupture is similar to when a rubber band breaks when overstretched. Two loose ends are physically separated. When the patellar tendon is completely torn, the tendon is separated from the kneecap. Without this attachment, you cannot straighten your knee.
CAUSES
Usually, a very strong force is required to tear the patellar tendon, such as falls resulting in direct impact to the front of the knee. Jumping can cause a tear when the knee is bent and the foot planted, like when landing from a jump or jumping up. Inflammation of the patellar tendon, called patellar tendinitis, weakens the tendon and may cause small tears. Chronic diseases, including rheumatoid arthritis and diabetes mellitus, can cause patellar tendon tears. With rheumatoid arthritis, it affects the joints. It causes the joints to become unstable and, in turn, causes weak tendons. As the disease progresses, it will affect the patellar tendon. As we age, the patellar tendon does not fold back upon itself during extension, which puts it at risk for strain and tearing.
ATHLETES AND PATELLAR TENDON TEARS
Athletes participating in certain sports are more likely to suffer a complete or partial patellar tendon tear. Football, basketball, soccer, lacrosse, and other sports that involve large amounts of jumping are the most likely to lead to overuse injuries, weakening the tendon over time. Volleyball players are especially susceptible to patellar tendonitis, a condition colloquially known as “jumper’s knee.” It is estimated the prevalence of jumper’s knee among elite volleyball athletes is as high as 50 percent. If a person pushes themselves to the limit, it will cause tears in the tendons over time. This could make even a simple, low-impact workout such as walking difficult. Anabolic steroids have been known to cause patellar tendon tears in men who lift heavy weights. Men feel that they can go heavier with the weights, and by doing so, this causes stress on the joints and can tear the patellar tendon. When lifting weights, men have to use their knees to pick up the weights. The heavier the weight is, the more pressure is put on the knees. Bad form when picking up heavy weights can weaken the patellar tendon and cause a tear, as well.
SYMPTOMS
At the time of injury, many people report feeling a sudden tear or pop in the knee. At times, this “pop” felt during a patellar tendon rupture may also be audible to observers. Pain and swelling may follow, and it will be hard to straighten the knee. Additional symptoms include:
- An indentation at the bottom of your kneecap where the patellar tendon is torn
- Bruising
- Tenderness
- Cramping
- The kneecap may move up into the thigh because it is no longer anchored to the shinbone
- Difficulty walking due to the knee buckling or giving way
NON-SURGICAL TREATMENT
Very small, partial tears respond well to nonsurgical treatment. The RICE method — an acronym for Rest, Ice, Compression, and Elevation — is an effective at-home preventive treatment to utilize after intense workouts or minor injuries that could add up over time. Over-the-counter medications can be used to manage pain and discomfort in the days following a less severe patellar tendon tear. Immobilization is often an effective treatment option for a small patellar tendon tear. Braces can be used to minimize the use of the knee joint and allow the tear to heal, and physical therapy can help strengthen the quadriceps muscles.
WHEN IS SURGERY INDICATED?
Even with rehabilitation exercises, there is a limit to what the knee can heal from on its own. A complete patellar tendon rupture will require surgery, as will a partial patellar tendon injury that has not responded adequately to non-surgical methods. Surgical repair reattaches the torn tendon to the kneecap. There are many types of surgical procedures that are dependent on the severity and extensiveness of the tear. and a good orthopedic surgeon will discuss the options.
GETTING THE RIGHT DIAGNOSIS
Above all, a good orthopedic surgeon needs to be thorough in discussing your symptoms and getting a detailed medical history. At this point, your doctor will examine your knee. To determine the exact cause of your symptoms, your surgeon will test how well you can extend or straighten your knee. While this part of the examination can be painful, it is important to identify a patellar tendon tear. To confirm the diagnosis, your surgeon may order some imaging tests, such as an x-ray or MRI scan. This will help them rule out a different injury that has similar symptoms. The doctor will consider many things when planning your treatment, including the type and size of the tear, your activity level, and your age. Getting the right diagnosis requires getting the right orthopedic specialist. At the Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado, you can trust you will be getting the right care. A patellar tendon tear can be mistaken for other disorders, such as bursitis or meniscal tears, and if not treated correctly, it can lead to weakness, stiffness, and muscle atrophy. Get the right help before that can happen. Schedule an appointment online now to get the right diagnosis.