Patellar Tendon Repair

Overview

Patellar tendon repair is a surgical procedure to reattach a ruptured patellar tendon to the kneecap (patella). The patellar tendon connects the patella to the shinbone and is essential for straightening the knee. Complete ruptures typically require surgical repair to restore the ability to extend the knee and walk normally.

Indications

This procedure may be considered when:

• •Complete rupture of the patellar tendon
• •Inability to actively extend the knee against gravity
• •Palpable gap at the site of rupture
• •Functional limitation preventing normal activities
• •High patella position (patella alta) on imaging indicating tendon discontinuity

How It Works

The procedure typically involves several coordinated steps:

• •Preoperative evaluation includes physical examination and imaging (X-ray, MRI or ultrasound) to confirm rupture
• •Surgery is typically performed under general or regional anesthesia
• •An incision is made at the front of the knee over the patellar tendon
• •The ruptured tendon ends are identified and prepared
• •Strong sutures are passed through the tendon and patella
• •The tendon is reattached to the patella, restoring normal length and tension
• •Suture anchors or tunnels through the patella may be used for secure fixation
• •Protective cerclage wire or sutures may be placed to protect the repair during healing
• •The knee is assessed for proper tracking and extension mechanism function
• •Incision is closed and the knee may be immobilized in extension

Risks

As with any surgical procedure, potential risks include:

• •Weakness or inability to fully straighten the knee
• •Re-rupture of the repaired tendon
• •Stiffness or loss of range of motion
• •Infection of the surgical site
• •Patella fracture during or after surgery
• •Persistent pain at the repair site
• •Blood clots in the legs or lungs
• •Quadriceps weakness requiring prolonged rehabilitation
• •Need for additional surgery to address complications or remove hardware

Recovery Expectations

Recovery follows a gradual progression:

• •Knee may be immobilized in a brace locked in extension initially
• •Weight bearing is typically protected or limited in the early postoperative period
• •Range of motion is gradually increased under supervision to protect the repair
• •Physical therapy begins early focusing on quadriceps activation and protected motion
• •Full weight bearing usually progresses over 4 to 6 weeks
• •Return to normal daily activities may occur by 3 to 4 months
• •Return to sports or heavy activities may require 6 to 12 months
• •Long-term rehabilitation is essential for optimal strength recovery

Alternatives

Depending on individual circumstances, alternatives may include:

• •Non-surgical management is generally not recommended for complete ruptures in active individuals
• •Bracing and physical therapy may be considered for partial tears or in patients who cannot tolerate surgery
• •Tendon reconstruction with graft material may be needed for chronic ruptures or failed repairs

Sources

• AAOS OrthoInfo – Patellar Tendon Tear
• Mayo Clinic – Patellar Tendon Tear
• Cleveland Clinic – Patellar Tendon Rupture