The patellar tendon is one of the most powerful in the human body, is about 4 or 5 centimeters long, slightly less than 3 wide and approximately one thick. We can consider it as a part of the Extensor Apparatus of the Knee, made up of the quadriceps muscle, its quadriceps tendon, the kneecap and the patellar tendon, which is inserted into the tibia.
It is a fundamental structure to keep us standing in front of gravity, necessary to walk, run and jump.
We could classify injuries of the patellar tendon in the following groups:
Tendon rupturesare usually acute, very incapacitating, and in almost all cases are treated surgically.
Tendinopathies, usually become chronic. We have abandoned the term tendinitis because there is almost never very evident inflammation, except in some moments. They are more related to overuse, almost always in sports in which running and jumping predominate. It is also the origin of anterior knee pain in patients with muscle weakness. Conservative treatment resolves most cases.
Patellar tendon ruptures
When the patellar tendon breaks, it often does so completely and abruptly. The most common is that the patient feels a sharp pain. Sometimes the tearing of the tendon is heard. From that moment on, it is not even possible to walk. In veteran patients it is more common to rupture the Tendon of the Quadriceps, that is to say a rupture of the Extensor apparatus above the kneecap.
Many of the athletes who suffer this serious injury did not previously have tendon discomfort. Most do sport on weekends or sporadically, but do not carry out a program of strengthening and stretching that prevents in some way this pathology. It is a rare injury but can be seen in football, basketball, handball, squash, or jumping.
Degeneration of tendon tissue has been shown to be a fundamental factor in favour of injury. The term for this degeneration is tendinosis.
An experienced traumatologist can diagnose the rupture simply with the story told by the patient and the physical examination, where an ascent of the kneecap can be noticed. Nevertheless, ultrasound or magnetic resonance imaging is routinely performed to find out exactly how the torn tendon is.
Surgical treatment is the most satisfactory. In cases of patients with many risks that contraindicate that the patient goes through the operating room the treatment consists of immobilization (about 6 weeks) and subsequent rehabilitation of strength.
The vast majority of patients are operated. The open repair is the technique that offers the best results for the return to the previous level of exercise. Almost always the break is very close to the bone so that a repair is made at that level, resuming the tendon at the lower pole of the kneecap, and reinforcing the area in different ways. In some patients with great degeneration or destructuring it may be necessary to use grafts or plastias with some tendon nearby as the semitendinosus.
The knee is immobilized for a few weeks and later rehabilitation is essential to achieve a good result.
Among the complications are post-operative (infection, thrombosis, wound dehiscence) and late complications (rerupture, loss of strength or limitation of knee flexion).
There are some cases in which the rupture was not detected or treated adequately initially, we call them chronic ruptures, and the surgical technique is similar, being necessary in this case more frequently the use of grafts or plastias with adjacent tendons.
If you need recommendations or help in orthopedic surgery and traumatology do not hesitate to contact me.
Dr. Leopoldo Maizo - Orthopedic Surgeon
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