Quadriceps tendon rupture - TM

Question 1

Where does this typically occur?

Answer 1

• Site of insertion with the superior pole of patella

Question 2

RF for rupture

Answer 2

• Increasing age - RARELY happens in those <40
• CKD
• Diabetes mellitus
• Rheumatoid arthirits
• Fluroquinolones and corticosteroids

Question 3

Presentation of quadriceps tendon rupture

Answer 3

• Hearing pop
• Tearing sensation
• Pain in anterior knee/thigh
• Difficulty weight bearing

Question 4

MOI tendon rupture

Answer 4

• Sudden and excessive loading eg landing from a jump

Question 5

Examination

Answer 5

• Localised swelling
• Tender palpable defect above superior pole of patella
• Inability to SLR (loss knee extension)

Question 6

Differentials

Answer 6

• Patella tendon rupture
• Patella #
• Femoral shaft #

Question 7

Investigations

Answer 7

• Diagnosed clinically
• X-ray can show caudally displaced patella in complete tears (shifts down)
• USS can measure degree of rupture (+MRI if uncertain)

Question 8

Management of rupture

Answer 8

• Depends on degree
• Partial tears - non op, immbolisation of knee in brace with intensive rehab
• Complete - surgery

Question 9

Surgical management of complete tears

Answer 9

• Insertion at patella - longitudinal drill holes or suture anchors
• Intratendinous - end to end sutures

Question 10

Post op management

Answer 10

• Immobilised in brace
• Progressive strength and flexibility exercises introduced at 6 weeks following repair

Chronic ruptures (>2 weeks since injury) may need tendon lengthening due to retraction