What is the treatment for a patellar tendon laceration?

Treatment for Patellar Tendon Laceration

Surgical repair is the mainstay of treatment for patellar tendon lacerations, with primary repair augmented with cerclage wire, Dall-Miles cable, or non-absorbable sutures showing the best clinical outcomes and lowest failure rates (2%). 1

Diagnostic Approach

• Clinical diagnosis includes:
  • Palpable defect in the tendon
  • Localized patellar tendon tenderness
  • Inability to actively extend the knee 2
• Imaging confirmation:
  • Standard radiographs should be the first imaging study 3
  • Look for patella alta (high-riding patella) compared to uninjured knee 2
  • Advanced imaging (ultrasound or MRI) may be needed when diagnosis is uncertain 2

Surgical Management

Acute Repairs

1. Primary Repair Techniques:

   • Transosseous tunnel technique: Drill 3 bone tunnels through patella to shuttle sutures 4
   • Suture anchor technique: Allows smaller incision with less soft-tissue dissection 4
   • Both use non-absorbable high-strength sutures or suture tape in running locking fashion 4

2. Augmentation Options:

   • Semitendinosus autograft augmentation allows immediate mobilization and improved rehabilitation outcomes 5
   • Augmentation particularly beneficial for:
     • Mid-substance injuries
     • Cases with compromised tissue quality 4

Chronic Repairs

• Autogenous grafts produce significantly better outcomes than primary repair alone for chronic cases 1
• Percutaneous reconstruction using semitendinosus tendon has shown excellent results 6
• May require additional procedures:
  • Quadriceps "picrusting" (lengthening)
  • Lateral release to mobilize the patella 6

Rehabilitation Protocol

Phased Approach

1. Initial Phase (0-4 weeks):

   • Protected weight-bearing in an orthosis
   • Safe-zone knee passive range of motion
   • Avoid active extension 4, 3

2. Intermediate Phase (4-8 weeks):

   • Progressive strengthening exercises
   • Eccentric training 3

3. Advanced Phase (8-12 weeks):

   • Occupation-specific training
   • Functional exercises 3

4. Return to Activity:

   • Typically by 6 months post-operatively 2
   • Criteria for return:
     • Complete resolution of pain
     • Full range of motion
     • Strength symmetry >90% compared to uninjured side
     • Successful completion of functional tests 3

Clinical Pearls and Pitfalls

• Time to surgery is the most important prognostic factor for success in complete tears 2
• Immediate mobilization following repair (particularly with augmentation) decreases recovery period and improves rehabilitation outcomes 5
• Regular assessment at 2,6, and 12 weeks is necessary to evaluate progress 3
• Avoid immobilization as it can lead to arthrofibrosis and quadriceps atrophy 3
• Consider NSAIDs such as ibuprofen (up to 2.4g daily) or naproxen (500mg twice daily) for short-term pain relief 3