Review Question - QID 637

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Patellar Tendon Rupture Presentation History QID: 637 (OBQ08.251)

QID 637 (Type "637" in App Search)

A 24-year-old basketball player feels a painful "pop" in his knee when landing from a rebound. He develops immediate swelling, pain, and inability to extend his knee. A lateral radiograph is shown in Figure A. Proper management should include which of the following

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Physical therapy for range of motion followed by surgical reconstruction with patellar tendon autograft

90/4443

Hinged knee brace locked at 30-degrees of flexion for 6 weeks followed by physical therapy for range of motion

35/4443

Medializing tibial tubercle osteotomy with lateral retinacular release

21/4443

Primary surgical repair

96%

4263/4443

Arthroscopy for debridement versus repair

20/4443

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While the history could be consistent with an ACL rupture, the lateral radiograph demonstrates patella alta, which in this setting is indicative of a patellar tendon rupture. Clinical findings include an inability to extend the knee against gravity, a large hematoma, and a palpable gap below the inferior pole.

Primary surgical repair within 2 weeks of injury is recommended to prevent extensor mechanism contracture. Patellar tendon ruptures typically occur in patients younger than 40 years old. Most ruptures occur at the junction of the tendon and distal pole of the patella. Sports such as basketball, football, and soccer which place high eccentric loads on the extensor mechanism are associated with this injury. Other predisposing factors include steroid injection, rheumatologic disease, renal failure, infectious disease, and metabolic disorders.

The Rose paper is a case report of atraumatic bilateral ruptures which goes on to review patellar tendon ruptures in general.

The paper by Casey et al is a series of 4 patients whose neglected ruptures were able to be surgically repaired.