| Introduction |
 Rupture of the quadriceps tendon leading to disruption in the extensor mechanism.- Epidemiology
- incidence
- quadriceps tendon rupture is more common than patellar tendon rupture
- demographics
- usually occurs in patients > 40 years of age
- males > females (up to 8:1)
- occurs in nondominant limb more than twice as often
- location of rupture
- usually where the tendon attaches to the patella
- Pathophysiology
- mechanism
- eccentric loading of the knee extensor mechanism
- often occurs when the foot is planted and knee is slightly bent
- in younger patients the mechanism is usually direct trauma
- Associated conditions
- renal failure
- diabetes
- rheumatoid arthritis
- hyperparathyroidism
- connective tissue disorders
- steroid use
- intraarticular injections (in 20-33%)
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| Anatomy |
- Quadriceps tendon
- has been described as having 2 to 4 distinct layers
- important when distinguishing between partial and complete tear and when repairing tendon
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| Classification |
- Rupture classified as either
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| Presentation |
- History
- often report a history of pain leading up to rupture consistent with an underlying tendonopathy
- Symptoms
- Physical exam
- tenderness at site of rupture
- palpable defect usually within 2 cm of superior pole of patella
- unable to extend the knee against resistance
- unable to perform straight leg raise with complete rupture
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| Imaging |
- Radiographs
- recommended views
- findings
- MRI
- indications
- when there is uncertainty regarding diagnosis
- helps differentiate between a partial and complete tear
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| Treatment |
- Nonoperative
- knee immobilization in brace
- indications
- partial tear with intact knee extensor mechanism
- patients who cannot tolerate surgery
- Operative
- primary repair with reattachment to patella
- indications
- complete rupture with loss of extensor mechanism
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| Techniques |
- Primary repair of acute rupture
- approach
- repair
- longitudinal drill holes in patella
- nonabsorbable sutures in tendon in a running locking fashion with ends free to be passed through osseous drill holes
- retinaculum is repaired with heavy absorbable sutures
- ideally the knee should flex to 90 degrees after repair
- postoperative care
- initial immobilization in brace, cast, or splint
- eventual progressive flexibility and strengthening exercises
- Primary repair of chronic rupture
- approach
- repair
- often the tendon retracts proximally
- ruptures >2 weeks old can retract 5cm
- repaired with a similar technique to acute ruptures but a tendon lengthening procedure may be necessary
- Codivilla procedure (V-Y lengthening)
- auto or allograft tissue may be needed to secure quadriceps tendon to patella
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| Complications |
- Strength deficit
- Stiffness
- Functional impairment
- 50% of patients are unable to return to prior level of activity/ sports
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