What is the treatment for a patella tendon tear?

Treatment for Patellar Tendon Tear

Surgical repair is the recommended treatment for complete patellar tendon tears, while partial tears may be managed conservatively depending on tear size and location. 1, 2

Diagnostic Evaluation

• MRI is the gold standard for evaluating patellar tendon tears with high sensitivity (95%) and specificity (95%) 1
• Ultrasound is an alternative with high specificity (94%) but lower sensitivity (58%) 1
• Clinical examination typically reveals:
  • Palpable gap at the injury site 2
  • Inability to perform straight leg raise (in complete tears) 2
  • Patella alta on radiographs compared to uninjured knee 2

Treatment Algorithm

For Complete Tears:

1. Surgical Repair 2

   • Technique options:
     • Transosseous repair: High-strength nonabsorbable sutures placed in running locking fashion along injured tendon, secured through bone tunnels in patella 2
     • Suture anchor technique: Allows smaller incision with less soft-tissue dissection 2
     • Cerclage wire protection may be added to strengthen repair 3

2. Post-operative Management 3, 2

   • Early mobilization with protected weight-bearing in orthosis 3
   • Safe-zone knee passive range of motion immediately 2
   • Avoidance of active extension for 6 weeks 2
   • Progressive rehabilitation after 6 weeks with full range of motion and concentric strengthening 2

For Partial Tears:

1. Conservative Management (for tears <50% of tendon thickness) 1, 4

   • Relative rest and activity modification 1
   • Cryotherapy (ice) for short-term pain relief, applied through wet towel for 10-minute periods 1
   • Eccentric strengthening exercises to promote tendon healing 1
   • Deep transverse friction massage to reduce pain 1
   • Tensile loading to stimulate collagen production 1

2. Surgical Intervention (for tears >50% of tendon thickness or when conservative management fails after 3-6 months) 1, 4

   • MRI findings that predict need for surgery:
     • Tendon thickness >11.5 mm 4
     • Tear thickness >55.7% of total tendon 4

Special Considerations

• Avoid complete immobilization to prevent muscular atrophy and deconditioning 1
• Avoid corticosteroid injections directly into the tendon as they may inhibit healing and reduce tensile strength 1
• For chronic tears, augmentation with grafts (such as Achilles tendon allografts) may be necessary 5
• Most partial tears are located in the posterior or posteromedial regions of the proximal tendon 4
• Patellar tendon thickness >8.8 mm on axial MRI strongly correlates with presence of a tear 4

Expected Outcomes

• With appropriate surgical repair and rehabilitation, excellent functional outcomes can be achieved 3
• Studies show mean Lysholm knee scores of 97 (range 92-100) following surgical repair with early mobilization 3
• Patients with properly treated tears can typically return to previous level of activity 6
• Potential complications include quadriceps weakness, loss of knee flexion, and hardware issues requiring removal 5