Dr. Ebraheim’s educational animated video describes the condition of quadriceps tendon rupture.
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The quadriceps is a large muscle that lies in front of the thigh. The quadriceps muscle extends the knee.
Tear of the quadriceps tendon will lead to disruption of the extensor mechanism. Quadriceps tendon rupture usually occurs in patients older than 40 years old and it usually occurs more often in males. Rupture usually occurs at the insertion of the tendon to the patella, just above the superior pole of the patella. Rupture of the patellar tendon is usually more common in younger patients. When the patellar tendon ruptures, the patella moves proximally. In case of tear of the quadriceps tendon, the patella moves distally due to the pull of the patellar tendon. In x-rays, you can see the patella baja and the chronic calcinosis, which may have caused weakness of the quadriceps tendon. Calcification indicates that the quadriceps tendon is not healthy. Bilateral rupture of the quadriceps tendon is rare, but is can occur! Bilateral Rupture of the Quadriceps tendon usually occurs: In older patients, may be missed or diagnosis could be delayed, or may occur due to underlying disease.
Predisposed conditions to quadriceps tendon rupture:
- Rheumatoid arthritis
- Diabetes
- Hyperparathyroidism
- Steroid injection in the knee
- Renal failure
- Gout
How does of the quadriceps tendon rupture?
It occurs due to elongation and failure of the tendon due to excessive loading of the knee extensor mechanism.
The tear can be partial or complete and the patient will complain of vague knee pain, swelling, and extensor lag. The patient will not be able to walk. Patient will be unable to extend the knee or do a straight leg raise. The quadriceps tendon is not attached to the patella (it is disconnected), so the patient cannot do straight leg raise of the leg or extend the knee. Defect at the superior pole of the patella within 2 cm from the patella. If the defect is present and the patient is still able to extend the knee, then the extensor retinaculum is intact or the tear of the quadriceps tendon is partial. The x-ray will show patella infera and you will not see patella alta in contrast to the patellar tendon rupture.
You will see loss of the quadriceps tendon mass and the patella will be in a lower position than normal. You will that there is an inferior position of the patella (patella infera). In patellar tendon rupture, the xray will show proximal migration of the patella, called patella alta. MRI is the probably the best study which will clearly show the injury, especially if you are not sure if the injury is partial or complete. If the clinical picture is very obvious, then you really do not need the MRI.
TREATMENT
Surgery should be done early to allow repair of thetendon, in case of a complete rupture of the tendon with loss of the extensor mechanism. The tendon is repaired to the superior pole of the patella.
Surgery
- We use running, locking, nonabsorbable sutures in the tendon (usually two sutures).
- There will be four free ends of the sutures which you pass through bone tunnels through the patella.
- You will tie these sutures and repair the retinaculum.
- Suture anchors may be used instead of the bony tunnels.
After you finish the operation, immobilize the knee in a splint or a brace for a period of 4 - 6 weeks.
COMPLICATIONS OF QUADRICEPS TENDON RUPTURE & REPAIR
You may lose approximately 1/3 of the quadriceps muscle strength. Stiffness of the knee.
The patient with bilateral quadriceps tendon rupture should be examined for any underlying disease.
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