eMedicine Specialties > Orthopedic Surgery > Knee

Patellar Tendon Rupture: Workup

Author: Christopher C Annunziata, MD, Orthopedic Surgeon, Commonwealth Orthopedics and Rehabilitation; Assistant Clinical Professor, Department of Orthopedic Surgery, Georgetown University Medical Center; Team Physician, DC United, Major League Soccer
Coauthor(s): Elizabeth Ignacio, MD, Associate Clinical Professor, Department of Orthopedic Surgery, John A Burns School of Medicine, University of Hawaii; Consulting Sports Medicine Orthopedic Surgeon, University of Hawaii Athletic Department
Contributor Information and Disclosures

Updated: Sep 25, 2009

Workup

Laboratory Studies

  • In the circumstance of patellar tendon rupture secondary to systemic disease, such as chronic renal failure, SLE, rheumatoid arthritis, or diabetes, the tendon rupture is rarely the harbinger or the first symptom of the disease. Therefore, although abnormal laboratory values may be found in the face of and consistent with the systemic disease, laboratory studies otherwise are indicated rarely in the workup for patellar tendon rupture.

Imaging Studies


Patellar tendon rupture. A lateral radiograph of ...

Patellar tendon rupture. A lateral radiograph of the right knee from a patient with an acute patellar tendon rupture. Note the superior patellar migration as well as the calcification below the inferior pole of the patella. This represents preexisting calcification within the patellar tendon, which likely contributed to the rupture.

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Patellar tendon rupture. A lateral radiograph of ...

Patellar tendon rupture. A lateral radiograph of the right knee from a patient with an acute patellar tendon rupture. Note the superior patellar migration as well as the calcification below the inferior pole of the patella. This represents preexisting calcification within the patellar tendon, which likely contributed to the rupture.

  • Plain radiographs
    • Plain radiographs (anteroposterior [AP], lateral, axial) should be obtained in all patients presenting with a traumatic injury to the knee or with a hemarthrosis.
    • Contralateral films should also be obtained as a means for comparison of patellar height.
    • Even if a palpable gap in the extensor mechanism allows for easy recognition of a patellar tendon rupture, radiographs are still necessary to assess for any other concomitant abnormalities.
    • The lateral view is particularly helpful to determine whether a patellar rupture has occurred. The classic finding is patella alta, but one may also notice calcification indicative of chronic patellar tendinosis (Image 2).
    • In addition, the axial view assists in determining whether any preexisting patellofemoral arthritis exists, which may impact the rehabilitative efforts and prognosis.
  • Ultrasound
    • High-resolution ultrasound can be useful in the diagnosis of acute and chronic patellar tendon ruptures.
    • Hypoechogenicity is associated with acute tears, while thickening of the tendon at the rupture site and disruption of the normal echo pattern is observed with chronic tears.
    • While this modality is easy to obtain and does not expose the patient to radiation, many do not have the experience to reliably perform or interpret this type of study. Because of this, ultrasound is not used routinely in the United States, although it is used quite frequently in Europe.
  • MRI
    • If the diagnosis cannot be established based on clinical and radiographic examination, an MRI is the imaging study of choice.
    • The typical finding is discontinuity of tendon fibers with adjacent hemorrhage or edema.23

Diagnostic Procedures

  • No diagnostic procedure is routinely necessary to identify an acute patellar tendon rupture. If a question or concern exists of an intra-articular fracture or osteochondral injury, the joint can be aspirated to look for fat droplets. The routine use of aspiration and injection is not recommended.

Staging

Blazina, Kerlan, and Jobe described 3 clinical stages of patellar tendonitis (ie, jumper's knee) that culminate with patellar tendon rupture.24

Initially, the insidious onset of aching in the knee centers over the infrapatellar region and localizes to the inferior pole of the patella. This usually arises after the patient engages in repetitive activity such as jumping, climbing, kicking, or running. During the first stage of the disease, the pain is present only after athletic participation. The pain typically disappears after a period of rest. Sensations of weakness or 'giving way' are transient and never associated with locking or catching.

In the next stage, pain and symptoms occur at the beginning of an activity, disappear after a warm up, and then reappear after completion of the activity. The aching becomes more persistent, and, eventually, the discomfort persists throughout the entirety of the activity, but athletic performance is not significantly impaired.

In the next stage, the symptoms are the same but more prolonged, and performance is definitely impaired. The athlete might even become apprehensive about further participation.

Finally, if the athlete continues with intensive activity despite exacerbation of symptoms, he or she eventually may experience a sudden catastrophic 'giving way,' with pain and inability to actively extend the knee. This coincides with an acute and complete rupture of the patellar tendon.

More on Patellar Tendon Rupture

Overview: Patellar Tendon Rupture
Workup: Patellar Tendon Rupture
Treatment: Patellar Tendon Rupture
Follow-up: Patellar Tendon Rupture
Multimedia: Patellar Tendon Rupture
References
Further Reading
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References

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Keywords

patellar tendon rupture, patellar ligament tear, knee tendon rupture, tendonitis, tendinitis, quadriceps tendon rupture, ruptured patella tendon

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Contributor Information and Disclosures

Author

Christopher C Annunziata, MD, Orthopedic Surgeon, Commonwealth Orthopedics and Rehabilitation; Assistant Clinical Professor, Department of Orthopedic Surgery, Georgetown University Medical Center; Team Physician, DC United, Major League Soccer
Christopher C Annunziata, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Eastern Orthopaedic Association, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Coauthor(s)

Elizabeth Ignacio, MD, Associate Clinical Professor, Department of Orthopedic Surgery, John A Burns School of Medicine, University of Hawaii; Consulting Sports Medicine Orthopedic Surgeon, University of Hawaii Athletic Department
Disclosure: Nothing to disclose.

Medical Editor

Robert D Bronstein, MD, Associate Professor, Department of Orthopedic Surgery, University of Rochester School of Medicine
Robert D Bronstein, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Medical Society of the State of New York
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Thomas M DeBerardino, MD, Associate Professor of Orthopaedic Surgery, University of Connecticut Health Center
Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine
Disclosure: Arthrex, Inc. Grant/research funds Other; Arthrex, Inc. Honoraria Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None; Arthrex, Inc. Consulting fee Speaking and teaching

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Carlos J Lavernia, MD, FAAOS, Adjunct Clinical Professor, Department of Orthopedic Surgery, University of Miami School of Medicine; Medical Director, Orthopedic Institute at Mercy Hospital
Carlos J Lavernia, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, Arthritis Foundation, Biomedical Engineering Society, Florida Orthopaedic Society, and Orthopaedic Research Society
Disclosure: Zimmer Stock Implant Designer

 
 
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