Acute Patellar Tendon Repair

Rupture of the patellar tendon is an infrequent knee extensor mechanism injury. It tends to occur during activities when a violent eccentric contraction of the quadriceps occurs during a flexed knee posture. Patellar tendon ruptures may also occur during less strenuous activity in individuals whose tendons are weakened by systemic illness or who has had the administration of local steroids or systemic use of certain medications (i.e., steroids or fluoroquinolones). Patellar tendon ruptures can therefore represent a spectrum of disease from acute traumatic rupture to rupture due to the final stages of a degenerative tendinopathy that occurs with repetitive microtrauma or systemic processes. The diagnosis of an acute patellar tendon rupture can often be made based on a careful physical exam and evaluating the patellar height on lateral radiographs. Magnetic resonance imaging is useful to rule out concomitant injuries, which is more likely to occur among young individuals with higher energy injury mechanisms. Surgical repair soon after the injury is recommended to achieve optimal results. This is usually accomplished by accurate approximation of the ruptured tendon ends and repair of the torn extensor retinacula if present. In addition to primary tendon repair, augmentation methods to reduce strain on the primary repair and permit early range of motion can be considered. A rehabilitation program that emphasizes early range of motion, protected weight bearing, and quadriceps engagement can improve the patient outcomes of individuals recovering from patellar tendon repairs. Return to activity following acute patellar tendon repairs is favorable with a general high return to work and return to sport after acute primary patellar tendon repairs.