Back Pain Doctor
Patellar Tendon Tear
Written by Dr Joshua Hatch, Musculoskeletal GP, RACGP Fellow, Diploma in Musculoskeletal Medicine (FSEM UK).
A patellar tendon tear disrupts the tendon that connects the bottom of the kneecap to the top of the shinbone: part of the mechanism that straightens the knee. Tears may be partial, where some fibres remain intact, or complete, where the tendon separates from the kneecap and the knee can no longer be straightened. Complete tears are disabling and almost always need surgery. It takes a strong force to cause the injury, and the risk is higher when the tendon is already weakened.
Assessment focuses on recognising the injury early (testing whether the knee can be straightened, feeling for a gap below the kneecap, and noting a high-sitting kneecap) because a complete tear is a time-critical problem. A side-view X-ray often confirms it, and MRI is used when the extent of the tear needs to be clarified. Recognised contributors such as corticosteroid use and previous knee surgery are taken into account.
Very small partial tears are managed non-surgically with a period of bracing and a graded physiotherapy program. A suspected complete tear is referred promptly for orthopaedic surgical repair, as outcomes are better when the tendon is reattached soon after the injury. Recovery after repair is gradual, generally taking around six months of protected rehabilitation before full strength and function return.
Load-related pain in the same tendon without a discrete rupture is more likely to be patellar tendinopathy, which is managed with progressive loading.
Common symptoms
- A tearing or popping sensation below the kneecap during injury
- Inability to straighten the knee, with the knee buckling or giving way
- A gap or indentation felt just below the kneecap
- Swelling, bruising and a kneecap that looks high or has ridden up
Commonly seen in
Evidence for twelve treatment options in patellar tendon tear
This is not a fixed ladder or a package of treatments. Every option is assessed independently against this diagnosis, including treatments with limited direct research that may still be reasonable for a clearly defined tissue target. The evidence level, likely benefit, risks, cost and alternatives are weighed at consultation.
Foundation: diagnosis, education and rehabilitation
The part of care with the broadest relevance. For many people it is enough on its own; other options are judged against it, not automatically added after it.
Diagnosis, education and progressive rehabilitation Working out what is driving the pain, explaining what your imaging does and does not mean, and building a graded loading plan you can actually follow. Core care
What it involves
Assessment to identify the likely pain source, an explanation of what the diagnosis means, adjustment of the loads that aggravate it, and a progressive strength and conditioning plan, with weight management where that is clinically relevant.
What the evidence shows
For degenerative structural problems, exercise matches surgery. A trial of 321 patients found exercise-based physiotherapy non-inferior to arthroscopic partial meniscectomy for knee function at five years, with the same rate of radiographic osteoarthritis progression (Noorduyn, JAMA Netw Open 2022), confirming an earlier trial at two years that also found better thigh strength in the exercise group (Kise, Br J Sports Med 2016). Even in adults aged 18 to 40 with MRI-verified tears, traumatic or not, early surgery was no better than twelve weeks of exercise and education at one year (Damsted, J Orthop Sports Phys Ther 2024).
Pairing reviewed 2026-09-02.
Where it fits
A tear on a scan is not automatically the thing to fix. Rehabilitation comes first, with surgical review where the history, examination and imaging together point to a problem that loading will not solve: mechanical locking, instability, or a failure to progress despite doing the work.
Muscle and symptom-modifying options
Useful only when the examination identifies the tissue they target or when short-term pain control creates a useful rehabilitation window.
Wet needling and trigger point injection (trigger point injection) A fine needle into a tender band of muscle, with a small volume of dilute glucose solution injected through it. No trials in this condition
What it involves
The needle is placed into the tender muscle band and a small volume of 5% glucose with a very dilute local anaesthetic (0.02-0.08%) is injected. Often done in the same visit as your assessment, and usable where the tender area sits deeper. Dry needling (the same technique with nothing injected) is not offered here.
What the evidence shows
A search pairing patellar tendon rupture, quadriceps tendon rupture, quadriceps tendon tear and extensor mechanism injury with dry needling, trigger point work and needling returned no records at all. Needling has never been tested in a torn extensor tendon at the knee, and a ruptured tendon is a surgical problem rather than one a needle addresses.
Pairing reviewed 2026-09-19.
Where it fits
Not a treatment for the tear. Considered only during rehabilitation, and only where a separate tender muscle band is reproducing part of your pain.
Ultrasound-guided injections Guidance means the needle can be seen reaching the target. What goes into the needle depends on the diagnosis. No injection for a tear
What it involves
The injection is performed under ultrasound so the needle can be watched into the target structure. What is injected is decided by the diagnosis, and corticosteroid is used sparingly, for the reasons set out below.
What the evidence shows
Searched 12 November 2026 (PubMed: ultrasound-guided injection with patellar tendon and rupture or tear, 7 records; trial and review pass, 1, on tendon pain and not a tear; a second search of corticosteroid, steroid or aspiration injection trials and reviews, 0; a further search of corticosteroid injection with quadriceps or patellar tendon rupture, 17 records). No study has tested an injection as a treatment for this tear. The corticosteroid literature here is about harm: it includes a report of both patellar tendons rupturing after repeated local steroid injections (Clark, J Accid Emerg Med 1995). Case reports cannot measure how often this happens.
Pairing reviewed 2026-11-12.
Where it fits
Not offered for the tear. A complete tear needs surgical repair and a partial tear is managed with protected loading and rehabilitation. Corticosteroid is not injected into or around these tendons.
V-ACTOR vibration therapy (vibration therapy) Low-frequency vibration applied over tender muscle. Not a shockwave, despite sharing the machine. Plausible: no studies
What it involves
A vibration handpiece is moved over the tender muscle and fascia for a few minutes. It runs from the same STORZ MASTERPULS icon console as radial shockwave but is a separate handpiece delivering a different, gentler form of energy. No needles, no anaesthetic, no downtime.
What the evidence shows
No published clinical trial of this device in this condition. It is a vibration handpiece delivered from the same console as radial shockwave, and the rationale is myofascial rather than tendon- or bone-directed.
Pairing reviewed 2026-08-30.
Where it fits
A comfort measure used within a session where muscular tightness is limiting movement. Never the reason for the appointment, and not a substitute for the treatments that do have evidence.
Energy-based treatment options
Radial pressure wave, focused shockwave and EMTT have different targets and different evidence. They are assessed separately rather than treated as one category.
Radial or focused shockwave? Read the overviewRadial shockwave (radial pressure wave) Broad treatment across tender muscle and fascia, close to the surface. Only if relevant
What it involves
A handpiece is moved over the tender tissue while ballistic pressure pulses are delivered, using a transmitter head chosen for the tissue, including heads shaped for fascia and for the muscle either side of the spine. The pulse is strongest at the skin and weakens with depth, so this is mainly a myofascial treatment, though it can reach deeper in some areas. No anaesthetic, no downtime, usually a course of sessions about a week apart.
What the evidence shows
Radial shockwave has not been studied in a patellar tendon tear or after its repair. PubMed searches on 25 October 2026 for shockwave terms with tendon ruptures, tears and repairs (30 records, all read) and for radial device terms with knee tears and repairs (12 records) found no human study in this injury; the radial evidence at the front of the knee is in patellar tendinopathy. Achilles ruptures have been reported after radial and other shockwave in case reports (Briffa, Cureus 2026; Lin, Phys Ther Sport 2012), without proof that the treatment caused them.
Pairing reviewed 2026-10-25.
Where it fits
May ease the tight, tender thigh muscle during rehabilitation after a repair. Not applied over the healing tendon.
Focused shockwave (ESWT) A true shock wave converging at depth: for tendon, joint, ligament and bone. Only if relevant
What it involves
A focused system generates an acoustic shock wave that converges at a focal point set at a defined depth, concentrating the energy where the target is. This is the form used for tendon, joint, ligament and bone. Typically four to six sessions about a week apart, no anaesthetic and no formal downtime.
What the evidence shows
No study has tested shockwave in a torn patellar tendon or after its repair. A PubMed search on 25 October 2026 for shockwave, shock wave, ESWT or pressure wave with tendon rupture, tear or repair, the quadriceps tendon, patellar tendon rupture or patellar dislocation (30 records, all read), a trial pass (12 records) and a systematic-review pass (8 records) found none. The shockwave evidence at this tendon is in patellar tendinopathy, where the tendon is intact. Tendon ruptures have been reported after shockwave at the Achilles - in two people aged 62 and 65 within one sham-controlled trial (Costa, Clin Orthop Relat Res 2005) and in single case reports (Lin, Phys Ther Sport 2012; Briffa, Cureus 2026) - though none was shown to be caused by it.
Pairing reviewed 2026-10-25.
Where it fits
Not used over a torn or recently repaired patellar tendon. Considered only later, for a coexisting tendinopathy, once the repair has healed and the strengthening program is under way.
EMTT (magnetotransduction therapy) High-energy magnetic pulses applied over the area. Usually painless, no contact. Plausible: no studies
What it involves
You sit with the applicator positioned over the area for a short session. It is usually painless and needs no gel or skin contact. It is usually given as a course, commonly alongside shockwave.
What the evidence shows
There are no published randomised trials of EMTT in this condition, or in any musculoskeletal condition, that could be identified. The supporting work is laboratory work: EMTT increased tenocyte proliferation, migration and collagen expression in cultured human tendon cells (Mancini, Int J Mol Sci 2025). The nearest human evidence for a related electromagnetic therapy is negative. A randomised trial of pulsed electromagnetic field therapy added to eccentric exercise for Achilles tendinopathy found no improvement in outcome scores or tendon neovascularity over eccentric exercise alone (Ko, Orthop J Sports Med 2024).
Pairing reviewed 2026-08-30.
Where it fits
Offered only as an adjunct alongside treatment that does have evidence, never as the plan itself, and only after that gap is explained. Much of the EMTT literature is manufacturer-affiliated, which is part of why it is described this way.
Biologic and joint injection options
Each injection is assessed independently for the named diagnosis. Cost, uncertainty, likely benefit, risks and alternatives are part of the decision.
Platelet-rich plasma (PRP) Your own blood, concentrated and injected under ultrasound guidance. Not offered for this
What it involves
Blood is taken from your arm, spun to concentrate the platelets, and injected into the target under ultrasound guidance in the same appointment.
What the evidence shows
A PubMed search for platelet-rich plasma in patellar and quadriceps tendon rupture and repair returned seven records, none of them a comparative trial. What exists is case reports of platelet-rich plasma used as an adjunct at the time of surgical repair (Jarjess, Cureus 2025). Pulling the other way, there is a published case of a complete patellar tendon rupture occurring after a course of four platelet-rich plasma injections into a severely degenerate tendon, with the authors questioning both its efficacy and its safety in that setting (Redler, Clin J Sport Med 2020).
Pairing reviewed 2026-09-04.
Where it fits
Not offered. A ruptured patellar tendon leaves you unable to straighten the knee against gravity, and it is repaired surgically. An injection does not restore a torn extensor mechanism, and the sooner the tear is recognised the better the result. Patellar tendinopathy without a tear is a separate problem with a separate answer.
Prolotherapy (dextrose) A course of dextrose injections into and around the structure and its attachments. Not offered for this
What it involves
Hypertonic dextrose is injected at the tender ligament and tendon attachments, and into the joint where relevant, usually as a series of treatments a few weeks apart.
What the evidence shows
The prolotherapy evidence in the patellar tendon is in tendinopathy, not in a tear: a systematic review of sclerotherapy and prolotherapy for chronic patellar tendinopathy found ten studies including three positive randomised trials, but rated the overall level of evidence IV (Morath, J Exp Orthop 2020). A search for prolotherapy or dextrose injection combined with patellar tendon, tendon tear or tendon rupture returns twelve records and no trial in a torn tendon. Complete extensor mechanism disruption should be repaired surgically, with high rates of return to work and sport and re-rupture under 5% (Tandogan, EFORT Open Rev 2022), and the largest recent prolotherapy randomised trial excluded complete tendon rupture at entry (Lhee, Am J Sports Med 2025).
Pairing reviewed 2026-09-02.
Where it fits
Not offered for a torn patellar tendon. The job here is confirming the tear and getting you to a surgeon quickly. If what you have is patellar tendinopathy rather than a tear, that is a different diagnosis with a different answer.
Viscosupplementation (hyaluronic acid) A gel-like injection into an arthritic joint. Widely used, and genuinely contested. Not used for tendons
What it involves
One or a short series of hyaluronic acid injections into the joint under ultrasound guidance.
What the evidence shows
A tested absence. Searched 12 November 2026 (PubMed: hyaluronic acid, hyaluronate, hyaluronan or viscosupplementation with patellar tendon and rupture or tear, 2 records; second wording, 0). One is a study in rats of tendon changes after training stops (Frizziero, Histol Histopathol 2015) and the other is an unrelated surgical video. Nothing has tested hyaluronic acid for a torn patellar tendon in people.
Pairing reviewed 2026-11-12.
Where it fits
Not offered for this. A complete tear needs surgical repair, and a partial tear is managed with protected loading and rehabilitation.
Nerve-targeted options
Relevant when examination identifies a superficial neuropathic pattern or a compressed peripheral nerve, not simply because pain is present.
Lyftogt perineural therapy (perineural injection therapy) A series of small dilute dextrose injections just under the skin, over tender superficial nerves. No studies in this condition
What it involves
Small injections of low-concentration dextrose, usually 5%, placed just beneath the skin along tender superficial nerves. Given as a series of short sessions.
What the evidence shows
A tested absence. Searched 12 November 2026 (PubMed: perineural injection, perineural dextrose, neural prolotherapy, glucopuncture, subcutaneous dextrose or 5% dextrose with patellar tendon and rupture or tear, 0 records; a second search of dextrose with subcutaneous, perineural or nerve, 0).
Pairing reviewed 2026-11-12.
Where it fits
Not a treatment for the torn tendon. Considered only after healing if a skin nerve at the front of the knee remains tender.
Ultrasound-guided nerve hydrodissection Fluid placed around a nerve to free it from the surrounding tissue. Only if relevant
What it involves
Under ultrasound, fluid is placed in the plane around the nerve to separate it from the tissue that is tethering or compressing it.
What the evidence shows
Searched 10 November 2026 (PubMed: hydrodissection, hydrorelease or perineural injection with tendon rupture, patellar tendon, quadriceps tendon or tendon repair, 23 records; the same terms with quadriceps, thigh, rectus femoris, vastus or infrapatellar, 24 records; a randomised-trial and systematic-review pass returned none). No study has tested hydrodissection for a torn patellar tendon, and it cannot repair one. The only patellar tendon record concerns a different situation: saline injected around the tendon sheath during open surgery when part of the tendon was harvested as an ACL graft, with less pain at four weeks than without it in 45 people (Luna-Pizarro, Cir Cir 2006). The nearest ultrasound-guided reports are at the nerve branch that crosses below the kneecap, after knee replacement or ACL reconstruction (Clendenen, Clin Orthop Relat Res 2015: 16 people, 9 with pain brought to 0 or 1 out of 10, no comparison group; Rao, J Back Musculoskelet Rehabil 2022, one case).
Pairing reviewed 2026-11-10.
Where it fits
Not a treatment for a torn patellar tendon, which usually needs surgical repair followed by a staged rehabilitation program. Considered only if burning or numbness below the kneecap persists after healing, in the pattern of the saphenous nerve branch there.
This is general information only and suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of the uncertainty, the expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.
Every treatment above is described in full on the non-surgical treatments page, including what each one is used for and what the evidence supports. Ratings apply to the named diagnosis; an adjacent muscle, tendon, joint or nerve problem is assessed as a separate target. The method behind the ratings, and the treatments not offered, are set out on the evidence page.
Corticosteroid injection is reviewed separately for each diagnosis.
Cortisone reliably reduces pain in the short term, and that can be genuinely useful when pain is stopping you sleeping or moving enough to rehabilitate. Beyond that window the picture changes. A systematic review of 41 randomised trials and 2,672 participants found that corticosteroid injection reduced pain in the short term but that the effect reversed at intermediate and long term; in pooled analysis for lateral epicondylalgia the short-term effect was large (SMD 1.44, 95% CI 1.17 to 1.71) while no intervention was favoured at 26 weeks (-0.40, -0.67 to -0.14) and at 52 weeks (-0.31, -0.61 to -0.01) (Coombes, Lancet 2010). In a randomised trial in lateral epicondylalgia, 83 per cent of the corticosteroid group had completely recovered or much improved at one year against 96 per cent given a placebo injection, and recurrence ran at 54 per cent against 12 per cent; adding physiotherapy made no significant difference at one year (Coombes, JAMA 2013). In joints, repeated corticosteroid injections have been associated with cartilage loss. It does not repair anything.
So treatment plans are not built around it. Where an injection is the right call, the specific diagnosis and target are reviewed, what is being injected and why is discussed, the number is kept low, and it is paired with the loading work that changes the longer-term course.
When it might still be considered
- Pain severe enough to block rehabilitation
- A clear inflammatory or bursal target on imaging
- A specific short-term goal: a trip, a procedure, a return to work
- Diagnostic use, where the response shows where the pain is coming from
When a cortisone injection is worth doing, and when it is not
Other knee conditions
Pain in the same area can come from more than one source, and the label matters less than what the examination and history point to. These are the other guides for this region.
Frequently asked questions
How is a patellar tendon tear diagnosed?
Do all tears need surgery?
Who is most at risk?
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