Quadriceps Tendon Tear
Quadriceps Tendon Tear is an injury that occurs when the tendon that attaches the quadriceps muscles (a group of 4 muscles in the front part of the femur) to the patella or kneecap tears. The quadriceps tendon may be partially or completely torn. This image is an X-rays of the leg showing a Quadriceps tendon rupture.
What are the other Names for this Condition? (Also known as/Synonyms)
- Quad Tendon Tear
What is Quadriceps Tendon Tear? (Definition/Background Information)
- Quadriceps Tendon Tear is an injury that occurs when the tendon that attaches the quadriceps muscles (a group of 4 muscles in the front part of the femur) to the patella or kneecap tears. The quadriceps tendon may be partially or completely torn
- Quadriceps Tendon Tear is usually caused by any athletic sport, such as basketball, which may involve jumping and landing awkwardly on one’s leg
- Middle-aged adults, who participate in athletics sports and physical activities, are more likely to experience Quadriceps Tendon Tears
- The treatments associated with this injury include both nonsurgical and surgical methods. However, surgery is necessary for individuals with a complete tear of the quadriceps tendon
- With proper treatment, the prognoses of Quadriceps Tendon Tears are usually excellent
Who gets Quadriceps Tendon Tear? (Age and Sex Distribution)
- Quadriceps Tendon Tears is more likely to occur in individuals over the age of 40 years
- The condition is more common in men than women
- By and large, middle-age adults who participate in certain sports activities have a higher rate of incidence of this injury
What are the Risk Factors for Quadriceps Tendon Tear? (Predisposing Factors)
Common risk factors for Quadriceps Tendon Tears include:
- Participation in certain sports such as basketball, football, and track and field activities
- Untreated quadriceps tendinitis
- Injection of corticosteroid into the quadriceps tendon
- Not warming-up prior to exercising or playing in a sports activity
- Previous injury to the knee or thigh
- Loss of strength and flexibility in the muscles and tendons supporting the knees, due to immobilization
Certain chronic diseases can also weaken the tendons by disrupting their blood supply and these include:
- Chronic inflammatory disorder such as rheumatoid arthritis (RA)
- Autoimmune systemic inflammatory condition such as systemic lupus erythematosus (SLE)
- Chronic kidney disease
- Certain conditions linked to renal dialysis
- Hyperparathyroidism, which is an abnormality of the parathyroid glands that result in excess production of parathyroid hormone (PTH)
- Gout, which is a medical condition caused by a high level of uric acid in the blood
- Leukemia: A type of cancer that results in an excessive amount of abnormal white blood cells
- Diabetes mellitus, which include type I diabetes, type II diabetes, and gestational diabetes
- Infection of the quadriceps tendon
- Metabolic disease (any condition that interrupts normal metabolism in the body)
It is important to note that even if individuals have these diseases, the incidence rate of a Quadriceps Tendon Tear is still very low.
It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.
Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.
What are the Causes of Quadriceps Tendon Tear? (Etiology)
Some of the common causes for a Quadriceps Tendon Tear include:
- A traumatic injury, such as due to an automobile accident or sports-related injury, affecting the region directly above the knee
- Participating in certain sports that involve repetitive running or jumping, such as basketball, football, or track and field events
- Injection of corticosteroid into the knee which causes muscle and tendon weakness
What are the Signs and Symptoms of Quadriceps Tendon Tear?
The signs and symptoms of Quadriceps Tendon Tears may include:
- Pain and tenderness above the knee
- Difficulty walking
- Difficulty straightening the leg
- Noticeable swelling above the knee
- A loud popping sound noticed at the time of the injury
How is Quadriceps Tendon Tear Diagnosed?
Diagnostic methods that a physician may use to help diagnose Quadriceps Tendon Tear include:
- Physical examination: The physician may perform a thorough physical examination that may include asking the individual to perform simple tasks such as to extend or straighten the knee, etc. Individuals are also expected to provide an explanation of the circumstances that caused the injury. In addition to this, a complete medical history may aid in arriving at a definitive diagnosis
- X-ray of the knee: When an individual experiences a Quadriceps Tendon Tear, the kneecap shifts out of its original position. This abnormality is usually visible on an x-ray image (lateral view). However, complete tears of the quadriceps tendon can usually be diagnosed with a normal X-ray image
- Magnetic resonance imaging (MRI) of the affected region: An MRI is a more detailed scan that uses a magnetic field to produce images, which allows a physician to view any damage to the bones and soft tissue to confirm the diagnosis
Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.
What are the possible Complications of Quadriceps Tendon Tear?
Complications of Quadriceps Tendon Tears include:
- Decreased range of motion and weakness of the leg
- Prolonged and chronic pain
- Permanent disability, unable to walk
How is Quadriceps Tendon Tear Treated?
Both nonsurgical and surgical methods may be used to treat Quadriceps Tendon Tears. However, treatment depends on the severity of the injury.
Nonsurgical treatment for Quadriceps Tendon Tears may include:
- Rest: Any activity that aggravates the injury should be avoided. The physician usually advises individuals to refrain from activities, until the symptoms stop
- Ice: Applying ice to the knee may help decrease pain and reduce swelling
- Elevation: Elevating the leg helps in decreasing swelling
- Non-steroidal anti-inflammatory medication, such as ibuprofen and naproxen, can help decrease the knee pain
- Physical therapy may help restore strength, as well as flexibility in the muscles
Surgical treatment for Quadriceps Tendon Tears may include:
- Quadriceps tendon repair: Quadriceps tendon repair is a surgical procedure to reattach the torn tendon back to the top of the kneecap, using small surgical instruments called sutures. A new technique in quadriceps tendon repair is the use of suture anchors, in which the physicians can avoid drilling a hole in the kneecap. However, data is still being collected on the effectiveness of this new technique and most repair procedures still involve drilling holes into the kneecap to tie the sutures to the bottom of the kneecap.
How can Quadriceps Tendon Tear be Prevented?
A few recommendations to help prevent Quadriceps Tendon Tears include:
- Warming-up prior to exercising
- Stretching before exercising or taking part in sports activities, which increases flexibility in the tendons
- Allowing for an adequate recovery time between exercises
- Individuals who participate in sports, such as basketball or football, should make sure that any safety equipment worn is properly adjusted and correctly fitted to provide support for the knee
- Maintain physical fitness, which helps keep the strength, flexibility, and endurance in the quadriceps tendon
- Avail proper treatment of chronic disorders that could put one at a higher risk for Quadriceps Tendon Tears
What is the Prognosis of Quadriceps Tendon Tear? (Outcomes/Resolutions)
- A high percentage of Quadriceps Tendon Tears heal without any serious complications. When properly treated under the guidance of a healthcare specialist, a high percentage of individuals regain their full strength and range of motion in their injured leg
- A full recovery and return to sports or normal daily activities may usually require 6-9 months. This also depends on whether the quadriceps tendon is partially torn or completely torn
- However, complications, such as decreased range of motion in the knee, may develop in some individuals even after a surgical repair of the quadriceps tendon
Additional and Relevant Useful Information for Quadriceps Tendon Tear:
The following DoveMed website link is a useful resource for additional information:
What are some Useful Resources for Additional Information?
American Academy of Orthopaedic Surgeons (AAOS)
6300 North River Rd. Rosemont, IL 60018-4262
Phone: (847) 823-7186
Toll-Free: (800) 346-2267
Fax: (847) 823-8125
References and Information Sources used for the Article:
http://orthoinfo.aaos.org/topic.cfm?topic=A00294 (accessed on May 23, 2015)
http://www.sw.org/HealthLibrary?page=Quadriceps%20Tendon%20Tear,%20Disruption%20with%20Rehab-SportsMed (accessed on May 23, 2015)
http://orthosurg.ucsf.edu/oti/patient-care/divisions/sports-medicine/conditions/knee/quadriceps-and-patella-tendon-rupture/ (accessed on May 23, 2015)
Helpful Peer-Reviewed Medical Articles:
Bianchi, S., Zwass, A., Abdelwahab, I. F., & Banderali, A. (1994). Diagnosis of tears of the quadriceps tendon of the knee: value of sonography. AJR. American journal of roentgenology, 162(5), 1137-1140.
Scuderi, C. (1958). Ruptures of the quadriceps tendon: study of twenty tendon ruptures. The American Journal of Surgery, 95(4), 626-635.
Rasul, T., & Fischer, D. A. (1993). Primary Repair of Quadriceps Tendon Ruptures: Results of Treatment Abraham. Clinical orthopaedics and related research, 289, 205-207.
Konrath, G. A., Chen, D., Lock, T., Goitz, H. T., Watson, J. T., Moed, B. R., & D'Ambrosio, G. (1998). Outcomes following repair of quadriceps tendon ruptures. Journal of orthopaedic trauma, 12(4), 273-279.
Levy, M., Goldstein, J., & Rosner, M. (1987). A Method of Repair for Quadriceps Tendon or Patellar Ligament (Tendon) Ruptures Without Cast Immobilization. Clinical orthopaedics and related research, 218, 297-301.
La, S., Fessell, D. P., Femino, J. E., Jacobson, J. A., Jamadar, D., & Hayes, C. (2003). Sonography of partial-thickness quadriceps tendon tears with surgical correlation. Journal of ultrasound in medicine, 22(12), 1323-1329.
Verdano, M. A., Zanelli, M., Aliani, D., Corsini, T., Pellegrini, A., & Ceccarelli, F. (2014). Quadriceps tendon tear rupture in healthy patients treated with patellar drilling holes: clinical and ultrasonographic analysis after 36 months of follow-up. Muscles, ligaments and tendons journal, 4(2), 194.
Secko, M., Diaz, M., & Paladino, L. (2011). Ultrasound diagnosis of quadriceps tendon tear in an uncooperative patient. Journal of Emergencies, Trauma and Shock, 4(4), 521.