Your doctor will consider several things when planning your treatment, including:

While you are wearing the brace, your doctor may recommend exercises to strengthen your quadriceps muscles. Straight-leg raises are often prescribed. As time goes on, your doctor or therapist will unlock your brace. This will allow you to move more freely with a greater range of motion. You will be prescribed more strengthening exercises as you heal.

Physical therapy. Once the initial pain and swelling has settled down, physical therapy can begin. Specific exercises can restore strength and range of motion.

Immobilization. Your doctor may recommend you wear a knee immobilizer or brace. This will keep your knee straight to help it heal. You will most likely need crutches to help you avoid putting all of your weight on your leg. You can expect to be in a knee immobilizer or brace for 3 to 6 weeks.

Surgical Treatment

Most people require surgery to regain knee function. Surgical repair reattaches the torn tendon to the kneecap.

People who require surgery do better if the repair is performed soon after the injury. Early repair may prevent the tendon from scarring and tightening into a shortened position.

Hospital stay. Although tendon repairs are sometimes done on an outpatient basis, most people do stay in the hospital at least one night after this operation. Whether or not you will need to stay overnight will depend on your medical needs.

The surgery may be performed with regional (spinal) anesthetic which numbs your lower body, or with a general anesthetic that will put you to sleep.

Procedure. To reattach the tendon, sutures are placed in the tendon and then threaded through drill holes in the kneecap. The sutures are tied at the top of the kneecap. Your surgeon will carefully tie the sutures to get the correct tension in the tendon. This will also make sure the position of the kneecap closely matches that of your uninjured kneecap.

To reattach the tendon, small holes are drilled in the kneecap (left) and sutures are threaded through the holes to pull the tendon back to the bone (right).

New Technique. A recent development in patellar tendon repair is the use of suture anchors. Surgeons attach the tendon to the bone using small metal implants (called suture anchors). Using these anchors means that drill holes in the kneecap are not necessary. This is a new technique, so data is still being collected on its effectiveness. Most orthopaedic research on patellar tendon repair involves the direct suture repair with the drill holes in the kneecap.

Considerations. To provide extra protection to the repair, some surgeons use a wire, sutures, or cables to help hold the kneecap in position while the tendon heals. If your surgeon does this, the wires or cables may need to be removed during a later, scheduled operation.

Your surgeon will discuss your need for this extra protection before your operation. Sometimes, surgeons make this decision for additional protection during surgery. It is then that they see the tendon shows more damage than expected, or the tear is more extensive.

If your tendon has shortened too much before surgery, it will be hard to re-attach it to your kneecap. Your surgeon may need to add tissue graft to lengthen the tendon. This sometimes involves using donated tissue (allograft).

Tendons often shorten if more than a month has passed since your injury. Severe damage from the injury or underlying disease can also make the tendon too short. Your surgeon will discuss this additional procedure with you prior to surgery.

Complications. The most common complications of patellar tendon repair include weakness and loss of motion. Re-tears sometimes occur, and the repaired tendon can detach from the kneecap. In addition, the position of your kneecap may be different after the procedure.

As with any surgery, the other possible complications include infection, wound breakdown, a blood clot, or anesthesia complications.

Rehabilitation. After surgery you will require some type of pain management, including ice and medications. About 2 weeks after surgery, your skin sutures or staples will be removed in the surgeon's office.

Most likely, your repair will be protected with a knee immobilizer or a long leg cast. You may be allowed to put your weight on your leg with the use of a brace and crutches (or a walker). To start, your surgeon may recommend "toe touch" weight bearing. This is when you lightly touch your toe to the floor, putting down just the weight of your leg. By 2 to 4 weeks, your leg can usually bear about 50% of your body weight. After 4 to 6 weeks, your leg should be able to handle your full body weight.

Over time, your doctor or therapist will unlock your brace. This will allow you to move more freely with a greater range of motion. Strengthening exercises will be added to your rehabilitation plan.

In some cases, an "immediate motion" protocol (treatment plan) is prescribed. This is a more aggressive approach and not appropriate for all patients. Most surgeons protect motion early on after surgery.

The exact timeline for physical therapy and the type of exercises prescribed will be individualized to you. Your rehabilitation plan will be based on the type of tear you have, your surgical repair, your medical condition, and your needs.

Complete recovery takes about 6 months. Many patients have reported that they required 12 months before they reached all their goals.