Quadriceps Tendon Rupture

Causes of a quadriceps tendon rupture

A quadriceps rupture usually occurs following overload with the knee flexed. One such example is an awkward landing during a basketball match. Ruptures also occur through a direct mechanism: impact to the knee against a hard surface, or a laceration.

Weakening of the tendon

A weakened tendon ruptures more easily. There are several situations in which the tendon may be weakened:

• Tendinitis. Inflammation of the quadriceps tendon, known as quadriceps tendinitis, weakens the tendon.
• Chronic diseases. Weakened tendons can also result from diseases that interrupt the blood supply. Such chronic conditions include chronic kidney failure, gout, leukaemia, rheumatoid arthritis, systemic lupus erythematosus and diabetes.
• Steroid use. This has been associated with weakening of the tendons.
• Immobilisation. With prolonged inactivity, tendons and muscles lose strength and flexibility.

Surgical causes

Very rarely, quadriceps tendon ruptures have occurred following knee surgery or dislocations.

Conservative treatment

Most small, partial tears respond well to conservative treatment.

• Immobilisation. The orthopaedic surgeon may recommend wearing a brace or a plaster cast. This keeps the knee extended so the tendon can heal. Immobilisation can last between 3 and 6 weeks.
• Physiotherapy. Once the pain and swelling have gone, physiotherapy can begin. Specific exercises can restore strength and range of movement. Straight leg raises to strengthen the quadriceps are at the centre of the physiotherapy plan.

The orthopaedic surgeon will advise on the right time to resume sporting activity.

Surgical treatment

Most patients with a complete quadriceps tendon rupture require immediate surgery to repair the torn tendon. Surgery is also an option for those with partial tears and a degenerate or weakened tendon.

The operation involves reattaching the torn tendon to the upper pole of the kneecap. Patients who need surgery do better when it is carried out soon after the injury. Early repair prevents the tendon from scarring and tightening in a higher position.

The procedure: reattaching the tendon involves passing sutures through the tendon and through bone tunnels in the kneecap. The sutures are tied at the lower pole of the kneecap. The tendon must be sutured under appropriate tension, and the position of the kneecap must be anatomical.

It is important to see a good orthopaedic surgeon early, from the moment the first symptoms appear.