Quadriceps Tendon Rupture

Epidemiology

 

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

 

Aetiology

 

Often preceded by quadriceps tendinosis

 

Quadriceps Tendinosis MRIQuadriceps Tendinosis 2

 

Location

 

1.  Avulsion of quadriceps tendon from superior patella

2.  Rupture of belly of rectus femoris

3.  Rupture at musclulotendinous junction in athletes

 

Clinical

 

Quadriceps Tendon RuptureQuads Tear

 

Palpable gap in tendon

Haemarthrosis

 

Extensor lag

- function usually good if tear incomplete

 

Extensor Lag

 

Diagnosis can be missed once acute features settle

 

Xray

 

Patella Baja

 

Quadriceps Rupture

 

MRI

 

MRI Chronic Quadriceps RuptureQuads rupture MRI

 

Management

 

Options

 

Incomplete

- immobilise for 4/52 in extension

- then rehabilitate

 

Rectus Femoris Avulsion 1Rectus Femoris Tear 2

 

Complete 

- surgical repair

 

Athlete 

- surgical repair

 

Surgical Technique

 

Position

- 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

 

Options

- 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

 

Tendo-achilles

- flat portion oversewn proximally

- two limbs passed through drill holes in patella

- sewn onto themselves