Patellar or quadriceps tendon repair

When the quadriceps or patellar tendon is torn all the way through, the extensor mechanism loses its continuity and the knee can no longer be actively straightened well. Surgical repair aims to restore that continuity — securing the torn tendon back to the patella (kneecap) or to its attachment so the thigh muscles can again straighten the knee.

In broad terms, the torn tendon is reattached to the patella or repaired at the site of the tear, and it is held while it heals. Fixation methods vary — sutures may be passed through bone tunnels in the patella or anchored to it, among other techniques — and associated tissue may be repaired at the same time. The exact technique depends on where the tear is, the quality of the tissue, how long ago the injury happened, and the surgeon's judgment. This page avoids naming specific devices or comparing techniques, because those choices are individualized.

Both operations share the same purpose — restoring the extensor mechanism — but they address different injured attachments. A quadriceps tendon repair reconnects the tendon above the patella, where the thigh muscles attach to the top of the kneecap. A patellar tendon repair reconnects the tendon below the patella, between the kneecap and the shin bone.

Because the injured structures and their locations differ, the two repairs are not identical in every respect, and the details of the operation and the recovery can differ. What they have in common is the aim of reestablishing your ability to actively straighten the knee.

A fresh (acute) tear can usually be repaired directly, reconnecting the tendon that has recently torn. An injury that has been present for a long time, or one that is recurrent, neglected, or has failed a previous repair, can be more complex. Over time the tendon can retract and scar, which may make a straightforward repair difficult.

In those situations, restoring the extensor mechanism may require a more involved reconstruction or augmentation rather than a simple repair, and the rehabilitation plan may be different as well. This page does not prescribe a specific graft or augmentation method — which approach, if any, is appropriate is decided individually with your surgeon based on what is found.

Sometimes the tendon tear is the only injury, and the repair addresses it alone. In other cases the tendon injury occurs alongside other problems — such as a fracture, or damage to other structures in the knee — and additional procedures may be needed at the same operation. Whether that applies depends on the individual injury, and it can change both the operation and the recovery. An isolated tendon repair and a repair performed together with other procedures are not the same, and your surgeon will explain what your particular situation involves.

Rehabilitation after a tendon repair is staged and progresses according to criteria rather than a fixed calendar, because the repair has to be protected while it heals before it is loaded and stressed. In broad terms, the stages move from early protection of the repair, to controlled motion, to a gradual return of weight bearing and a normal walking pattern, to progressive activation and strengthening of the quadriceps, and later to functional and activity-specific progression.

The specifics — including how the knee is braced, how much weight may be placed on it, and how far it may bend at each stage — are set by the protocol your surgical team selects for your repair, and they can differ between a quadriceps and a patellar tendon repair and between an acute and a chronic case. Those detailed restrictions are not reproduced here; your surgeon's protocol and operative note take precedence over any general description. Recovery of strength can take a substantial amount of time, and this page does not promise a specific return-to-sport date.

As with any surgery, tendon repair carries risks, and it has limits. The possible problems below are for discussion with your surgeon and are not a complete list; which matter most depends on your situation:

• Infection
• Stiffness or loss of motion
• Persistent weakness of the knee
• Incomplete healing, or a re-tear (re-rupture) of the repair
• A change in the position of the kneecap
• Blood clots in the leg
• Wound-healing problems
• Problems related to the hardware or fixation used to hold the repair
• The possible need for additional surgery

Repairing the tendon aims to restore the extensor mechanism so the knee can be straightened again, but recovery is gradual and individual. Rebuilding strength can take a substantial amount of time, and no operation guarantees a complete restoration of preinjury function. A realistic picture for your specific injury — the type of tear, whether it is acute or chronic, and any associated injuries — is best discussed with your surgeon.