Quadriceps/Patellar Tendon Rupture
Why does it occur?
In this section, Quadriceps and Patellar Tendon will be discussed together as the mechanism of injury and treatment are very similar. The Quadriceps (Quad) is a muscle responsible for extending/straightening your knee. The muscle turns into a tendon as it attaches to your kneecap (patella). The Patella Tendon connects your Patella to the Tibial Tubercle, allowing you to extend your knee as your Quad muscle contracts. Excessive forces on the Quadriceps or Patella tendon or direct trauma to the area can cause the tendon to partially tear or completely rupture off its bony attachment. Ruptures are more common in males and those over 40 years of age. Risk factors include renal disease, Diabetes, steroid use (either orally and especially injected into the tendon), use of fluoroquinolone antibiotics (e.g. Levaquin, Ciprofloxacin), Rheumatoid Arthritis, Hyperparathyroidism, and connective tissue disorders.
The most common symptom is pain just above the kneecap for a Quad tendon rupture, and below the kneecap for a Patellar tendon rupture. A palpable defect may also be present, especially acutely. Patients are often unable to perform a straight leg raise or extend their knee against resistance. In a complete rupture, the patient may be able to bear weight on the affected leg while keeping the leg fully straight, however any amount of bend of the knee with weight-bearing will usually result in significant pain, weakness, and even collapse. While some patients present with a previous history of Quad or Patella Tendonitis, patients often do not have any identifiable previous issue with the knee.
Typically this diagnosis can be determined purely on the history and physical. However, an X-ray is usually ordered to rule out a possible fracture or other bony pathology. An MRI may be ordered if there is a question if there is a partial versus complete rupture.
Patients with partial tears <25% the width of the tendon who are able to extend their knee are usually placed into a knee immobilizer for 4-6 weeks and then started on therapy afterwards.
Surgery is recommended for patients with tears >25-50% the width of the tendon. The goal of the surgery is to reattach the Quadriceps or Patella tendon back to its anatomic insertion on the kneecap using strong sutures. The surgery is relatively simple in nature, and takes less than 30 minutes to perform. Usually it is able to be performed in an outpatient setting.
Dr. Steven Lee is part of the teaching faculty for the Lenox Hill Sports Medicine Fellowship (which is the oldest sports medicine fellowship in the country), and is currently the Associate Director at NISMAT, which is the first institute in the country dedicated to sports medicine research. Dr. Lee has many years of experience successfully treating quadriceps ruptures.
Patients will need to remain in a knee brace locked in extension for 4-6 weeks after surgery, after which range of motion will gradually be increased over the next 6 weeks. Physical Therapy is usually started 4 weeks after surgery. It is important to note that patients may continue to improve for up to 1 year after surgery. Even with optimal treatment and rehab, it is not uncommon for patients to have some residual weakness after surgery unfortunately.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.