Located just below the kneecap, the patella tendon is part of the makeup of the extensor mechanism of the knee, which is responsible for the extension of the knee joint, allowing us to straighten our legs and stand up. Patellar tendon repair is a surgical intervention conducted to address patellar tendon rupture.
Below are deciding factors as to when a patella tendon repair is performed:
An acute patella tendon injury is sustained. When a patient presents symptoms of a third-degree injury, reconstruction surgery is non-negotiable. This means one has sustained a complete tear or rupture of the ligament and possibly with evidence of a multi-ligamentous injury. This is common among athletes who injure themselves from jumping and landing incorrectly and swiftly changing directions.
The conservative approach provides no relief of symptoms. If 2nd-degree injuries show no improvement and present signs of progression to the latter stage.
Patients specify a desire to return to sports or athletic endeavours; patients that are athletes tend to seek treatment with the quickest recovery rate where a patellar tendon repair may be considered.
How does patella tendon repair work?
Unlike most injuries of the knee joint, a patellar tendon rupture is not treated arthroscopically. Instead, an open surgery is conducted to provide the surgeon with direct access to the kneecap as the patella tendon is present outside the joint.
First, incisions are made on the front of the knee, providing visual access to the conditions of the joint. Holes are then created in the patella and sutures are tied into the holes, subsequently reattaching the patella to the kneecap.
If any other injuries at the kneecap are evident, these will be treated as well. You will be informed during the diagnostic phase about these injuries if they are identified from imaging tests. However, if these injuries have evaded the imaging tests, your surgeon will address them during surgery.
Finally, the site of surgery is cleaned with antiseptic solutions to prevent infections. The incisions are then closed with sutures.
Benefits of patella tendon repair
Prevents future degenerative conditions such as arthritis
Prevents damage to the quadriceps tendons
What conditions does patella tendon repair treat?
Patella tendon repair can be used to treat the following conditions:
Patellar tendonitis: inflammation of the patellar tendon can cause pain, swelling, and affect daily activities such as walking and running.
Rheumatoid arthritis: a type of arthritis, rheumatoid arthritis is an inflammatory and autoimmune disease that can cause damage to the patella tendon.
Patella tendon rupture: the patella tendon can rupture due to a variety of reasons such as injury, chronic diseases such diabetes, chronic renal disease, and previous surgeries.
What results can I expect?
Patella tendon injuries are generally uncommon. When performed, one may expect relief from pain and restored functionality of the knee. The period of complete recovery and return to sport may range anywhere from 6-12 months depending on the severity of the injury incurred.
Some muscle atrophy is to be expected in the following weeks as your knee will be immobilised post-surgery. Via physiotherapy, you will be treated to obtain at least 80-90% strength of your injured knee.
Results will vary from person to person, depending on the severity of the issue and your overall health. Your orthopaedist can give you a better idea of what to expect based on your individual needs and circumstances.
How many treatment sessions do I need?
Patella tendon repair is a one-off treatment. However, re-injuries are quite common especially if patients have incurred previous injuries such as ACL injuries or a mistake had occurred during your previous surgery.
If you are seeking treatment for a revised patellar tendon repair an optimised approach is required if there are:
Presence of quadriceps atrophy
Patellar tendon contracture
Improper patella height
Treatment does not stop at surgery. To attain complete recovery, one will need to attend physiotherapy sessions and appropriately manage medications such as painkillers and antibiotics. The frequency of physiotherapy sessions will vary according to your personal goals such as the need to return to athletic endeavours.
Your orthopaedic surgeon will be able to provide you with a bespoke treatment plan, tailored to your needs and requirements.
Dr Puah KL is our Senior Consultant Orthopaedic Surgeon at Artisan Sports & Orthopaedic Surgery. He used to serve the sports service of Singapore General Hospital - the highest volume trauma centre for orthopaedics in Singapore.