Patellar Tendon Ruptures

  • 1.

    Location/anatomy of the patellar tendon

    • The patellar tendon is part of the extensor mechanism of the knee.

      The extensor mechanism is made up of the following muscles and tendons:

      • Quadriceps muscles
      • Quadriceps tendon
      • Patella (kneecap)
      • Patellar tendon

      The quadriceps muscles attach to the top of the patella (kneecap) via the quadriceps tendon. This tendon covers the patella and continues down to form the patellar tendon, which attaches the patella to the tibia (shin bone).

      Patient Info C-Patellar Tendon Rupture Image C-1 numbered 72dpi

      1. Quadriceps muscles
      2. Quadriceps tendon
      3. Patella
      4. Patellar tendon
      5. Tibia
  • 2.

    What is the main function of the patellar tendon?

    • The patellar tendon works with the rest of the extensor mechanism to move the knee from a flexed (bent) position to an extended (straight) position. This makes basic activities such as walking and kicking possible.

      If your patellar tendon is ruptured, you will no longer be able to straighten your knee, and walking or even standing on the injured leg becomes difficult because the leg will give way.

      If the patellar tendon is ruptured, instead of bending and straightening the knee, the patella is pulled upwards towards the hip. This is because the patella is no longer attached to the tibia via the patellar tendon.

  • 3.

    What are the main causes of patellar tendon rupture?

    • Patellar tendon ruptures can be caused by a direct blow to the knee just below the patella, or by a direct fall onto the knee.

      Patellar tendon ruptures can also be caused by “excessive loading”. This is when stress is placed on the quadriceps muscle in such a way that it is made to contract at the same time as being stretched. This places excessive force and tension on the patellar and quadriceps tendons, and can cause damage to either of them. Excessive loading can occur when landing with the foot flat on the ground and the knee slightly bent, after jumping from a height.

      Particularly in older people, the tendon can rupture as a result of a decreased blood supply.

      An existing condition of patellar tendonitis can develop into a rupture if it is left untreated.

  • 4.

    What is patellar tendonitis?

    • Patellar tendonitis is an inflammation of the patellar tendon, which can be caused by repetitive strain on the tendon, for example from running or other sports.

      Treatment for patellar tendonitis is generally non-surgical, and usually involves physiotherapy. The RICE method may also be used. This consists of:

      • Rest
      • Ice
      • Compression
      • Elevation

      In some cases, plasma or saline injections may be administered.

  • 5.

    Typical treatment options for patellar tendon ruptures

    •  

      Conservative treatment

      Conservative, or non-surgical treatment, is not generally recommended for patellar tendon ruptures, as the patient may not be able to extend their leg or walk properly without assistance. Surgical treatment is therefore usually necessary.

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      Surgical treatment

      For information on some typical surgical treatments for patellar tendon ruptures, please click the buttons above.

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      Autografts

      Typical surgical treatment for patellar tendon ruptures can involve autografts. This is where tissue is taken, or “harvested” from another part of the patient’s body and implanted at the site of injury to repair the patellar tendon.

      Disadvantages of autografts can include weakness in the area from which the harvested tissue is extracted. This is known as donor site morbidity. Autograft tissue also tends to debilitate (lose strength) when it is harvested, as the tissue suffers necrosis (tissue death). Some strength is gradually regained after implantation, but this can mean a longer recovery period.

    •  

      Allografts

      Alternatively, allografts can be used to repair a ruptured patellar tendon. These are similar to autografts in that harvested tissue is implanted at the injury site. However, unlike autografts, which come from the patient’s own living body, allograft tissue is cadaveric and comes from a donor.

      Like autografts, disadvantages of allografts can include a longer recovery period due to the initial loss of strength in the harvested tissue. Weakness in the area from which the tissue is harvested is eliminated with allografts, as the tissue comes from a donor rather than the patient’s own body, however there may be some risk of disease or infection transmission from the donor tissue.

    •  

      Synthetic grafts

      Synthetic grafts are similar to autografts and allografts, but instead of repairing the injury using tissue harvested from the patient or a donor, a synthetic implant (such as Neoligaments’ PatellarTape) is used.

      Unlike autografts and allografts, there is no donor site morbidity or weakening of other areas of the body and no tissue necrosis, which can mean a shorter recovery period. There is also no risk of disease or infection transmission as there can be with allografts.

  • 6.

    Repairing patellar tendon ruptures with Neoligaments’ PatellarTape

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      Implant

      The Neoligaments 30 mm x 800 mm Poly-Tape implant (PatellarTape) is indicated for patellar tendon reconstruction. The PatellarTape can be implanted alone, or in conjunction with the Neoligaments Fastlok fixation device.

      The PatellarTape is a textile implant made from polyethylene terephthalate (polyester), which has been in use for the reconstruction of ligaments and tendons for more than 25 years.

      The Fastlok consists of a titanium alloy staple and buckle, and is designed to securely fix polyester tapes directly to the bone.

      Patient Info C-Patellar Tendon Ruptures Image C-6a 72dpi
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      Benefits

      • The open weave structure of the PatellarTape acts as a scaffold and allows new tissue to grow through and strengthen the repair (tissue ingrowth).
      • No need to harvest tissue or grafts from anywhere else in the body, which makes for a shorter operative time as well as a shorter recovery period; particularly advantageous for active people.
      • Use of small incisions (minimally invasive) rather than “open” surgery makes the procedure suitable for patients who may have problems with wound healing (such as elderly patients, or patients following a steroid programme).
      • Specialized postoperative rehabilitation regime developed in conjunction with a leading physiotherapist.
    •  

      Surgical technique

      • The PatellarTape is passed through the quadriceps tendon just above the patella.
      • It is then crossed over the patella and passed through a bone tunnel in the tibia (shin bone), to make a figure-of-eight shape.
      • The PatellarTape is pulled tight, drawing the ends of the tendon together.
      • The ends of the ruptured tendon are secured together by sutures (stitches), and the ends of the PatellarTape are secured either by a knot or the Neoligaments Fastlok fixation device.

      Patient Info C-Patellar Tendon Ruptures Image C-6c numbered 72dpi

      1. Quadriceps muscles
      2. Quadriceps tendon
      3. Patella
      4. Ruptured patellar tendon
      5. PatellarTape
      6. Tibia
    •  

      Postoperative care and rehabilitation

      All of our rehabilitation regimes have been developed in conjunction with Ian Horsley MSc, MCSP, Clinical Lead Physiotherapist, English Institute of Sport (EIS) North West, of BackinAction Physiotherapy and Sports Injury Clinic, Wakefield.

      Below is a brief outline of the prescribed programme following surgery with the PatellarTape. If you would like to see the full rehabilitation programme, please click the link below.

      PatellarTape System Rehabilitation Programme

      Rehabilitation programmes should always be supervised by a specialist physiotherapist, and prescribed activity levels should not be exceeded before complete healing has occurred.

      Weeks 0-1:

      • Full weight bearing using crutches for stability.
      • A brace or splint is used to allow the patient to mobilize between physiotherapy sessions.

      Weeks 1-3:

      • Static cycling and pool work are commenced.
      • Crutches are discarded.
      • Brace or splint is discarded.
      • Stitches are removed.

      Weeks 3-6:

      • Balance exercises are commenced.

      Weeks 6-12:

      • Elliptical trainer and functional training are commenced.

      Week 12 onwards:

      • Jog walk and jog run exercises are commenced.
      • On agreement with the physiotherapist, return to activity is allowed.
  • 7.

    Surgeon collaboration

    • The technique for patellar tendon reconstruction using the Neoligaments 30 mm x 800 mm Poly-Tape (PatellarTape) was developed in conjunction with Mr. A. D. Toms of Royal Devon and Exeter Hospital, and Mr. S. H. White of Robert Jones and Agnes Hunt Orthopaedic Hospital.