The patellar tendon attaches to the tibial tubercle on the front of the tibia (shin bone) just below the front of the knee. It also is attached to the bottom of the patella (kneecap). At the top of the patella, the quadriceps tendon is attached. At the tope of the quadriceps tendon is the quadriceps muscle.
The quadriceps muscle is the large muscle on the front of the thigh. As the quadriceps muscle contracts (shortens), it pulls on the quadriceps tendon, the patella, the patellar tendon, and the tibia to move the knee from a flexed (bent) position to an extended (straight) position. Conversely, when the quadriceps muscle relaxes, it lengthens. This allows the knee to move from a position of extension (straight) to a position of flexion (bent).
The patellar tendon is prone to rupturing in individuals with a history of patellar tendon injury such as jumpers knee or degeneration due to age. Injuries of this type serve to weaken the patellar tendon and in the event of strong eccentric quadriceps contraction (contraction during lengthening of the muscle), such as landing from jump, the patella tendon may snap or rupture most commonly at the lower end of the patella.
When the patellar tendon ruptures, the patella loses its anchoring support to the tibia. Without this anchoring effect of the intact patella tendon, the patella tends to move superiorly (towards the hip) as the quadriceps muscle contracts. Without the intact patella tendon, the patient is unable to straighten the knee. If a rupture of the patella tendon occurs, and the patient tries to stand up, the knee will usually buckle and give way because the body is no longer able to hold the knee in a position of extension (straight).
The examination consists of palpating the patellar tendon and the patella. Usually, when the tendon ruptures, the patella moves upwards on the thigh. At the same time, the hole between the ends of the ruptured tendon is palpable on the front of the knee. X-rays of the knee reveal the abnormal position of the patella, indicating a rupture of the patella tendon.
Signs and Symptoms of patellar tendon rupture:
- Patellar tendon ruptures are extremely painful and may be accompanied with an audible 'pop' at the time of injury
- Swelling of the knee
- Inability to weight-bear
- Inability to straighten the knee or hold it in a straightened position
What can the athlete do?
- Apply RICE technique as soon as possible.
- Take NSAID's (e.g. Ibuprofen) for pain relief and to help decrease swelling.
- Seek professional medical assistance immediately.
- In most cases the patellar tendon becomes completely ruptured across its width and thus surgical intervention is required to repair the damage. This involves suturing (stitching) the torn tendon.
- Following surgery the patient will be advised on a specific rehabilitation plan which normally involves little or no weight-bearing on the affected knee and wearing a knee brace to prevent the knee from bending. This may be required for more than 6 weeks.
- Once the knee brace has been removed exercises to regain full range of movement and build up the strength of the quadriceps muscle group should be carried out.
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