This has been the week of the patellar tendon tear in the NFL.
Gerald McRath, a Tennessee Titans’ linebacker who had missed some playing time at the close of last season in part due to knee pain, is set for surgery to repair the partially torn left patellar tendon that has continued to hamper him. He is expected to be out for the year.
The Tampa Bay Buccaneers lost right guard Davin Joseph to a what is likely a season-ending right patellar tendon tear suffered on August 24th during a preseason victory over the New England Patriots,
Rounding out the list is promising Steelers’ rookie guard David DeCastro, who hit a terrible trifecta with a dislocated right patella, torn MCL (medial collateral ligament) and partially torn patellar tendon on August 25th in a preseason game against Buffalo. In spite of what is clearly a “severe knee injury”, optimistic reports have DeCastro returning in three to five months.
Jim Leonhard, Ryan Williams, Nate Allen and Clint Sintim are amongst NFL sufferers from recent seasons who could counsel the newest members of the patellar tendon club.
The Patellar Tendon
A tendon connects muscle to bone, while a ligament connects bone to bone.
The patella is also known as the kneecap, and the patellar tendon, which connects it to the tibia (the larger bone of the lower leg), is sometimes referred to as the patellar ligament. This tendon is a part of the extensor mechanism of the knee. The extensor mechanism also includes the quadriceps muscle (located at the front of the thigh), the quadriceps tendon (which attaches the quads to the patella), ligaments that connect the patella to the femur (thigh bone) and tibia, connective tissues that help secure and stabilize the patella, as well as the tibial tubercle (the point of attachment of the patellar tendon to the tibia).
Ruptures of the extensor mechanism occur either to the quadriceps tendon or patellar tendon and may be complete or partial. Patellar tendon ruptures generally occur in those younger than than 40 years of age, while quad tendons are more likely to rupture in those over 40. Prolonged steroid use is thought to increase the risk of rupture. When either the quad or patellar tendons are completely ruptured, the knee cannot be actively straightened at all. With a partial tear, it is generally possible to extend it at least somewhat.
Most ruptures of the patellar tendon occur when the knee is bent and subject to more of a demand than it can tolerate. Ruptures occur more frequently at the upper part of the tendon and its attachment to the patella than at the lowermost portion where it attaches to the tibia. A patellar tendon rupture may also be referred to as an avulsion, which is the term used to describe the tearing away of a body part. In the case of a tendon tear, a portion of the attaching bone may be torn away as well. Without the tendon to anchor it, when someone has a torn patellar tendon, the kneecap will ride upward and remain there. Interestingly, there is a greater incidence of patellar tendon ruptures amongst those of African decent. The reason for this is not absolutely clear.
Complete rupture of the patellar tendon requires surgical repair, and surgery is best if performed promptly to optimize outcomes. Partial tears may heal sufficiently depending on the degree of disruption and the demands placed on the muscle tendon unit. Newer operative procedures allow patients to avoid prolonged immobilization in a cast and work on mobility of the knee in the post-operative period. This generally accelerates recovery. However, healing and rehab is a process that cannot be rushed. A gradual restoration of full range of motion, muscle flexibility, strength and endurance as well as balance and agility is all a part of that process.