Quadriceps Tendinopathy

Abstract

Quadriceps tendinopathy is a rare cause of anterior knee pain. It is typically caused by repetitive overloading of the quadriceps tendon as it inserts into the proximal patella. It is much less frequent than patellar tendinopathy, which occurs at the distal patella. A careful history and physical are usually sufficient to make the diagnosis. Imaging is rarely needed. Musculoskeletal ultrasound can be considered to document echo texture changes consistent with tendinopathy. Treatment consists of rest, ice massage, and rarely, anti-inflammatory medications. Physical therapy can be considered for more resistant cases. Injection and surgery are almost never used for this condition.

Keywords

anterior knee pain, overload, patella, tendinopathy, quadriceps

Synonym
Quadriceps tendinosis
ICD-10 Codes
M76.891	Enthesopathies of right lower limb, excluding foot
M76.892	Enthesopathies of left lower limb, excluding foot
M76.899	Enthesopathies of unspecified lower limb, excluding foot
S83.90	Sprain of unspecified site of unspecified knee
S83.91	Sprain of unspecified site of right knee
S83.92	Sprain of unspecified site of left knee
S89.90	Injury of unspecified lower leg
S89.91	Injury of right lower leg
S89.92	Injury of left lower leg
S99.911	Injury of right ankle
S99.912	Injury of left ankle
S99.919	Injury of unspecified ankle
S99.921	Injury of right foot
S99.922	Injury of left foot

Definition

The quadriceps tendon is located at the insertion of the quadriceps muscle (rectus femoris, vastus medialis, vastus lateralis, vastus intermedius) into the superior aspect of the patella and functions as part of the knee extensor mechanism ( Fig. 77.1 ). Quadriceps tendinosis or tendinopathy is an overuse syndrome characterized by repetitive overloading of the quadriceps tendon. The common mechanism of injury is microtrauma, in which the inherent ability of the tissue to repair itself is outpaced by the repetition of insult. Quadriceps tendinopathy often occurs in athletes who have a change in training or activities. The large and broad insertion into the superior patella makes quadriceps tendinopathy a less frequent clinical condition than patellar tendinopathy. There are no gender or age differences described in the literature. It is more likely to occur in jumping or high impact-loading sports (e.g., basketball and volleyball).