Patella and Quads Tendon

A tear of the quadriceps or patella tendon is a serious injury that can occur when the tendon that connects the quadriceps muscles to the patella (kneecap) is partially or completely torn. Typically quadriceps tendon ruptures occur in patients over 60 years old and patella tendon tears in the third decade of life. The quadriceps muscle is the large muscle on the front of your thigh, and the patella tendon runs from the bottom of the kneecap to the top of the shinbone. A tear in either of these tendons can be caused by sudden trauma or overuse, and can lead to severe pain, swelling, and difficulty moving the affected leg. The knee will tend to buckle unless it is forced fully straight, causing you to feel that you have to walk on a ‘peg-leg’ to stop it collapsing. In some the patella itself is where the failure occurs. A fracture of the patella may consist of a minor avulsion of bone, a separated fractured bone or undisplaced crack in the bone.

If you suspect that you have a tear of the quadriceps or patella tendon, it is important to seek medical attention right away. In the meantime, there are a few things you can do to help manage your symptoms and prevent further damage:

• Rest your affected leg, and avoid any activities that cause pain or discomfort.
• Apply ice to the affected area for 15-20 minutes at a time, several times a day.
• Elevate your leg above heart level to help reduce swelling.
• Use crutches or a knee brace to help support your affected leg and prevent further injury.

If you suspect a torn tendon or fracture you should seek specialist advice as these are best treated in the first week or two.

If you have a tear of the quadriceps or patella tendon and decide to wait and see how it turns out, you risk further injury and may delay the healing process. In some cases, a partial tear may heal on its own with rest and rehabilitation, but a complete tear will not heal and requires surgical intervention to join up the torn ends. Waiting too long to seek treatment may also result in more complex surgery and longer recovery time. Fractures need specialist advice.

Treatment options for a tear of the quadriceps or patella tendon

Treatment for a tear of the quadriceps or patella tendon will depend on the severity of the injury. In general, treatment options may include:

• Rest, ice, compression, and elevation (RICE) to help manage pain and swelling.
• Physiotherapy to help restore range of motion and strength in the affected leg.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) to help manage pain and inflammation.
• Surgery, which may be necessary for complete tears or partial tears that do not respond to conservative treatment. Surgery may involve reattaching the tendon to the kneecap or using a tendon graft to repair the torn area.
• Not all fractures require surgery but for some patterns of displaced tear it is very important that the patella is wired together.

Although relatively rare, I have treated large numbers of patients with tears of the patella and quadriceps tendons. If you suspect that you have a tear in either of these tendons, I can help you determine the best course of treatment based on the severity of your injury and your individual needs. Depending on the extent of the injury, treatment may include rest, physiotherapy or surgery. My goal is to help you achieve a full recovery and return to your normal activities and sports as soon as possible, but with this type of injury it may take months to return to sports. I have treated many patella fractures and my experience is that they need careful surgery to minimise complications that can occur.

Patella tendinopathy, also known as jumper's knee, is a common overuse injury that occurs when the patella tendon becomes painful. The patella tendon connects the kneecap (patella) to the shinbone (tibia) and plays an important role in straightening the leg. Repetitive stress on the tendon, such as from jumping or running, can cause a small tear. In many cases this will heal with some scar formation and eventually settle down. In some cases, however, the repair/failure cycle persists and eventually leads to new blood vessels and nerves growing into onto the tendon which can, in turn, bring on pain. Typically the pain is bad at the start of exercise and eases when the tendon warms up but returns again after exercise has ceased and may persist for 24 hours. Tendinopathy can create a similar problem in the quadriceps tendon, and though it less common the principles of diagnosis and management are similar.

If you suspect you have patella tendinopathy there are several things you can do to help manage your symptoms and prevent further damage:

• Cease activities that are aggravating the problem.
• In the very early stages inflammation may be present so ice and nonsteroidal anti-inflammatory drugs (NSAIDs) may help.
• Using a patella strap can be helpful.
• Begin a targeted exercise program designed for treating tendinopathy.
• Stretching tight muscles in the lower leg may help.
• A physiotherapist can help develop a programme tailored to your needs.

If you decide to wait and see how patella tendinopathy turns out you may be just delaying the healing process. If you catch the injury when it is a fresh (less than a few weeks), minor tears of the patella tendon may heal on their own with rest and rehabilitation, but in other cases, more extensive treatment may be needed. Waiting too long to seek treatment may also result in a more complicated recovery process, an increased risk of surgery and longer time away from your usual activities.

Treatment options for patella tendinopathy
Treatment for patella tendinopathy will depend on the severity of the injury. In general, treatment options may include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) may help if it is caught very early, ie in the first three weeks.
• Physiotherapy is the mainstay treatment, to help strengthen the muscles around the knee and improve flexibility.
• Extracorporeal shockwave therapy (ESWT), a non-invasive treatment that uses high-energy sound waves to stimulate healing in the affected area may help.
• Platelet-rich plasma (PRP) therapy, a treatment that uses your own blood platelets to promote healing, although there isn't full agreement on whether this works. Various other injections have been tried but once again there isn't full agreement on whether they work.
• Surgery may be necessary in severe cases when other treatments have not been effective.

This condition isn't as common as some knee problems but I have considerable experience of managing this condition non-surgically and have published on two novel techniques for non-surgical management. I can help determine the best course of treatment based on the severity of your injury and your individual needs. Depending on the extent of the injury, treatment may include rest, physiotherapy or more advanced treatments like ESWT or PRP therapy. My goal is to help you achieve a full recovery and return to your normal activities as soon as possible.