One of the great aspects of working as an orthopaedic surgeon in sports medicine is helping people return to play sports. In my latest Ask Dr. Geier column, I answer the question from a reader in the United Kingdom who asks about return to sports after a tough injury – patellar tendon tear.
Chris Hurley in Dorset, United Kingdom writes:
Good evening, I ruptured my patella tendon about 18 months ago playing soccer. I am thinking about going back to playing. I don’t play at any high standard, but did enjoy playing. Do you know what the chances of re-injury are by going back to playing? Is it advisable to return to contact sports if you are an amateur?
That’s a great question and one that patients should ask their surgeons prior to any orthopedic surgery. Before I address reinjury and chances of return to play, let’s discuss the injury.
The patellar tendon is the one just below the patella (kneecap). It’s critical in extending the knee. An athlete who tears his patellar tendon almost always requires surgery to reattach it to the base of the patella.
Surgery to repair a patellar tendon tear
The surgery is fairly straightforward, requiring a small incision on the front of the knee. The surgeon passes sutures through the tendon and usually passes the sutures through drill holes in the patella and ties them at the top of the patella. He then places the patient in a brace that limits knee range of motion while the repair heals. Over the course of the next 2 to 6 weeks, the patient gradually works to regain full range of motion. Strengthening and functional training requires months of work with a physical therapist. Return to sports can take 4 to 6 months or more.
I can’t quote you exact numbers on re-ruptures of patellar tendon tears, but I would guess it is low. Most studies looking at retears after surgical repair of Achilles tendon ruptures cite rates less than 5%. I would expect similar or even better percentages with patellar tendon repairs.
Return to sports
The return to sports question is important. Most people who rupture their patellar tendons are under the age of 40. They are also usually active and athletic, often tearing the tendon while playing sports. Getting them back to what they want to do is critical to their happiness. And generally orthopaedic surgeons are successful in helping them return to sports after the surgeries.
Arguably NFL players are the most physical contact or collision sports athletes. Martin Boublik and other researchers at the Steadman Hawkins Clinic in Denver compiled data on 22 NFL players who suffered 24 patellar tendon ruptures between 1994 and 2004. In their study, 100% of the injured players were re-signed by NFL teams, and they participated in training camps after recovery. Only 19 of the 24 players returned to play in the regular season. Using that criterion, roughly 80% of elite athletes returned to the same or higher level of play after patellar tendon rupture. Anecdotally, in my experience with adults who play semi-professional or recreational league sports, the patients almost always return to play. I would guess that most sports medicine orthopaedic surgeons have similar results.
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Boublik M, Schlegel T, Koonce R, Genuario J, Lind C, Hamming D. Patellar tendon ruptures in National Football League players. American Journal of Sports Medicine. November 2011. 39. 2436-2440.