No one ever thinks about their quadriceps tendon or patella tendon until they have injured them. They are integral to human functioning for walking, climbing, standing up from a chair or the ground, and running. As an orthopedic surgeon, I am privileged to see what unfortunately can happen to someone who tears their tendon. It makes me appreciate the human body so much more when I see the disability of this injury. A quadriceps or patella tendon tear can make someone immobile and unable to walk which is the reason why it is an absolute indication for surgery.
As you can see the quadriceps tendon attaches to the superior aspect of the patella. The patella tendon then connects the patella to the tibia.
When one of the tendons is not connected to the patella, an injured person can’t lift their tibia and ultimately their foot off the ground. This injury is pretty rare in Crossfit in my practice but it can occur anytime the tendon’s strength is exceeded. It typically occurs in that age group of 40 to 60-year-olds when people are still very active and can generate enough force that they are able to rip their tendons from the bone. An 80-year-old usually doesn’t have this injury unless there is a fall.
As with any tendon injury, and quite simply, a tendon can pull away from the bone when the force exerted on it exceeds the strength of the tendon attachment. Classically it occurs with an eccentric contraction. This occurs when the muscle and tendon lengthen during a contraction. This can occur jumping down from a box jump or during sudden heavy squat. When you land your quadriceps contract and as your knee bends, the quad and patella tendon lengthen. If you then generate enough force the tendon can then pull away. So then what happens. If you can’t lift your leg and there is a big divot near your kneecap that you can feel, then this is the diagnosis and you need to see a surgeon.
When the exam and the X-ray confirm the diagnosis, you can then undergo a repair. X-ray below shows a because the patella tendon is torn and the quad pulls the patella higher than normal. When the quadriceps tears, the patella lowers and you can have a patella baja.
An MRI is sometimes useful in partial tears or when the exam is not absolutely certain.
The surgery involves reattaching the tendon through the bone and repairing the joint capsule or retinaculum.
The pictures shown next are graphic intraoperative photos taken with the permission of the patient.
Here are the steps to repair a PATELLAR tendon tear:
Torn patella tendon to left, the white is the femur, and to the right the circular red structure is the kneecap or patella
2 Sutures secure the patella tendon into one bundle
Drill 3 tunnels in patella
Pass sutures through tunnels
4 suture limbs go through three tunnels
Tie sutures on other side of patella bringing tendon back to patella
Below are the steps for a QUADRICEPS tendon repair:
Quad tendon to right, patella to left
Sutures in quad tendon
Drill pin in patella to pass sutures
Eyelet in pin with sutures in it passed through patella
Sutures passed through patella
Physical therapy and rehab is extensive. It starts with a brace and crutches for about six weeks weight bearing as tolerated. Range of motion is begun usually in the first 2 weeks and can take 6 to 8 weeks to get full range. Strengthening has to wait until the tendon grows into the bone starting at 6 weeks. It can take 4 months before running again and 6 to 8 to get really strong again. Typically, people return to full activities and strength returns after an extensive rehab.