Patellar Tendon Rupture: Overview скачать в хорошем качестве

Patellar Tendon Rupture: Overview

🦴 Patellar Tendon Rupture: Overview 🔍 Definition: A patellar tendon rupture is a full or partial tear of the tendon connecting the inferior pole of the patella to the tibial tubercle. It's a disabling injury that disrupts the knee extensor mechanism, making active extension and weight-bearing nearly impossible. ⚠️ Risk Factors & Mechanism 🧠 Mechanism of Injury: Usually occurs due to a sudden eccentric contraction of the quadriceps (e.g. landing from a jump or missing a step). Often seen in athletes, manual laborers, or following trauma like a fall. 🔬 Risk Factors: Chronic tendinopathy (jumper’s knee) Systemic diseases: Diabetes, rheumatoid arthritis, lupus Steroid or fluoroquinolone use Prior surgery (e.g. ACL with patellar tendon graft) Dialysis (due to uremic tendon changes) Obesity or high BMI Poor quadriceps flexibility or imbalance 🩻 Clinical Diagnosis Signs: Inability to actively extend the knee or perform straight leg raise Palpable gap below the patella High-riding patella (patella alta) on X-ray Swelling, bruising, tenderness over tendon Imaging: X-ray: Lateral knee may show patella alta (Insall-Salvati ratio greater then 1.2) Ultrasound or MRI: Confirms tear location and extent 🛠️ Surgical Management Timing: Acute ruptures (2–3 weeks): Primary repair Chronic ruptures: Require reconstruction with autograft/allograft or synthetic augmentation Technique: Primary repair: Tendon is reapproximated to inferior patella using Krackow sutures Suture anchors or transosseous tunnels May use augmentation with suture tape or cerclage Reconstruction (chronic): Semitendinosus/gracilis autograft Achilles tendon allograft with bone block Synthetic augmentation (e.g. FiberTape) Pearls: Repair tension must be anatomical to restore patellar height Early mobilization reduces stiffness but must balance with repair protection 🏥 Postoperative Protocol 📅 Typical Rehab Timeline: Week 0–2 (Protection Phase): Hinged knee brace locked in extension Partial or non-weight bearing Isometric quads/glutes, straight leg raises (with brace) DVT prophylaxis Week 2–6 (Early Mobilization): Gradual increase in ROM (goal: 0–90° by 6 weeks) Begin weight-bearing as tolerated with brace Closed chain quad exercises in brace Week 6–12 (Functional Recovery): Brace discontinued once quad control restored Full weight bearing ROM to full Begin light stationary biking, closed chain strengthening Month 3–6 (Advanced Strengthening): Progress to open chain exercises Plyometrics, proprioception training Return to sport-specific drills Return to Sport: Non-contact sports: ~4–5 months Contact/high-impact sports: 6–9 months depending on strength symmetry, hop tests, and sport demands 📊 Outcomes & Risks 🟢 Good Outcomes: Most patients regain full ROM and strength with proper rehab High return-to-activity rate for non-elite athletes 🔴 Complications: Re-rupture (rare if protected properly) Patella baja (shortened tendon after overtight repair) Quadriceps atrophy Knee stiffness/loss of motion Wound complications or infection #PatellarTendonRupture #KneeInjury #SportsMedicine #OrthopedicSurgery #TendonRepair #KneeSurgery #ACLRecovery #RehabJourney #PhysicalTherapy #InjuryRecovery #ExtensorMechanism #OrthoLife #PostOpRecovery #SportsInjury #TendonInjury #KneeRehab #MobilityMatters #ReturnToPlay #ActiveRecovery #SurgicalRepair #OrthoEducation #InjuryPrevention #KneePain #AthleteRecovery #RehabProtocol