Partial patellar tendon tears in athletes: a systematic review of treatment options

Key points

1. 01Across 11 studies and 454 athletes, 92.1% returned to sport after treatment, at an average of 3.9 months.
2. 02Surgery was used in 65.0% of patients, usually after non-operative care failed; 37.2% were treated non-operatively only.
3. 03Reoperations were uncommon at 6.8%, lower than typical ACL reconstruction revision rates.
4. 04The one study comparing approaches found more operative patients returned to their prior activity level (89%) than non-operative patients (63%).
5. 05No meta-analysis or direct comparison trial exists, so the best treatment for a given tear is still uncertain.

How it was conducted

Design

Systematic review (PRISMA), no meta-analysis; PROSPERO CRD42023416787

Search

PubMed, Embase, and Cochrane from inception to May 1, 2023

Included studies

11 studies: 3 prospective cohorts (Level II), 3 retrospective cohorts (Level III), 3 case reports and 2 case series (Level IV)

Participants

454 athletes, mean age 25.84 years (range 15 to 55), 86.2% male

Outcomes

Treatment modality, surgical failures/reoperations, complications, return to sport, and time to return to sport

Risk of bias

JBI Critical Appraisal tools for cohort studies, case series, and case reports

What they found

• Return to sport occurred in 267 patients (92.1%), at an average postoperative time of 3.9 months.
• 169 patients (37.2%) received only non-operative treatment; 295 (65.0%) were treated surgically, generally after failing conservative care.
• Reoperations were reported in 20 patients (6.8%); one study reported 2 superficial wound infections (2.6%).
• Mean follow-up was 55.8 months.
• One direct comparison found 7 of 11 (63%) non-operative versus 40 of 45 (89%) operative patients returned to previous activity levels.
• Individual study return-to-sport rates included Raatikainen 1994 at 119/124 (96.0%) and Karlsson 1991 at 71/78 (91.0%), with Karlsson reporting a Lysholm score of 95 (range 74 to 100).
• Teran-Vela 2021 reported VISA-P improving from 37.5/100 before to 89.5/100 after treatment.

Limitations

• Most included studies were low-level evidence (case reports and series), and no randomized or direct-comparison trial was available.
• Outcome measures and surgical techniques varied widely across studies spanning 1991 to 2021, with no individual patient data.
• No meta-analysis was performed, so pooled estimates are weighted descriptive summaries rather than statistically combined effects.
• Return to sport was defined only as resuming general sporting activity, not return to pre-injury performance level.

Why it matters

For patients

Most athletes with a partial patellar tendon tear can expect to return to their sport within a few months whether they have surgery or not.

For clinicians

Conservative care is a reasonable first line, with surgery reserved for failures or tears over 50% thickness, but no evidence-based gold-standard protocol exists.

For readers

This review shows partial patellar tendon tears have favorable outcomes overall, while highlighting the absence of comparative trials to guide treatment choice.