Injury of the quadriceps tendon

An acute rupture of the quadriceps tendon is clearly indicated by an extension deficit in the knee joint. The tendon is located at the teresitas tibiae (bony roughening on the upper front part of the tibia) and has the patella (kneecap) embedded. The quadriceps muscle is the main extensor in the knee joint.

If these tendons rupture completely, the ability to stretch the affected leg is almost completely lost. This can be tested by asking the patient to bend the knee, for example, while sitting with a fixed thigh. This is not possible with a complete rupture.

In the case of a partial rupture, stretching force may still have been retained. When looking at the knee, a depression cranially (above) of the kneecap in the course of the tendon is noticeable. In the palpation findings, the tear of the tendon may also be conspicuous.

The rupture is almost certainly noticeable in the ultrasound of the tendon. One of the most common reasons for a rupture of the quadriceps tendon is a fall on the bent knee. In this condition, the tendon is already very severely stretched to its maximum.When additional traction is applied due to the forced (forced) flexion during a fall, it is sometimes no longer able to withstand this acute force and ruptures.

This happens especially in older patients whose tendons have lost their strength and extensibility. In this patient clientele, the tendon often tears cranially (above – towards the thigh) of the kneecap. In younger patients, tears and tears occur at the kneecap.

A rupture must be treated surgically! The incision is made on the outer side of the quadriceps tendon lengthwise. In the next step, the fascia are removed at the affected area through individual incisions.

Now the rupture in the tendon is searched for and exposed. If the capsule is also affected, it is also attached. The tendon is adapted again by simple sutures (the stumps are pulled together).

These seams are sewn end-to-end into the tendon. They are applied in all layers of the tendon. Resorbable sutures are often used here, which are decomposed by the body after a certain time.

In addition, a frame seam is placed to ensure that the seams do not tear. This seam is sewn in a loop through the upper tendon stump and is usually made of non-absorbable material. It is pulled lengthwise through the lower stump and then anchored in the patella.

This is done by drilling a horizontal channel through the patella through which the suture is pulled. In addition, so-called augmentations can be used for securing. Resorbable cords are used for this.

These take over a part of the traction force from the tendon. After a certain time, however, they are resorbed by the body, i.e. they are broken down. At this point, however, the tendon has healed sufficiently for it to be able to fully carry the traction force again.

If the quadriceps are not ruptured but ruptured from their bony anchorage in the patella, the tendon must be reattached. This is done by means of small holes that run vertically. Sutures are pulled through these holes and sewn into the torn out tendon.

Also here a frame seam is created to prevent a tearing. After the operation the leg must be immobilized for 3 weeks. In the course of a physiotherapeutic aftercare the knee is brought back to full mobility.

If a patient presents with an old rupture that had not been operated on, surgery should also be performed. These patients often complain of weakness when stretching the knee. This is because the tendon is longer due to scarred healing.

It has grown back together on its own – but it is too long. During the surgical procedure, the tendon is shortened. The tendon is incised in a Z-shaped incision to create two triangular ends.

These are now placed on top of each other until the desired length of the tendon is reached. Another option is to cut out the scarred part in the former rupture gap of the tendon and sew the two stumps together as in a complete rupture. If a rupture site is to be reinforced, an inverted plastic can be used.

A thin flap is cut out of the front of the quadriceps tendon at another location. This flap is then placed over the already sewn rupture site and also sewn back in the visual field. Normally, the prognosis is very good and the patient can use the knee without complications after completion of the treatment. A possible complication would be another rupture in case of premature loading. Possibly the sutures were not sufficient (insufficient).