Updated: 8/20/2019
Listen now

Quadriceps Tendon Rupture

Topic
Review Topic
0
0
Questions
2
0
0
Videos
1
Techniques
1
https://upload.orthobullets.com/topic/3023/images/quad rupture.jpg
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 at insertion of tendon to the patella
    • risk factors
      • renal failure
      • diabetes
      • rheumatoid arthritis
      • hyperparathyroidism
      • connective tissue disorders
      • steroid use
      • intraarticular injections (in 20-33%)
  • 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
Classification
  • Rupture classified as either
    • partial
    • complete
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
Presentation
  • History
    • often report a history of pain leading up to rupture consistent with an underlying tendonopathy
  • Symptoms
    • pain
  • 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
Imaging
  • Radiographs
    • recommended views
      • AP and lateral of knee
    • findings
      • will show patella baja
  • MRI
    • indications
      • when there is uncertainty regarding diagnosis
      • helps differentiate between a partial and complete tear
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
Techniques
  • Primary repair of acute rupture
    • approach
      • midline incision to knee
    • 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  
      • repair with suture anchors has been shown to have decreased gap formation and increased ultimate loads to failure  
      • 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
      • midline to knee
    • 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
Complications
  • Strength deficit 
    • 33%-50% of patients
  • Stiffness
  • Functional impairment
    • 50% of patients are unable to return to prior level of activity/ sports
 

Please rate topic.

Average 3.5 of 24 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Technique Guides (1)
Questions (2)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
ARTICLES (2)
VIDEOS & PODCASTS (2)
Topic COMMENTS (4)
Private Note