A quadriceps tendon rupture is a devastating injury to the knee that uncommonly occurs in sports. The quadriceps tendon is the tendon that extends from the quadriceps muscle of the thigh to the top of the patella (kneecap). Overall, it is part of the lower extremity’s extensor mechanism. The quadriceps muscle becomes the quadriceps tendon that inserts onto the patella. The patellar tendon extends from the bottom of the patella and runs to the tibial tubercle (the top of the tibia). This entire extensor mechanism helps to extend the knee and efficiently transfers force from the thigh to the leg. A disruption anywhere along the extension mechanism, whether it is a quadriceps tendon rupture, a patellar fracture, or a patella tendon rupture, causes the athlete to be unable to extend his or her knee.

Mechanism of injury

This is almost always a traumatic event. The athlete knows that a serious injury has occurred. Usually it is very difficult to walk normally after the injury, let alone to keep playing. It typically occurs in older athletes, meaning athletes 30 or 40 and older. It is actually a common injury in older segments of the nonathletic population as well. There has been some suggestion that quadriceps tendon ruptures are more common among athletes who have taken steroids, either illegally or for medical reasons. There are also certain antibiotics that weaken tendons, and in theory taking them makes quadriceps tendon ruptures more likely.

If your rupture is not a complete tear, there are other options.

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

Surgery for a quadriceps tendon rupture

Unfortunately quadriceps tendon ruptures need to be fixed surgically. While it is not a surgical emergency, surgery does need to be performed in the first few days, or within the first week or two at the latest. It is usually an outpatient surgery. It is not performed arthroscopically but instead requires a vertical incision across the top of the knee. The area where the tendon is ruptured off of the bone is exposed. Stitches are placed in the tendon, and these sutures are used to repair the tendon back to the top of the patella.

Recovery and rehab of a quadriceps tendon repair

Surgery does bring the tendon back down to the top of the patella, but the surgeon has to ensure that the tendon heals in that position. Therefore some degree of immobilization is usually indicated. The patient will be placed in a long leg cast, a knee brace, or a knee immobilizer that keeps the knee straight for some length of time. I usually place the patient in a hinged knee brace that is locked with the knee in full extension for approximately two weeks before slowly instituting some knee flexion. I gradually increase the amount of bending I’ll allow the patient to do over the first six weeks after surgery. It can be a difficult balance between going slow enough that the tendon heals properly and does not stretch out but quickly enough that the knee does not get stiff. Aggressive work with a physical therapist to help regain range of motion and strength is critical. It’s a difficult injury from which to recover, and it can take many months, sometimes four to six months or more, before the athlete is back to sports at the same or higher level.

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