What is the treatment for a partial tear of the patella tendon?

Treatment for Partial Tear of the Patella Tendon

The treatment for a partial tear of the patella tendon should begin with conservative management including relative rest, activity modification, eccentric strengthening exercises, and cryotherapy, with surgical intervention only considered after 3-6 months of failed conservative treatment. 1

Diagnostic Evaluation

• MRI is the gold standard imaging modality for evaluating patellar tendon tears, with high sensitivity (95%) and specificity (95%) 1
• Ultrasound is a useful alternative with high specificity (94%) but lower sensitivity (58%), making it better at confirming rather than ruling out tendinopathy 1
• Tendon thickness >8.8mm on axial MRI views strongly correlates with the presence of a partial tear, while thickness >11.45mm and tear thickness >55.7% may predict the need for surgical management 2

Conservative Management (First-Line Treatment)

• Implement relative rest and activity modification to reduce pain-causing activities while avoiding complete immobilization to prevent muscle atrophy 1
• Apply cryotherapy (ice) through a wet towel for 10-minute periods for short-term pain relief 1
• Initiate eccentric strengthening exercises as the cornerstone of treatment to reduce symptoms, increase strength, and promote tendon healing 3, 1
• Incorporate tensile loading to stimulate collagen production and guide normal alignment of newly formed collagen fibers 1
• Consider deep transverse friction massage to help reduce pain 3, 1
• Up to 90% of patients with patellar tendinitis can be successfully treated conservatively with expectation of good results 4
• Most partial tears (particularly those <50% of tendon thickness) respond well to conservative management 2

When to Consider Surgical Intervention

• Surgical intervention should be considered when conservative management fails after 3-6 months of appropriate treatment 1, 5
• Patients with tendon thickness >11.45mm and/or tear thickness >55.7% on axial MRI are less likely to improve with nonoperative treatment 2
• Surgical options include:
  • Open techniques: longitudinal splitting of the tendon, excision of abnormal tissue, resection and drilling of the inferior pole of the patella 5
  • Arthroscopic techniques: shaving of the dorsal side of the proximal tendon, removal of hypertrophic synovitis, tendon debridement 5
• Over 90% of athletes can return to sport following either conservative or surgical treatment, with average return time of 3.9 months 6

Important Considerations and Pitfalls

• Avoid corticosteroid injections directly into the tendon substance as they may inhibit healing, reduce tensile strength, and potentially predispose to spontaneous rupture 1
• Avoid complete immobilization to prevent muscular atrophy and deconditioning 1
• Most partial tears (91%) involve the posterior and posteromedial regions of the proximal tendon 2
• Regular assessment of pain levels, range of motion, and functional improvement should guide progression of treatment 1

Anatomical Considerations

• Pay special attention to anatomic deformities such as forefoot and heel varus and excessive pes planus or foot pronation, which may contribute to tendon problems 3
• The decline squat test places increased load on the patellar tendon and often reproduces a patient's pain, helping to confirm diagnosis 3