Quadriceps Rupture



Usually occurs in patients over 60

- due to decreased vascularity & collagen weakness


Younger patient on steroids / growth hormone


Occasionally occurs in young athlete with excessive contracture




Often preceded by quadriceps tendinosis


Quadriceps Tendinosis MRIQuadriceps Tendinosis 2




1.  Avulsion of quadriceps tendon from superior patella

2.  Rupture of belly of rectus femoris

3.  Rupture at musclulotendinous junction in athletes




Quadriceps Tendon RuptureQuads Tear


Palpable gap in tendon



Extensor lag

- function usually good if tear incomplete


Extensor Lag


Diagnosis can be missed once acute features settle




Patella Baja


Quadriceps Rupture




MRI Chronic Quadriceps RuptureQuads rupture MRI







- immobilise for 4/52 in extension

- then rehabilitate


Rectus Femoris Avulsion 1Rectus Femoris Tear 2



- surgical repair



- surgical repair


Surgical Technique



- patient supine


Midline incision

- expose quadriceps

- mobilise tendon / release from subcutaneous tissue

- debride insertion on patella


Quads Repair 1Quads Repair 2Quads Repair 3


Drill holes in patella

- pass sutures with houston suture passer

- pass large non absorbable suture

- multiple times through tendon


Quads Repair 4Quads Repair 5Quads Repair 6


Other option

- suture anchors in distal patella


Post operative rehab

- keep in extension 6 - 8/52


Late presentations / Rerupture



- quadriceps VY advancement

- allograft

- tibial tuberosity osteotomy and proximalization of the patella


1.  VY advancement


Will give an extra 2 cm


VY advancement chronic quadsVY Advancement Chronic Quads TearVY Advancement Chronic Quads Tear


2. Tibial tuberosity osteotomy and proximalization of the patella


Note: Patella Baja with chronic rupture

- patient may develop patella baja

- with chronic injuries / failed injuries

- may need to perform tibial tuberosity osteotomy


Failed Quadriceps Repair


Tibial Tuberosity OsteotomyTibial Tuberosity Osteotomy 2



Quads Repair Tibial OsteotomyQuads Repair Tibial Osteotomy 2


Revision Quadriceps Repair with Tibial Tuberosity Osteotomy


3. Allograft Reconstruction


Chronic Quads TearQuads Recon 1Quads Recon 2


Quads Recon 3Quads Recon 5


Quads Allograft Final 1Quads Allograft reconstruction 2



- flat portion oversewn proximally

- two limbs passed through drill holes in patella

- sewn onto themselves