Orthopedics Hip & Knee Kneecap (Patella) Conditions Overview of Patellar Tendon Tear Tears Typically Require Surgical Repair By Jonathan Cluett, MD Jonathan Cluett, MD LinkedIn Twitter Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. Learn about our editorial process Updated on September 17, 2021 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Stuart Hershman, MD Medically reviewed by Stuart Hershman, MD LinkedIn Stuart Hershman, MD, is a board-certified spine surgeon. He specializes in spinal deformity and complex spinal reconstruction. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Symptoms Causes Diagnosis Treatment Recovery and Prognosis Frequently Asked Questions The patellar tendon is the structure that connects the kneecap (patella) to the shinbone (tibia). A ligament is a structure that connects one bone to another bone, and therefore some people refer to this as the patellar ligament. However, this structure is really connecting the quadriceps muscle to the shin bone, and a tendon connects muscle to bone, and therefore patellar tendon is the more common description. The patellar tendon is an important part of the extensor mechanism of the lower extremity. The extensor mechanism includes the quadriceps muscle, quadriceps tendon, patella (kneecap), and patellar tendon. These structures function together to allow the knee to straighten, and can do so with significant force. The extensor mechanism is critical to normal functions ranging from walking and stair climbing to athletic activities including running and kicking. Without an intact extensor mechanism, all of these activities can become difficult to perform. Verywell / JR Bee Patellar Tendon Tear Symptoms The typical individual who sustains a torn patellar tendon is a young, male athlete. As more middle-aged people are remaining physically active, this injury is becoming more common in an older population. The injury usually involves an awkward landing from a jumping position where the quadriceps muscle is contracting, but the knee is being forcefully straightened. This is a so-called eccentric contraction and places tremendous stress on the tendon. Athletes who sustain the injury may feel a snapping or popping sensation and will typically be unable to walk following the injury. The typical signs of a torn patellar tendon include:Pain directly under the kneecapSwelling and bruising in the front of the kneeA defect, or soft spot, where the tendon should be tightDifficulty walking or doing sports activities Causes It has been found that in nearly all patients who sustain a patellar tendon rupture there is abnormal tendon tissue consistent with a chronic tendinosis. The patellar tendon is usually injured in the watershed region of the tendon, where blood flow to the tissue is poor, and the tendon is weakest. Tendon tears can also occur in non-athletic settings. Usually, there is a reason for the patellar tendon to be weakened in these individuals, such as a systemic disease that weakens tendons or recent surgery on the knee the caused tendon weakening. Treatment is usually similar in athletes and non-athletes alike. Diagnosis Making the diagnosis of a torn patellar tendon is usually obvious on clinical examination. People who tear the tendon will be unable to extend their knee against gravity, and unable to perform a straight leg raise test. The examiner can usually feel the gap in the tendon, just below the kneecap. An X-ray will be obtained, as a patellar fracture can cause similar symptoms, and should be excluded as a possible diagnosis. On the X-ray, the patella is usually up higher when compared to the opposite knee, as the quadriceps pulls up on the kneecap, and nothing is holding it down in its normal position. While often not needed, an MRI may be used to confirm the diagnosis and inspect the knee for any other damage that may have occurred. Treatment A torn patellar tendon does not heal well on its own, and left untreated will lead to weakness of the quadriceps muscle and difficulty with routine activities, including walking. Surgery to repair the torn tendon is relatively straightforward in concept but can be difficult to perform. The torn ends of the tendon need to be sewn together. The difficulty lies in the fact that it is important to restore proper tension to the tendon, not making it too tight or too loose. Also, it can be difficult to get a good repair, especially if the tendon has torn directly off the bone. In these situations, the sutures used to repair the tendon may have to be attached directly through the bone. Recovery and Prognosis Recovering from a torn patellar tendon is difficult and takes time. One of the most important prognostic factors for recovery is the time to surgery, and surgery delayed beyond a few weeks can limit recovery ability. It is known that early mobility after surgery, protected strengthening, and preventing excessive stress on the repair will speed overall recovery. Even with these steps, there is a minimum of three months until the return of normal daily activities, and four to six months until sports should be resumed. While most people heal completely from a patellar tendon surgery, there can be long-term weakness even with a successful repair. Athletes who are attempting to return to competitive sports may take a year or longer to return to their preinjury level of function. Performing guided physical therapy can be helpful to ensure athletes are able to resume their normal sports activities. Frequently Asked Questions Can you exercise with a torn patella tendon? Not right away. After the tear, you should rest the knee and let it heal for a few weeks. After some of the pain and swelling have eased, you can begin exercises to rebuild the knee’s strength and range of motion. Learn More: R.I.C.E. Treatment for Injuries Can a patellar strap help my knees stop hurting when I run? For occasional pain, a patellar tendon strap may help you during exercise. The strap supports an aching knee by keeping it in alignment during physical activity. The strap isn’t a solution for a chronic knee problem, though. If you usually have pain when you run, see a doctor to find the underlying cause. Learn More: Guide to Knee Braces How can I strengthen my knee tendons? Resistance exercises can build up tendons, but to help regain strength, stability, and range of motion, you need to do exercises for the quadriceps muscles. Exercises that improve hip flexibility may also improve how the patellar tendons work. Learn More: Keeping Knees Healthy Was this page helpful? Thanks for your feedback! Dealing with joint pain can cause major disruptions to your day. Sign up and learn how to better take care of your body. Click below and just hit send! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 6 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Matava MJ. Patellar tendon ruptures. J Am Acad Orthop Surg. 1996;4(6):287-296. doi:10.5435/00124635-199611000-00001 Wilson JJ, Best TM. Common overuse tendon problems: A review and recommendations for treatment. Am Fam Physician. 2005;72(5):811-8. American Academy of Orthopaedic Surgeons. Patellar Tendon Tear. OrthoInfo. American Academy of Orthopaedic Surgeons. Patellar tendon tear. Cleveland Clinic. How a patellar tendon strap works. University of Michigan Health. Patellar tracking disorder: Exercises. Additional Reading Matava MJ. "Patellar Tendon Ruptures." J Am Acad Orthop Surg November 1996 vol. 4 no. 6 287-296.