images-2Victor Cruz, a key NY Giants receiver, knew he’d suffered a significant injury before he’d even landed from a leaping attempt to catch a fourth-and-six pass down 20-0 to the Eagles in the fourth quarter on Sunday night. The diagnosis, a ruptured patellar tendon, more than ends Cruz’s season, it puts his career in jeopardy.

The patellar tendon is a part of the extensor mechanism of the knee, connecting the patella, or kneecap, to the tibia of the lower leg. Since tendons connect muscle to bone, enabling them to function, and ligaments provide joint stability by connecting one bone to another, the patellar tendon is actually a ligament. However, this vital structure is referred to as a tendon because rather than serve primarily for stability, its function is to enable the quadriceps muscle to extend the knee.

The extensor mechanism of the knee includes the quadriceps muscle, the quadriceps tendon (which attaches the muscle to the patella), the patellar tendon, the tibial tubercle (which is where the patellar tendon attaches to the tibia), and various ligaments that provide soft tissue restraints to the patella while it rides up and down during knee motion (the medial & lateral retinaculum and patellofemoral & patellotibial ligaments).

Because all the structures of the extensor mechanism are so superficial, they can be easily injured, though complete ruptures occur infrequently. The quadriceps tendon and patellar tendon are most vulnerable to rupture, which can be partial or complete. Rupture of the patellar tendon occurs more frequently amongst those under 40, while quad tendon ruptures occur more typically in the over 40 set. Young athletes generally do not suffer from complete ruptures, though chronic steroid use and diabetes are thought to be predisposing factors.

Another patellar tendon injury more common in the under 40 group is an avulsion of the tendon, which means part of the bone is pulled away along with the tendon, either at its attachment to the inferior pole of the patella itself (the more common avulsion), or at tibial tubercle. Interestingly, patellar tendon avulsions occur more frequently amongst those of African descent.

The most common cause of patellar tendon ruptures is during athletics when resisted knee flexion is accompanied by a violent quadriceps contraction – typically when landing from a jump.

A completely ruptured patellar tendon will not heal sufficiently to provide adequate function without surgical intervention. Surgery is generally performed shortly after incurring the injury and, in the interim, an attempt is made to control the inflammation. The success rate is improved if the procedure is not delayed, as the tissue will have little time to retract. The torn tendon is repaired and then sutured through bone tunnels in either the patella or tibial tubercle.

Post-operative rehab for a patellar tendon repair is a lengthy process. Controlling inflammation, restoring soft tissue and patellar mobility, knee range of motion and strength and power of the muscles that cross the hip and knee are of paramount importance. Return to full weight bearing and routine daily activities can take three months and sports specific activities are generally initiated at four to six months. It takes longer to return to full participation.

Even after a successful patellar tendon repair and when full knee flexion is obtained, the strength and explosiveness of the quadriceps may not be fully restored. This is but one facet of Victor Cruz’s game, though one that has set him apart. He has a lot of work ahead and hopefully will prevail.

Follow Abby on Twitter @abcsims.


About the author

Abby serves as the Injury Expert for CBS New York where, since 2010, her Injury Breakdown Blog examines injuries in professional sports. She also blogs on health & fitness as well as sports injuries for Huffington Post, and Recovery Physical Therapy.com, where her blog earned a top ten mention for physical therapy blogs in 2012 @ WorldWideLearn.com. In a ranking of the Top 30 Healthcare Blogs for 2012, Top Masters in Healthcare also rated Abby’s blog in the top three in Physical Therapy! Abby is the founder of Fit-Screen and she welcomes your comments and questions!

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