Basic Approach to a Patella Tendon Strain
Understanding A Patella Tendon Injury
The patella tendon is a large tendon connecting the kneecap to the lower leg. It is a continuation of the quadriceps tendon which connects to the upper part of the knee cap and the quadriceps muscles in the front of the knee. Injury to the tendon can be problematic for athletes in a variety of sports. Due to significant stresses with sprinting sports as well as with lower body exercises such as squats, the patella tendon is susceptible to several injuries such as tendonitis, tendon strain or tendon rupture. If the injury is acute and sudden, such as during a slide or jumping movement, the tendon can be strained or even completely torn. Typically tendonitis or tendinopathy will be more chronic, with overuse to the quadriceps muscle in sports.
Evaluation OF Patella Tendon
Athletes will usually have notable swelling over the front of the knee. Keep in mind, the swelling is usually concentrated over the tendon rather than throughout the entire knee such as in an ACL tear or Meniscus tear. Tenderness is typically seen with deep pressure directly over the patella tendon (pictured below). Pain may also be reported at the patella tendon with extension of the knee against resistance, as well as with exercises like lunges or squats.
Treatment and Return to Play
In general, a patella tendon strain is relatively straightforward if given the proper time to heal. In general, I would recommend the athlete to weight bear as tolerated based on pain. I would limit significant flexion (bending) of the knee. If the tear is significant, one may opt to immobilize the knee in a brace to allow the tendon complete rest. Although the injury can be diagnosed without imaging, either an Ultrasound or an MRI can give greater detail to the extent of the injury. In the initial stages, some providers will recommend soft tissue stimulatory techniques, such as ASTYM, Graston or Dry Needling to help stimulate healing. Additionally, for professional athletes and for those that can afford the out of pocket expense, stem cell therapy or PRP injection can be considered. Usually within 2- 3 weeks if the pain has largely resolved, athletes can start more aggressive physical therapy. Return to play is generally about 4-6 weeks, however it depends upon the sport. If an athlete chooses to play through this injury it can be difficult to treat and convert into a long term issue.