Patellar Tendon Injuries Surgical Treatment

Surgery is recommended for:

• Complete patellar tendon ruptures: Surgery is required to restore the extensor mechanism.
• Partial tears that fail nonoperative treatment: Tears that progress or do not heal with bracing and rehabilitation.
• Chronic or neglected ruptures: Tears diagnosed late, in which the tendon has retracted and scarred.
• Failed prior repairs: Tendons that have re-torn or not healed after an earlier surgery.
• Recalcitrant patellar tendinopathy: Symptoms that persist despite a well-executed rehabilitation program carried out over at least six months.

After a complete rupture, the kneecap is pulled upward by the quadriceps, and the tendon begins to retract and scar. Repairs performed within the first few weeks are generally more straightforward, while a neglected rupture often requires a more complex reconstruction. Ruptures are sometimes missed at the initial visit because a patient can still walk with a stiff, straight leg, which is why Dr. Rynecki Baker emphasizes prompt evaluation of any knee injury that leaves a patient unable to straighten the knee.

Patellar tendon repair is the treatment for an acute complete rupture. Through an incision at the front of the knee, Dr. Rynecki Baker reattaches the torn tendon to the lower pole of the kneecap using suture anchors. Careful attention is paid to restoring proper tendon length and kneecap height, which are important for normal knee mechanics.

In some cases, augmentation is added to protect the repair during early healing. This typically involves a strong suture or tape placed around the kneecap and the tibial tubercle to share load with the repaired tendon, which can allow for earlier motion. This also may involve a tendon graft, using your own hamstring tendon or an allograft.

Reconstruction is reserved for chronic, neglected, or failed repairs, where the native tendon is retracted or of poor quality. Graft tissue, either from the patient’s own body or from a donor, is used to rebuild the tendon and restore the extensor mechanism. The kneecap is brought back down to its proper position before the graft is secured.

Debridement is the surgical option for tendinopathy that does not respond to nonoperative care. The degenerative tissue at the lower pole of the kneecap is removed and the healthy tendon is repaired. This can be performed open or arthroscopically, depending on the pattern of disease.

After repair or reconstruction

• Early protection: The knee is protected in a brace, with gradual increases in permitted bending while the tendon heals to bone.
• Quadriceps activation: Early emphasis is placed on quadriceps activation to prevent the profound weakness that follows these injuries.
• Weightbearing: Weightbearing in the brace is allowed right away with the assistance of crutches. Gait mechanics are a focus in physical therapy as you are permitted to bend your knee more and more.
• Motion and strengthening: Range of motion and strengthening advance over the following months.
• Return to sport: Return to sport is guided by strength and functional testing rather than the calendar alone.

After debridement for tendinopathy

Recovery is also measured in months. Rehabilitation follows a progressive tendon loading program similar to nonoperative treatment, and patience with the program is what produces durable results. Every patient receives a written protocol specific to the procedure performed, and Dr. Rynecki Baker works closely with each patient and their physical therapist throughout recovery.