Acute Quadriceps Tendon Rupture

Christopher S. Proctor

Brooke S. Prather

INDICATIONS/CONTRAINDICATIONS

Quadriceps tendon rupture is an uncommon injury that requires early diagnosis and surgical correction. Clinical findings for quadriceps tendon rupture include immediate suprapatellar pain, inability to obtain full knee extension, and a suprapatellar gap. Imaging useful for diagnosis includes bilateral radiographs demonstrating patella baja, ultrasound, and magnetic resonance imaging (MRI). Nonsurgical treatment may be appropriate to consider in cases of partial quadriceps tendon tears. Unrepaired complete rupture of the quadriceps tendon results in a poorly functioning lower extremity extensor mechanism. Acute surgical repair is indicated in all cases of complete quadriceps tendon rupture except for the medically unstable or previously nonambulatory patients.

Risk Factors

Middle-aged individuals are more likely to suffer from nontraumatic ruptures of the quadriceps tendon with the greatest incidence in the sixth decade (3, 4, 5). The incidence is higher in males than females (4,5). Medical conditions such as gout, diabetes mellitus, obesity, and end-stage renal disease are associated with spontaneous quadriceps tendon rupture (1, 2, 3). An additional risk factor for spontaneous tendon rupture is hyperparathyroidism, particularly after quinolone antibiotics and steroid use (6). Young athletes are also at risk for quadriceps tendon rupture when they have a history of chronic extensor mechanism inflammation. Sports that increase risk are basketball, volleyball, soccer, high jump, bodybuilding, and weight lifting. Systemic use of anabolic steroids and steroid injections for “body enhancement” should also be considered as a risk factor (2). The common mechanism of injury for quadriceps tendon rupture is contraction of the quadriceps muscle apposed by forced knee flexion (7).

Tendon Vascularity

Decreased quadriceps tendon vascularity plays an important role in tendon rupture and can explain the most common tear pattern. The most frequent pathological finding in ruptured quadriceps tendons is hypoxic degenerative change (8,9). This hypoxic degeneration may be influenced by an unequal distribution of blood supply within the tendon. Recent studies demonstrate a hypovascular zone within the tendon 1 to 2 cm proximal to the superior pole of the patella (3

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