Question 1

I tore my patellar tendon 2 weeks ago playing basketball and had surgery yesterday to repair it. The surgeon said I can't bend my knee for 6 weeks and can't bear weight—this seems really restrictive compared to my friend who had ACL surgery and was walking within days. Why is the recovery so much slower?

Accepted Answer

The restrictive post-op protocol for patellar tendon repair is CRITICAL to prevent re-rupture—this is very different from ACL reconstruction. Here's why: HEALING BIOLOGY: When your patellar tendon was surgically reattached to your patella, the surgeon used sutures to hold it in place. However, sutures alone don't have enough strength to withstand normal walking forces—the tendon must biologically heal to the bone (or to other tendon tissue) before it can handle load. This takes 6-8 weeks minimum. If you load the repair too early (bend knee or bear full weight), the sutures will pull out and repair will fail. Compare to ACL reconstruction: ACL graft is rigidly fixed to bone with screws or buttons that immediately handle loads, so early weight-bearing is safe. Your patellar tendon repair has no rigid fixation—just sutures holding soft tissue to bone. WHY NO KNEE BENDING: Bending your knee pulls the patella upward (quadriceps muscle contracts to bend knee), creating tension on the repaired tendon. This tension can pull the repair apart in first 6 weeks before healing solid. Keeping knee straight in brace protects the repair. WHY NO WEIGHT-BEARING: Standing and walking activate quadriceps muscle (to prevent knee from buckling), which pulls on patellar tendon. Even partial weight-bearing creates substantial force across repair site. Non-weight-bearing for 6 weeks allows tendon to heal to patella without being stressed. WHAT HAPPENS IF YOU CHEAT: Studies show patients who don't follow post-op restrictions have 15-25% re-rupture rate vs 5-10% in compliant patients. If your repair fails, you need revision surgery which has much worse outcomes (50-60% success vs 75-85% for primary repair). You'd also lose months of recovery starting over. TIMELINE RATIONALE: Weeks 0-6: tendon healing to bone (fragile, protected in brace, non-weight-bearing). Weeks 6-8: early biological healing achieved, start protected weight-bearing and gentle passive motion. Weeks 8-12: tendon strengthening, progressive active motion and weight-bearing. Months 3-6: tendon remodeling, progressive strengthening. Months 6-12: return to activities as tendon approaches normal strength (though never 100% of pre-injury). BOTTOM LINE: Yes, it's frustrating and restrictive, but following the protocol exactly gives you 75-85% chance of good outcome. Rushing recovery risks re-rupture and permanent disability. Trust the process.

Question 2

I'm a 45-year-old with chronic kidney disease on dialysis and I ruptured my patellar tendon 6 weeks ago. I was told to see an orthopedic surgeon urgently but I've been waiting for a public hospital appointment. The surgeon I finally saw said my rupture is 'chronic' now and the surgery will be much more complex with worse outcomes. Why wasn't I operated on immediately and what should I expect from surgery now?

Accepted Answer

This is unfortunately a common and frustrating scenario. Patellar tendon ruptures require urgent surgery (ideally within 2 weeks), but public hospital waiting lists can cause delays that significantly worsen outcomes. Here's what you're facing: WHY DELAY IS A PROBLEM: In the 6 weeks since your rupture: Tendon ends have retracted (pulled apart by muscle forces)—gap now much larger than initial tear. Quadriceps muscle has shortened and become fibrotic (scarred)—can't stretch back to normal length easily. Patella has been pulled up into abnormal position by quadriceps muscle and scar tissue has formed. Torn tendon ends have degenerated and scarred—poor quality tissue for repair. These changes make surgery much more complex—can't simply sew ends together like acute repair. Need reconstruction with grafts to bridge gap. WHY CHRONIC KIDNEY DISEASE MAKES IT WORSE: CKD patients (especially on dialysis) have: Calcium deposition in tendons making them brittle and weak (calcific tendinopathy). Impaired wound healing and higher infection risk. Poorer tissue quality for surgical repair. Your patellar tendon likely already weakened before rupture—why it tore with relatively minor trauma. These factors mean: longer healing time, higher complication rates (infection, re-rupture), worse functional outcomes than non-CKD patients. WHAT SURGERY WILL INVOLVE: Chronic reconstruction rather than simple repair: V-Y quadriceps lengthening (cutting and sliding quadriceps down to bridge gap). Allograft or autograft reconstruction (using donor tissue or your hamstring tendons to bridge tendon gap). Possible synthetic graft augmentation. Surgery takes 2-3 hours vs 1-1.5 hours for acute repair. Higher complexity, higher complication risk. Post-op similar to acute repair but longer protected period (8-12 weeks non-weight-bearing). REALISTIC EXPECTATIONS: Success rate 50-60% for chronic reconstruction in CKD patients (vs 75-85% for acute repair in healthy patients). You'll likely regain walking ability and basic function, but: expect significant residual weakness (20-30% weaker than other leg), may not regain stairs or getting up from chair easily, chronic anterior knee pain likely, may need walking aid long-term. Higher complication rates: re-rupture 15-20%, infection 10-15% (CKD impairs healing), stiffness 30-40%. ADDRESSING SYSTEM FAILURE: While it doesn't help your situation now, this highlights problem with public hospital access for urgent orthopedic conditions. Patellar tendon ruptures should be treated as semi-emergent (within 1-2 weeks), but often deprioritized compared to fractures and trauma. Private surgery would have been ideal if financially feasible. MOVING FORWARD: Proceed with surgery as soon as scheduled—even chronic repair is better than no repair (which leaves you unable to walk). Optimize your dialysis and nutrition before surgery (improves healing). Have realistic expectations about outcomes—you'll improve from current state but won't return to normal. Consider private physiotherapy post-op if accessible (public physio may have limited availability). Advocate for yourself in the healthcare system—if given long wait for surgery, ask to be on cancellation list, request urgency upgrade.

Medical Disclaimer

Patellar Tendon Tear (Complete Rupture)

📖What is Patellar Tendon Tear (Complete Rupture)?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention