Knee > Kneecap 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.

   Make 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 is scheduled.

   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.

   Any 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.

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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:

   You 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 anesthesia.

    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 help.

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A kneecap tendon repair usually takes between one to one-and-a-half hours to perform. Many patients are put under general anesthetic.

   An incision is made lengthwise from the top of your knee to below the kneecap.

   The ends of the ruptured tendon are identified and then isolated from the surrounding tissue.

   If the rupture occurred more than a few days prior to surgery, the surgeon must cut away any scar tissue, until healthy tissue is exposed.

   Surgeons 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 knee.

   The 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:

   You will likely feel pain or discomfort for the first few days, and you will be given a combination of pain medications as needed.

   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.

   Your 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 physical therapist.

   As 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 pain.

   Ask your surgeon when it is safe to take a shower.

   When 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.

   Many surgeons will let you put weight on your knee as long it is protected in a cast or brace.

   For 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.

   Your physician generally will send you to a physical therapist for a consultation about rehabilitation within six weeks after the surgery.

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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 of rehab.

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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.