Quadriceps tendon rupture is a tear of the tendon between the thigh muscle and the kneecap. The injury is not very common and usually only occurs when there is already wear and tear on the tendon.
What is a quadriceps tendon rupture?
Quadriceps tendon rupture is a tear (rupture) of the tendon that connects the quadriceps thigh muscle to the kneecap. This muscle is located on the front of the thigh and is responsible for extension movements. That is, you need it to stand up, climb stairs, run or even jump. It consists of four parts, all of which are connected to the kneecap by a tendon and then extend to the lower leg. The quadriceps muscle is the strongest muscle in the entire body and enormous forces act on the connecting tendon. Overall, quadriceps tendon rupture is relatively rare, but when the tendon does rupture, it is usually at the point where the tendon joins the bone of the kneecap.
Causes
The cause of a quadriceps tendon rupture is usually an antecedent degenerative change, meaning that the tendon has worn down and changed in structure. This wear and tear is caused by various diseases, such as diabetes or gout. Obesity is also a risk factor. Furthermore, circulatory disorders, chronic inflammatory diseases or acute infections can reduce the elasticity and durability of the tendons. Medications such as cortisone, if taken over a long period of time, can also lead to a certain brittleness of the tendons. But wear and tear alone usually does not lead to quadriceps tendon rupture. It is only when the degenerated tendon is subjected to a heavy or incorrect load, for example during a sudden movement, when stumbling or when suddenly slowing down a movement. The tendon can then no longer withstand the load due to the previous damage, and quadriceps tendon rupture occurs.
Symptoms, complaints, and signs
Quadriceps tendon rupture often manifests as sudden severe pain in the knee. Sometimes the tendon ruptures with a loud pop. The affected leg can no longer be extended or cannot be extended sufficiently. In quadriceps tendon rupture, the rupture of the tendon takes place above the patella (kneecap). In contrast, in a patellar tendon rupture, the tendon tears below the patella. In both cases, swelling occurs at the site of the tear. Furthermore, local pain occurs. Hematomas are also observed. When the swelling has subsided, a dent can be felt at the site of the rupture. This void can also be felt before the swelling occurs. Because of the stretch deficit, there is unsteadiness when standing and walking. If the leg can no longer be extended at all, a complete rupture is present. If the leg is partially extendable or has reduced strength, the tendon is incompletely ruptured. Another characteristic after rupture is the unusual displaceability of the patella. When the patellar tendon ruptures above the knee joint (quadriceps tendon rupture), the patella is very easily displaced distally (away from the center of the body). In the case of patellar tendon rupture, the congenital (toward the center of the body) displaceability of the patella is greatly facilitated. Quadriceps tendon rupture particularly affects older people who already have previous damage to the tendons due to wear and tear.
Diagnosis and course
The quadriceps tendon rupture is first noticeable by a dent above the kneecap. In addition, the leg can no longer be properly extended and standing is no longer possible without problems. Sometimes it happens that the leg can no longer be lifted in an extended state. In some patients, at the moment the tear occurs, a sudden sharp pain occurs and a noise is perceptible. However, this is not the case for every affected person. On physical examination, the physician may first notice the palpable dent and then clearly see that the patella has slipped toward the lower leg. An ultrasound examination (sonography) can detect the gap in the course of the tendon. With the help of an X-ray, the displaced position of the kneecap also becomes visible and the diagnosis of quadriceps tendon rupture can be made unequivocally.
Complications
A quadriceps tendon rupture can cause several complications. First, the injury leads to restricted movement of the leg. This is usually associated with pain and a feeling of pressure above the kneecap. The restricted movement also causes evasive movements and can thus promote deformities and joint wear. Severe ruptures may be accompanied by sensory disturbances and occasionally paralysis in the area of the injury. In the case of hasty or particularly intensive movements, there is a risk that the tendons may tear completely. The limited mobility usually also restricts the well-being and quality of life of the affected person. If treatment is delayed too long, the tendons contract and the risk of further complications increases. Complications such as bleeding, infection or tearing of the suture are possible with surgical intervention. Rarely, thrombosis or the development of scars occurs. Risks also come from prescribed medications. Painkillers, for example, can trigger side effects in some cases. If other medications are taken at the same time or in the case of other illnesses, interactions are also conceivable. Allergic reactions to the agents and materials used cannot be ruled out.
Treatment and therapy
Quadriceps tendon rupture can be treated surgically or conservatively (without surgery), depending on its severity. If the tear is only incomplete, that is, the tendon is still partially attached, then conservative treatment is possible. In this case, the leg must be immobilized for several weeks in an extended position using a splint. It must not be bent. In the case of a complete quadriceps tendon rupture, when the tendon is completely torn and there is no longer any connection, surgery is inevitable. In this case, the two ends of the tendon are rejoined in a surgical procedure and sutured using a special suturing technique. This operation should be performed as soon as possible after the tendon rupture, since the tendons tend to contract like rubber bands (retraction) and the longer you wait, the more difficult it becomes to sew them back together. The leg must also be immobilized in an extended position after surgery. Healing of quadriceps tendon rupture after surgery takes about 4 weeks, while conservative treatment requires at least 6 weeks before the leg can be loaded again. In both cases, once therapy is complete, the muscle must be strengthened with physiotherapy exercises to restore it to its condition before the quadriceps tendon rupture.
Prevention
Preventing a quadriceps tendon rupture is limited because it usually happens in accidents. If it is known that, due to a disease the tendons are worn out, avoiding excessive sports activities can help to prevent a quadriceps tendon rupture.
Aftercare
Follow-up care for quadriceps tendon rupture is important. It is ideally discussed with the orthopedic surgeon, sports medicine physician or physical therapist. Specially qualified sports instructors or fitness trainers are also competent contacts in this context. Two pillars are important in aftercare. On the one hand, it is important to consistently rebuild the quadriceps femoris, which has usually been significantly weakened by the tendon tear. On the other hand, it is also crucial to do this while optimally protecting the sensitive structures of the tendon that has been treated. The treating physicians and therapists provide the decisive information here with regard to the permitted load. Regular follow-up examinations complement the solid aftercare. Strength training is the effective method for retraining the important muscle of the front of the thigh. Under no circumstances should the tendon be overloaded in the process, so that the risk of a new tear is kept as low as possible. This means that the full range of motion must not be utilized, especially with regard to flexion of the joint. It is in flexion that the pull on the muscle is greatest and the same is true for the tendon structures. In addition, it is important to always gently stretch the thigh muscle after training has been completed. This creates length in the affected muscles and the tension with regard to the tendon is thus reduced.
This is what you can do yourself
Quadriceps tendon rupture is usually treated surgically.Subsequently, the patient can contribute a great deal to ensuring that regeneration proceeds optimally and that the condition prior to the tear is restored as best as possible through self-help in everyday life. There are two factors in particular with which the patient can make a decisive contribution to recovery and well-being. Firstly, the doctor will determine a period after the operation during which bending of the knee joint is not allowed. It is imperative that the patient adhere to it consistently. Flexing too early may put too much stress on the sutured tendon, leading to fear of a new tear that may not be as amenable to surgery the second time around. On the other hand, self-help can be continued after the phase of prohibition of flexion. It refers to the fact that the patient has weakened muscles on the upper side of the thigh due to the tear of the tendon and the prohibition of movement that followed the surgery. In this case, it is important to retrain the muscles in order to restore balance to the muscles of the thigh and regain old strength and mobility. Here it is important that exercises are first guided by the physiotherapist. After some time, in consultation with the physiotherapist, the patient can also perform exercises at home by himself or visit a gym.
