Abstract | May 6, 2021

Quadriceps Tendon Rupture: A Clinical Summary

Presenting Author: Justin Arash Sedgewick, BA, Medical Student (MS3), Department of Orthopaedics, Tulanve University School of Medicine, New Orleans, Louisiana

Coauthors: Evan Arnold, BS, Medical Student, Department of Orthopaedics, Tulane University School of Medicine, New Orleans, LA, Ryan J. Wortman, BS, Medical Student, Department of Orthopaedics, Tulane University School of Medicine, New Orleans, LA, Mary Mulcahey, MD, Associate Professor, Department of Orthopaedics, Tulane University School of Medicine Department of Orthopaedics, New Orleans, LA

Learning Objectives

  1. Describe the clinical presentation of a quadriceps tendon rupture;
  2. Identify the most common complications of quadriceps tendon rupture treatment;
  3. Discuss prevention of quadriceps tendon ruptures, and a need for further research into this area.

Background:
Quadriceps tendon ruptures (QTRs) are uncommon, yet serious, injuries that occur most frequently in individuals older than 40, peaking in the sixth and seventh decades of life. The incidence of QTRs is estimated to be 1.37 per 100,000/year.

Methods/Design:
A literature review was conducted using the PubMed database with the keywords “quadriceps tendon rupture” as the search terms. Articles were assessed for information regarding the epidemiology, risk factors, clinical presentation, diagnosis, treatment, and outcomes of QTRs.

Results/Findings:
The exact etiology of QTRs is unknown, though underlying comorbidities are thought to increase risk by causing degenerative tendon changes. The mechanism of rupture is most often the result of an indirect trauma, typically a simple fall. The classic presentation is a triad of acute pain, limited knee extension, and a suprapatellar gap. Diagnosis is based on exam findings as well as imaging studies. Treatment is variable – partialtears are typically managed with immobilization and protected weight-bearing, while complete tears must be surgically repaired. Prompt intervention is key to achieving good outcomes, with early intervention often considered to be within one month of injury.

Conclusion/Implications:
QTRs are serious injuries that most commonly affect the elderly population. Early intervention typically affords the best clinical outcomes. Several techniques exist for surgical management, with the predominant method utilizing transosseous sutures passed through longitudinal patellar drill holes. Patients achieve excellent outcomes in most cases. The most common complication of tendon repair is loss of full knee motion, though long-term decreases in muscle strength have been reported in up to 67% of cases. Tendon re-rupture is a concerning complication, however there appears to be no significant association between specific postoperative rehabilitation regimens and rates of tendon re-rupture. There is limited evidence to support the prevention of ruptures, but strength and flexibility training may have some efficacy. Further research on prevention would be invaluable for decreasing rates of QTRs, which tends to affect more vulnerable populations.

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