The patellar tendon (patellar ligament) runs from the inferior patellar pole to the tibial tuberosity, transmitting quadriceps force to extend the knee. It is a continuation of the quadriceps mechanism and is under the highest tensile load of any tendon in the body during jumping activities — up to 8 times body weight. Despite the name, it functions as a ligament connecting patella to tibia.
Patellar tendinopathy (jumper's knee) affects the proximal tendon at the inferior patellar pole, producing activity-related anterior knee pain reproduced by the single-leg decline squat. MRI and ultrasound demonstrate hypoechoic intratendinous signal at the proximal pole. Conservative management follows the VISA-P assessment and progressive tendon loading protocol. Patellar tendon rupture (at the inferior pole or mid-substance) produces loss of active knee extension and a high-riding patella (patella alta). Repair requires suture anchor or transosseous fixation at the patellar pole followed by protective immobilisation.
Inferior patellar pole degenerative overload producing pain during and after jumping, reproduced by decline squat.
Complete tear from sudden quadriceps overload causing inability to extend the knee and a high-riding patella.
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