From the Guidelines
The best management for a patellar tendon intrasubstance tear typically involves a conservative approach initially, unless there is a complete rupture requiring surgical intervention. This approach is supported by the evidence from 1, which recommends relative rest and reduced activity to prevent further damage and promote healing and pain relief. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-600mg three times daily with food) for 1-2 weeks can help manage pain and inflammation, as suggested by 1.
Some key points to consider in the management of patellar tendon intrasubstance tear include:
- Relative rest and activity modification to reduce stress on the tendon while maintaining some function
- Use of NSAIDs for short-term pain relief
- Application of ice for 15-20 minutes several times daily, especially after activity
- Physical therapy focusing on eccentric strengthening exercises, starting with isometric exercises and progressing to eccentric loading
- Gradual incorporation of stretching and range of motion exercises
- Consideration of ultrasound-guided corticosteroid injections or platelet-rich plasma (PRP) injections for persistent cases
According to 1, eccentric exercise is recommended to reduce symptoms, increase strength, and promote tendon healing. Additionally, deep transverse friction massage can help reduce pain, and corticosteroid iontophoresis may be effective for treating patellar tendinosus pain and function.
It's also important to note that surgery may be an effective treatment option in carefully selected patients who have failed conservative therapy, as stated in 1. However, this should be considered only after a well-managed conservative treatment trial has been attempted.
Overall, the goal of management is to allow the tendon to heal while gradually strengthening it and addressing biomechanical issues that contributed to the injury, with complete recovery typically taking 6-12 weeks depending on tear severity, as supported by the evidence from 1.
From the Research
Management of Patellar Tendon Intrasubstance Tear
The management of patellar tendon intrasubstance tear can be challenging due to the poor quality of the remaining tendon fibers.
- Operative intervention to repair the ruptured tendon is the gold standard treatment for these injuries and can be performed using a variety of techniques 2.
- Tendon repair with augmentation via bio-inductive implants has gained popularity in upper extremity literature, as it has demonstrated improved tendon strength and patient outcomes 2.
- A modified SpeedBridge repair and augmentation with a bio-inductive implant can be used to repair an intrasubstance patellar tendon rupture 2.
- In cases of chronic patellar tendon tears, techniques such as Krackow suture repair augmented by autograft semitendinosus and gracilis can be employed 3.
- The selection of an appropriate technique should be based on individual patient characteristics, resource availability, and the surgeon's expertise 3.
Non-Operative Management
Non-operative management of patellar tendinopathy, which can include intrasubstance tears, involves a variety of treatment options, including:
- Rest, physical therapy with eccentric exercises, cryotherapy, anti-inflammatories, corticosteroid injections, extracorporeal shockwave therapy, glyceryl trinitrate, platelet-rich plasma injections, and ultrasound-guided sclerosis 4.
- Injection therapies, such as platelet rich plasma, corticosteroids, autologous blood, and aprotinin, can give promising results in the management of patellar tendinopathy 5.
- Rehabilitation programs, including eccentric exercises, can be effective in the management of patellar tendinopathy 6.
Challenges and Considerations
The management of patellar tendon intrasubstance tear can be challenging due to:
- Poor tissue quality, scar tissue formation, and quadriceps atrophy 3.
- Proximal migration of the patella and heterotopic ossification can increase the complexity of the injury 3.
- The selection of an appropriate technique should be based on individual patient characteristics, resource availability, and the surgeon's expertise 3.