Is it acceptable for a patient to wait several months before undergoing surgery for a knee injury? My latest Ask Dr. Geier column addresses this question specifically for a serious knee injury – a patellar tendon rupture.

Christina Sanford – Chinle, Arizona writes:

Have you ever known of, or personally treated a patient, whom had suffered with a complete patella rupture injury for the lengthy time of 2 months before undergoing surgical repairing? Would the healing process still be typical alongside others with the same injury?

The patella tendon is the tendon below the patella (kneecap) that connects the patella to the tibia. It works as part
of the lower extremity’s extensor mechanism (quadriceps muscle, quadriceps tendon, patella, patella tendon) to extend the knee.

Location of a patellar tendon rupture

Mechanism of injury of a patellar tendon rupture

Athletic people often rupture the patella tendon with a noncontact mechanism. Usually the injury occurs in a similar manner as an ACL tear or patellar dislocation. The athlete often lands awkwardly from a jump. He will usually have significant knee swelling and notice the inability to lift his leg.

Surgery for a patellar tendon rupture

Treatment almost always involves surgery. Ideally orthopaedic surgeons try to operate within two weeks of the injury. In the days after the injury, the surgeon can perform a surgical repair that basically involves reattaching it to the patella. He then requires the patient to wear a hinged knee brace that keeps the knee fully extended and only allows a certain range of motion as the repair heals. As the strength of the patellar tendon repair increases, the surgeon increases range of motion. As the repair fully heals and the athlete regains full knee range of motion, the patient works to gradually increase strength and progresses through sport-specific activities.

Timing of surgery

Orthopedic surgeons prefer to operate quickly after the injury before the tendon scars down and the patella starts to retract up the thigh. As time goes on, the surgeon’s ability to reattach the torn tendon to the base of the patella decreases. In these more chronic ruptures, he can use more complex surgical techniques, such as making incisions in the quadriceps tendon to lengthen it. These techniques can help the surgeon reattach the tendon to the retracted patella. Unfortunately he might have to protect the knee longer and progress range of motion more slowly.

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