Patellar tendon tear

introduction

From Patellar tendon tear one speaks when the tendon is between the anterior Thigh muscles and the lower portion of the Kneecap (patella) cracks partially or completely. The term is also synonymous with the patellar tendon tear Patellar tendon rupture used.

A patellar tendon tear is a relatively rare diseasethat with existing Pre-damage to the tendon or through Lifting effects can occur conditionally. Mostly she joins younger people and should receive medical attention to avoid any subsequent restriction of movement as Late consequences absolutely to be avoided.

From an anatomical point of view, this tendon is for the Extension in the knee joint indispensable as it is the starting point for the overlying Extensor muscles of the thigh is. It is mainly the four-headed extensor muscle (Quadriceps femoris muscle), which lies on the front of the thigh and its four parts together into the patellar tendon at the lower pole of the kneecap (patella) flow. The patellar tendon also holds the kneecap in place bearings and serves as a flexion in the knee joint Pulley.

causes

The patellar tendon rupture usually occurs spontaneously due to excessive tension in the leg against resistance or when the knee is tensed in a flexed position. Such accident mechanisms often arise in sports such as skiing or tennis.

However, if the tendon is completely healthy, it is unlikely to tear. Most of the time, there is another previous damage that increases the likelihood of a crack in such an event. These are, for example, degenerative changes in the tendon in the context of other concomitant diseases, patellar tendon irritation, previous operations or, in rare cases, cortisone injections into the knee joint.

In children and adolescents, the patellar tendon tear usually occurs at the transition between the tendon and the shin. In adults, the tear is usually higher up, at the lower transition from the tendon to the kneecap.

Sometimes a bone fragment of the kneecap is also torn off, which is referred to as a bony tendon tear.

The tendon tears in the middle only in the context of injuries with direct violence.

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Symptoms

The patellar tendon tear usually manifests itself as a sudden pain in the affected person. In addition, there is an unsteady walking and standing situation due to the loss of stability, as well as a reduction in strength in the knee joint. Active extension of the knee joint is usually limited or no longer possible. In addition, one can observe that the kneecap is higher compared to the opposite side (Patellar high) and a dent can often be felt at the point of the crack.

Another phenomenon that occurs when the patellar tendon ruptures is the gliding up of the kneecap when the thigh muscles are tensed or when the knee is flexed, because the torn tendon is no longer adequately fixed to the shin.

You might also be interested in: Pain in the patellar tendon

Diagnosis of a ruptured patellar tendon

In the Palpation examination (Palpation) of the patellar tendon tear, on the one hand, the Patellar high and on the other hand the tactile one Dent on. In addition, the tendon can no longer be felt in its continuity.

On one X-ray image the exact nature of the crack can be assessed well. You can also see whether there is also a bony tendon avulsion present or not. Others can also be found in the side mount Diagnoses with similar symptoms (e.g. Patellar rupture) exclude what is of fundamental importance for further therapy.

The diagnosis is ultimately confirmed by means of a Ultrasound examination instead of. In the case of more complicated variants of the patellar tendon tear or to be able to rule out accompanying injuries to the knee joint, further imaging diagnostics may be necessary. This is, for example, the MRI of the knee. Especially with partial tears of the patellar tendon, a MRI of the knee give valuable information about the condition of the remaining patellar tendon.

therapy

In the Acute phase of the patellar tendon tear you can try with ice bring about pain relief and that Leg up.

At a complete tear of the tendon should always go through a surgical procedure sewn back together become. The exception would be if the patient was in acute danger to life floats or, in addition, an extended one Soft tissue damage present. Then it makes more sense to wait a little and stabilize the patient's overall situation before performing the operation of the patellar tendon tear.

Without any surgical intervention can however just strains or small cracks treat the tendon that does not cause any relevant reduction in strength.

A different procedure is used depending on the location of the patellar tendon tear.

At the deep patellar tendon tear at the transition to the shin, which often occurs in children and adolescents, on the one hand the Tendon suture performed and additionally the tendon with a suture anchor fixed to the bone.

To the newly fixed tendon in front mechanical overload to protect is usually a so-called McLaughlin Cerclage used. It is a wire loop that is placed between the Kneecap and the Shin is held in place to relieve the tendon during the healing process. This enables early treatment to regain the full range of motion of the knee joint as quickly as possible. To three to six months this wire loop is removed again, unless it has already loosened or detached.

In addition, it must be ensured that the previous length of the tendon is restored because of too tight a fixation too Long-term effects such as restricted mobility or arthrosis can lead.

The Operation of the patellar tendon tear is in general anesthetic carried out and usually takes no longer than 30 to 45 minutes.

As with all surgical measures, complications that can occur during this procedure include bleeding in the knee joint area, possible infection and damage to neighboring structures.

Aftercare

Overall it takes The healing phase for the patellar tendon rupture is relatively long, there Tendons are among the types of tissue that are less well supplied with blood. Immobilization is therefore of the utmost importance for the healing process.

Be for it various aids used, such as a so-called Extension orthosis or one Thigh tutorial splint. The extension orthosis is a Aluminum railthat is padded from the inside and keeps the knee bent at a certain flexion angle. The thigh tutorial splint is a plaster castthat of the Groin down to the ankle enough and keep the knee at a defined flexion angle.

With such an aid, the leg can fully loaded immediately after the operation be just that Knee flexion should be done gradually become. The first two weeks should be the knee joint maximum 30 degrees flexed, followed by an increase in Every two weeks at 60 and 90 degrees. About seven weeks after the operation the Movement of the knee without splinting if no other factors speak against it.

However, despite the immobilization, it is extremely important to do the early Knee training in order to be able to achieve the full previous range of motion again and to avoid further complications from the immobilization. These are for example Thrombosis or Embolism events, Soft tissue damage by the rail and Muscle regression (atrophy) due to lack of exercise.

For the early mobilization of the knee and avoiding these complications is the physiotherapy very suitable. This specifically trains the affected muscle groups and exercises for knee mobility that are adapted to the respective healing step.

Many sufferers report one Restriction of knee extensionwhat, however, by targeted training can usually be remedied.

forecast

For one good prognosis of the patellar tendon tear it is important in spite of the immobilization start mobilizing earlyto regain the previous range of motion. Most of the time this works well.

However, there are factors that can delay the healing process too early or not adapted full load of the knee, which can tear the wire loop, or postoperative wound infections. In the case of degenerative pre-damaged tendons, it can also renewed cracks the tendon come.

However, if there are no negative factors, it comes to one complete healing the patellar tendon rupture and no further restrictions in everyday life or other sporting activities.