If you suffer a complete quadriceps tendon rupture, you will need surgery to repair or reattach the tendon. Do you need surgery for a partial quadriceps tendon rupture? I address that question in this Ask Dr. Geier column.

Steve asks on Twitter:
@DrDavidGeier I’m a 52yo MD in NJ tore 50% of quad tendon- mostly anterior. Ortho says no surgery since I can contract quad. What do you think?

The quadriceps tendon attaches the quadriceps muscle to the patella (kneecap). Quadriceps tendon ruptures are most often complete tears, meaning there is no tendon intact connecting the muscle to the patella. As such, the patient usually cannot actively extend the knee or lift the leg off the table.

Quad tendon
The quad tendon connects the quadriceps muscle to the top of the patella (white arrow).

Surgery for a complete quadriceps tendon rupture

Most often complete ruptures require surgery to repair the tendon. In theory, a sports medicine surgeon could put the patient in a cast with the knee completely straight, but the risk of significant knee stiffness and rerupture after nonoperative cast treatment can be high. Only older patients with many medical conditions and increased complication risks would be candidates for nonoperative treatment.

Surgical repair involves a small open incision and sewing the tendon back down to the bone at the top of the patella. The surgeon works to restore motion over the first six weeks but can only advance it slowly to avoid disruption of the repair. Once the repair is felt to be strong enough to allow strength training, physical therapy will work to restore strength and functional abilities. The entire process can be lengthy – up to 4-6 months.

Treatment for a partial quadriceps tendon rupture

A partial quadriceps tendon rupture is less common. It is also less straightforward in terms of treatment options. If the patient can actively perform a straight leg raise – meaning he or she can lift the leg off the table with the knee straight by himself or herself – then enough tendon remains intact to provide quadriceps function while the partial tear heals. Efforts to augment healing of the part torn, such as platelet-rich plasma, are controversial. There is a chance that even partial tears don’t heal and the patient doesn’t fully regain function. Younger, more active patients or those with a larger percentage of the tendon torn might be in that higher risk group, and they therefore might be candidates for more aggressive repair from the start.

Strengthening a partial quadriceps tendon rupture

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