Quadriceps Tendon Tear
What is it?
The quadriceps tendon connects the quadriceps muscle to the knee and is one of the thickest tendons in the knee. The amount of force that comes through the quadriceps through the knee requires a tendon that is capable of taking that force and transmitting it through the rest of the knee. The quadriceps tendon may partially or completely tear, meaning the muscle is no longer anchored to the kneecap. Without this attachment, the knee cannot straighten when the quadriceps muscles contract.
How does it get hurt/damaged?
The quadriceps tendon transmits force through the kneecap, but if a patient sustains a high amount of force to the kneecap when they’re not ready for it, like landing straight-legged from a jump when skiing, landing a fall from a great height, or misstepping on stairs, the quadriceps tendon may tear. Most commonly, patients who experience a quadriceps tendon tear are over the age of 40 or have diabetes or kidney issues and take fluoroquinolone antibiotics. Quad tendon tears can cause major issues because when that particular tendon is torn, the leg isn’t able to extend fully.
How common is a quad tendon tear?
Quad tendon tears occur at a rate of about 5,000 per year in the United States.
When should you be worried about a quad tendon tear and what should you do initially?
If you experience a feeling like a popping sensation above the knee, instability, or an inability to walk, see a primary care provider. If it is a quad tendon tear, it will be easily diagnosed. Due to the crippling nature of this injury and the sensations associate with it, quad tendon tears are usually rapidly diagnosed and treated. The longer you wait to be seen by a care provider, the worse an untreated quad tendon tear can become. If left untreated, a quad tendon tear can become chronic and will become more difficult to treat and to endure through the healing process. When a quad tendon tear becomes chronic, the kneecap will slide down farther down to the shinbone and could potentially get stuck, making it more difficult to restore the overall length of the actual quadriceps structure. This can then lead to the quadriceps tendon shortening, requiring a tendon graft before any reconstructive surgery can take place.
What is the severity of the injury and my treatment options?
Severity of the injury depends completely on the intensity of which the tendon has torn. If there is minor soreness with no obvious tendon tear, It would be classified as a mild tear. A moderate tear would be where a patient has a partially torn quadriceps tendon but also still has the ability to perform a straight legged raise. A complete tear is where the attachment of the quadriceps tendon to the superior pole of the patella is completely disrupted.
Treatment of a quadriceps tendon tear depends completely on the level of tear. Mild and moderate tears have the potential to be treated with activity modification and physical therapy, whereas a complete tear will require surgery.
Surgery for a quadriceps tendon tear starts with incision just above the knee so the surgeon can clean up the end of the tendon, giving it a good margin, and reattaching it to the kneecap. The reattachment itself is commonly done using suture anchors that get placed through the kneecap or through tunnels made into the kneecap, with the sutures then tied into the tendon. Surgeons will make sure the quadriceps tendon repair sutures are tight enough to allow a couple things: 1) to hold the tendon in place long enough to actually complete the healing process, and 2) to make sure the tendon doesn’t slip in the process, creating a longer quadriceps mechanism then there was prior.
What is my recovery timeline and the anticipated outcome?
Patients in recovery from a quadriceps tendon tendon tear may still experience some pain at the site of the original injury but will likely be able to restore it back to full strength and regular level activities. Recovery from a quadriceps tendon tear will require patients to rest completely, and then have a period of time on crutches. Patients should refrain from impatiently trying to push the injured leg through activity level that it’s not ready for. Patients who return to activity too soon, when the ligament isn’t completely healed, will likely sustain a second injury that could have been prevented. If the injury involves the right leg, patients will usually be able to return to driving in seven to eight weeks, while a full return to activities requires full quad strength, and can take four to six months to occur.
