Massage therapy · Kitchener–WaterlooPatellar Tendon Tear

For a tear to occur, either the tendon must already be weakened, or the force must be very strong. The tendon can tear partly or completely (rupture). Patellar tendinopathy, a long-term overuse problem in the tendon, is far more common than a tear. When the tendon tears, you often feel a tearing or popping sensation, followed by pain and swelling, and you may not be able to straighten your knee. Other signs include a dent at the bottom of the kneecap, bruising, tenderness, the kneecap moving up into the thigh, and difficulty walking because the knee buckles or gives way (AAOS, n.d.).

Warning signs: if you feel a tear or pop at the front of the knee and then cannot straighten your leg, or you have a deep cut over the front of the knee, call 911 or go to the emergency room at your nearest hospital. Complete tears almost always need surgery, and people do better if the repair is done soon after the injury (AAOS, n.d.).

The anterior cruciate ligament stops the femur sliding backward on the tibia. The medial and lateral collateral ligaments stop the femur sliding from side to side. The posterior cruciate ligament stops the femur sliding forward on the tibia.

Another name for the patellar tendon is the ligamentum patellae, because it is a very thick and strong fibrous ligament-like tendon. It holds the patella down while the knee straightens. The quadriceps are very strong muscles that allow us to squat and stand up from sitting. They also allow us to jump and run. So they need a very strong anchor point, and that is the attachment of the patellar tendon. The tendon holds the patella down, which acts like a pivot (fulcrum), giving the quadriceps more leverage and making them work more efficiently.

1. Immobilisation

For a small partial tear, your doctor may recommend a knee immobiliser or brace that keeps the knee straight while it heals, and you will most likely need crutches to avoid putting all your weight on the leg (AAOS, n.d.). Your doctor will tell you how long to use the brace and crutches.

2. Physical Therapy

Once your medical team allows, I can support your rehabilitation with exercises and hands-on work to restore movement and strength in your knee. See the My Approach tab for how I work.

Once the initial pain and swelling have settled, specific exercises can help restore movement and strength in the knee. While you are wearing the brace, your doctor or physical therapist may recommend exercises to strengthen the quadriceps, such as straight-leg raises. As time goes on, your physical therapist or doctor will unlock the brace, allowing you to move more freely with a greater range of movement, and you will be given more strengthening exercises as you heal (AAOS, n.d.).

Options outside my scope

• Surgery: most people with a complete patellar tendon tear need an operation to reattach the torn tendon to the kneecap, and surgical repair is the standard treatment for a rupture (AAOS, n.d.; King's College Hospital NHS Foundation Trust, 2024). Follow your surgical team's own instructions and physiotherapy plan after the operation.

How I can help (see the My Approach tab)

• Easing the areas working overtime while your knee is protected
• Swelling, stiffness and scar work once your team allows
• Rebuilding thigh strength and a gradual return to activity

If your calf becomes painful, swollen and warm, or you have chest pain or shortness of breath, call 911 or go to the emergency room.