Tendon Rupture > Treatments
Surgical Tendon Repair
Preparing for Surgery
Unlike many sports injuries,
kneecap tendon ruptures do not respond to non-operative
treatments. However, surgeons can successfully repair
a ruptured kneecap tendon by sewing the split ends together.
This open procedure has a long healing time but many
people are able to return to activities at full strength
with few complications. The decisions you make and the
actions you take before your surgical tendon repair
can be every bit as important as the procedure itself
in ensuring a healthy recovery. Most insurance companies
require a second opinion before agreeing to reimburse
a patient for a surgical procedure. Getting a second
opinion from a surgeon who is as qualified as the surgeon
who gave the initial diagnosis is advisable in any case.
However, because this is a traumatic injury that generally
requires immediate attention, this may not be an option
in all cases.
sure you have received any equipment you will need when
you get home from the hospital. This may include a knee
brace, crutches, ice packs or coolers, or a continuous
passive motion (CPM) machine. You should receive prescriptions
for any of these from your doctor when your surgery
Understand the potential risks and benefits of the surgery,
and ask your surgeon any questions that will help you
better understand the procedure. It can also help to
talk to someone else who has undergone the same surgery.
physical problems, such as a fever or infection, should
be reported to your surgeon, and you should notify your
surgeon of any medication you are taking.
Make sure the orthopedist performing the surgery is
board-certified, which can be determined by calling
the American Board of Orthopaedic Surgery at 919-929-7103.
to ask the doctor
to take to the hospital
At most medical centers, you will
go to "patient admissions" to check in for
your surgical tendon repair. If your surgery is going
to be inpatient, there may be a separate department,
so be sure to ask your doctor. After you have checked
in to the hospital or clinic, you will go to a holding
area where the final preparations are made. The paperwork
is completed and your knee area may be shaved (this
is not always necessary). You will wear a hospital gown
and remove all of your jewelry. You will meet the anesthesiologist
or nurse anesthetist (a nurse who has done graduate
training to provide anesthesia under the supervision
of an anesthesiologist). Then, you will ride on a stretcher
to the operating room. Here are some important steps
to remember for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under general
Because the anesthetic and pain medications may make
you drowsy and you will be unable to drive, arrange
for someone to help take you out of the hospital and
drive you home when you are released.
Wear shorts or a loose pair of pants that will fit comfortably
over your knee bandage when you leave the hospital.
You will also be given a brace so be sure there is plenty
of extra room in your clothes.
Take it easy. Keeping a good frame of mind can help
ease any nerves or anxiety about undergoing surgery.
Distractions such as reading, watching television, chatting
with visitors, or talking on the telephone can also
to take to the hospital
A kneecap tendon repair usually takes
between one to one-and-a-half hours to perform. Many
patients are put under general anesthetic.
incision is made lengthwise from the top of your knee
to below the kneecap.
ends of the ruptured tendon are identified and then
isolated from the surrounding tissue.
the rupture occurred more than a few days prior to surgery,
the surgeon must cut away any scar tissue, until healthy
tissue is exposed.
use thick stitches to sew the tendon tightly together.
Most of the time the tendon tears from its attachment
on the kneecap. In this case, the sutures are placed
through drill holes in the kneecap for a strong repair.
The internal sutures are permanent and remain in your
incision over the knee is stitched and/or stapled you
are taken to the recovery room.
After surgical tendon repair, you usually stay in the
recovery room for at least two hours while the anesthetic
wears off. General anesthesia usually wears off in about
an hour and spinal anesthesia may take about two hours
to wear off. Most patients experience a moderate amount
of pain after surgery. You should take the pain medicine
as directed. Remember that it is easier to keep pain
suppressed than it is to treat pain once it becomes
present. Ask for medication when you feel pain coming
on. When you wake up, your knee will be bandaged and
probably be immobilized in a cast or brace and may have
ice on it. The types of casts and braces vary from physician
to physician. Many physicians prefer to use a plaster
or fiberglass cast or splint to keep the knee straight
for three to six weeks. The most common type of knee
immobilizing brace is cloth with metal stays and Velcro
straps. You should try to move your feet while you are
in the recovery room to improve circulation. Your temperature,
blood pressure, and heartbeat will be monitored by a
nurse, who, with the assistance of the doctor, will
determine when you are ready to leave the hospital or,
if necessary, be admitted for an overnight stay.
After surgical tendon repair, some patients remain
in the hospital for one or two days. Depending on the
severity of your injury and your physician's preference,
your knee may be immobilized for up to six weeks. There
will likely be pain, and you can expect to be given
pain medication as needed. Be sure to ask for medication
as soon as you feel pain coming on, because pain medication
works best on pain that is building rather than on pain
that is already present. The nurses will not give you
more than your doctor has prescribed and what is considered
to be safe. Ice also helps control pain and swelling.
You will usually be allowe to bear weight on the injured
leg while in a brace or cast. In addition, you will
be given an appointment to return and a prescription
for pain medicine. You will not be able to drive, so
be sure to have arranged for a ride home.
After surgery to repair a kneecap tendon rupture, your
knee may be held straight for up to six weeks by an
immobilizer or cast. Most patients can bear weight on
their leg soon after surgery, but normally will have
to walk with the leg straight until the cast or brace
is removed. This can limit your ability to return to
work and drive a car. Here is what you can expect and
how you can cope after surgical tendon repair:
will likely feel pain or discomfort for the first few
days, and you will be given a combination of pain medications
There may be some minor drainage on the bandage since
fluid may have accumulated during the surgery. Expect
some blood to show through the bandage during the first
24 to 48 hours.
knee will probably be immobilized in a cast or, more
commonly, a stiff brace that should be worn most of
the day. Remove the brace only to perform passive motion
exercises if they are prescribed by your physician or
much as possible, you should keep your knee elevated
above heart level to reduce swelling and pain. It often
helps to sleep with pillows under your ankle. Icing
your knee for 20 or 30 minutes a few times a day during
the first three days after surgery also will reduce
your surgeon when it is safe to take a shower.
possible, the dressing on your knee is usually removed
one to three days after surgical tendon repair. If your
knee is in a cast, the dressing usually stays on the
knee for one to three weeks.
surgeons will let you put weight on your knee as long
it is protected in a cast or brace.
two or three days after surgery, you may experience
night sweats and a fever of up to 101 degrees. Your
physician may suggest acetaminophen, coughing, and deep
breathing to get over this. This is common and should
not alarm you.
physician generally will send you to a physical therapist
for a consultation about rehabilitation within six weeks
after the surgery.
to call the doctor after surgery
Passive motion is usually not started until about six
weeks after surgery to repair a ruptured kneecap tendon.
When your physician determines that the repaired ligament
has sufficiently healed, most patients visit a physical
therapist to begin moving their knee. Too much movement
after surgery may hinder the healing process. Your physical
therapist can help you learn the proper combination
of rest, gentle movement to stimulate blood flow and
healing, and light exercises. The first motion most
patients undergo is called active flexion/passive extension.
You lie on your back and slowly bend your knee. Then
you let your knee straighten as gravity lowers your
leg back down. You may still be asked to wear an immobilizer
that holds your leg straight while walking. Your doctor
may then prescribe a removable hinged knee brace with
a dial adjustment that allows the knee to bend at various
degrees. The brace may initially be locked so your knee
can bend only up to 30 degrees. The degree of bending
will increase over a period of several weeks. When you
can comfortably bend your knee greater than 90 degrees
and have sufficient quadriceps strength to support the
leg, the brace is typically discontinued. This can range
from four months to a year after surgery depending on
your age and ability to participate in rehab. After
you stop using the brace, it is important not to twist
or bend in ways that may strain the kneecap and pull
the tendon apart. Your physician and physical therapist
will design a custom physical therapy program to fit
your needs. Rehab progresses into stretching and strengthening
exercises that focus on the quadriceps and hamstrings
the main stabilizing muscles for your knee. Physicians
suggest you gradually increase the amount of weight
as your leg muscles get stronger. Most physical therapists
suggest you do not perform knee extension exercises
that isolate the quadriceps muscles. Instead, physical
therapy for a ruptured tendon may consist of squatting
movements that use the hamstrings, calf muscles, and
quadriceps at the same time. Strengthening exercises
require dedication because results often take months
and pain may recur. Once the muscles of your injured
leg are about as strong as the uninjured leg, the focus
of rehab turns to increasing your coordination. After
a few months of rehab, physical therapy can become activity
oriented as you regain the ability to perform complicated
movements, using stationary bikes, elliptical machines,
and cross-country skiing machines. The time it takes
different people to return to activities varies greatly
after a ruptured tendon. Younger, athletic people may
be able to properly heal and complete rehab in five
to eight months, but older people or people with a history
of knee injuries may need up to a maximum of 18 months
strengthening exercises: Kneecap (patella) injuries
The only way to prevent re-injury of a ruptured kneecap
tendon is to adhere to your prescribed rehab program.
Once physical therapy ends, you should continue to maintain
flexibility and strength in the leg. Physicians usually
suggest that you continue strength training even after
your knee has been rehabilitated. Balanced strength,
between the quadriceps muscles in the front of your
thigh and the hamstrings in the back, can help prevent
forces from unevenly pulling on your kneecap tendon.
Always warm up before any exercise and particularly
before any explosive knee activity such as running,
jumping, or playing sports.