Quadriceps Tendon Rupture

What are the Symptoms?

• Inability to weight bear.  
• The knee may give way during movement as the tendon does not have the strength to support the weight of the body.
• Lack of muscle strength when straightening the knee against resistance In more serious cases there may be a complete inability to straighten the leg or to perform a straight leg raise.
• The injury is associated with swelling, pain and sometimes bruising just above the knee joint.  
• At the time of injury there may have been an audible 'crack' or 'pop'.  
• The patella may be seen to move downwards, in the direction of the foot.

What is a Rupture of the Quadriceps Tendon?

The quadriceps muscle is composed of four different muscles: the vastus intermedius, vastus medialis, vastus lateralis, and rectus femoris. These muscles converge just above the patella (kneecap) and form an extremely strong tendon, known as the quadriceps tendon. This attaches into the upper surface of the patella.

The quadriceps muscle group function in extending (straightening) the knee joint. They are also vital for the overall stability of the legs during movement, working in conjunction with the hamstrings to keep the body balanced.

Ruptures of the quadriceps tendon mainly occur in middle aged individuals during sporting activities. The most common mode of injury is landing from a jump as this leads to excessive loading on the quadriceps tendon causing it to tear. Most ruptures occur at a point between 0-2cm above the patella.

This injury usually comes secondary to degenerative changes in the quadriceps tendon itself. These changes may be due to ageing but the risk of injury is highly increased in individuals with other medical conditions such as obesity and diabetes or those who have had previous steroid injections.

Treatment of Quadriceps Tendon Rupture

What can the athlete do?

• Apply RICE (Rest, Ice, Compression, Elevation) immediately
• Use an elasticized compression bandage around the injury
• Avoid movements that make the symptoms worse
• See a sports injury professional.

In less serious tears, conservative treatment may be advised. This may include:

• Ultrasound and TENS electrotherapy.
• Rehabilitative quadriceps strengthening and proprioception exercises (e.g. wobble board exercises)
• Manual techniques, such as massage.
• Heat and ice therapy.

Surgery

In cases where there has been a severe or complete tear of the tendon, surgery is required. If the tendon has been pulled off the patella, it is sutured (stitched) firmly back in place. Following surgery the knee must remain immobilized in a knee brace and non-weight bearing is usually advised for a number of weeks. Prescribed rehabilitative exercises should be followed once the rupture has healed sufficiently.