Quadriceps tendon rupture is uncommon, occurring much more frequently in males than in females (3,4,6) and more often in patients over 40 years of age. Rupture of the quadriceps tendon is a serious injury that we believe should be surgically repaired within 2 weeks of injury. Beyond 2 weeks, quadriceps contracture and scarring can begin to make the repair more difficult, and postoperative strength and patient satisfaction are adversely affected (4). Some studies have found a loss of range of motion (ROM) with delayed repair as well (5,6). Complete ruptures that go unrepaired produce a lower extremity with a poorly performing extensor mechanism; however, even chronic tears stand to make significant gains through repair (4). We feel that repair is indicated in all acute cases of complete rupture other than the medically unstable patient and those patients who were not ambulatory prior to the injury.

The first step in treating a quadriceps rupture is a prompt and accurate diagnosis. Unfortunately, quadriceps tendon rupture often goes unrecognized in the family practice and emergency setting, leading to delayed diagnoses and repair. Patients with a quadriceps rupture will generally present with suprapatellar gap, suprapatellar pain, and an inability to extend the knee. Diagnosis is complicated by hematoma filling the suprapatellar gap and an unwillingness by some evaluators to thoroughly palpate the tender area. Medical providers often rely on radiography, which can show patella baja if bilateral radiographs are obtained, but more often the case is a normal appearing unilateral series. In some patients, systemic medical issues lead to tendon degeneration and relatively little pain on rupture with a low-energy mechanism of injury. Bilateral ruptures are more likely to have a medical predisposition for tears, such as autoimmune diseases, gout, diabetes mellitus, rheumatoid arthritis, hyperparathyroidism, long-term steroid use, and end-stage renal disease (1,2,3

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