MANUAL MINORS
A patellar tendon rupture is a severe injury in which the tendon connecting the patella (kneecap) to the tibia tears, leading to a complete or partial loss of knee extension capability. This injury is more common in young individuals and athletes and usually occurs from jumping or falling with the knee in forced flexion. Patients with complete rupture present with severe pain, swelling, inability to walk, and often an upwardly displaced patella (patella alta).
Diagnosis
Clinical diagnosis is made through physical examination, noting the inability to actively extend the knee and palpating a gap just below the patella. X-rays reveal an elevated patella (patella alta), while MRI confirms the extent of the rupture and helps rule out associated injuries.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Quadriceps Tendon Rupture | Low-riding patella (patella baja) on X-ray, inability to extend the knee. |
Patellar Tendinitis | Anterior knee pain without significant loss of function. |
Patellar Fracture | Severe pain and bone deformity, confirmed by X-ray. |
Prepatellar Bursitis | Anterior swelling without involvement of the extensor mechanism. |
Anterior Cruciate Ligament Injury | Rotational instability of the knee, positive Lachman test. |
Emergency Management
Initial emergency management involves immobilising the leg in extension with a long splint, applying ice to reduce swelling, and administering NSAIDs for pain control. Active knee movement should be avoided. Urgent referral for surgical evaluation and treatment is necessary.
Definitive Treatment
Definitive treatment for patellar tendon rupture is usually surgical, especially in cases of complete rupture, where the tendon must be reattached to the patella. After surgery, an intensive rehabilitation program is required to restore knee strength and mobility. In partial tears or patients with low activity levels, a conservative approach with immobilisation and gradual physiotherapy may be considered.
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