The quadriceps tendon rupture is a tear in the tendon between the thigh muscle and the kneecap. The injury is not very common and usually only occurs when the tendons are already worn.
What is a quadriceps tendon rupture?
A quadriceps tendon rupture is a tear (rupture) in the tendon that connects the quadriceps muscle to the kneecap. This muscle is located on the front of the thigh and is responsible for the stretching movements.
That means 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. See sportingology for Meaning of Hip Dysplasia (or Hip Dislocation) in English.
The quadriceps muscle is the strongest muscle in the entire body and tremendous forces are at work on the connecting tendon. Overall, quadriceps tendon rupture is relatively rare, but when the tendon ruptures, it usually occurs at the point where the tendon meets the bone of the kneecap.
The cause of a quadriceps tendon rupture is usually a degenerative change in advance, i.e. the tendon has worn down and changed in its 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 longer period of time, can also lead to a certain degree of brittleness in the tendons. But wear and tear alone usually does not lead to a quadriceps tendon rupture. Only when the degenerated tendon is heavily or improperly loaded, such as during a sudden movement, stumbling, or suddenly stopping a movement. The tendon can then no longer withstand the load due to the previous damage and the quadriceps tendon ruptures.
Symptoms, Ailments & Signs
The quadriceps tendon rupture is often manifested by sudden severe pain in the knee. Sometimes the tendon tears with a loud bang. The affected leg can no longer be stretched or can no longer be stretched sufficiently. In a quadriceps tendon rupture, the tendon ruptures above the patella (kneecap). In contrast, with a patellar tendon rupture, the tendon tears below the patella.
In both cases, swelling occurs at the site of the tear. Local pain also occurs. Hematomas are also observed. When the swelling has gone down, a dent can be felt at the site of the rupture. Even before the swelling occurs, this gap can already be felt. Due to the stretch deficit, there is insecurity when standing and walking. If the leg can no longer be extended at all, there is a complete rupture.
If the leg can only be stretched partially or with reduced strength, the tendon has torn incompletely. Another feature after the rupture is the unusual mobility of the patella. If the patella tendon tears above the knee joint (quadriceps tendon rupture), it is very easy to move the kneecap distally (away from the center of the body).
In the case of a patellar tendon rupture, the congenital (towards the center of the body) mobility of the patella is greatly facilitated. Older people in particular are affected by quadriceps tendon ruptures, as they already have previous damage to the tendons due to signs of wear.
Diagnosis & History
The first sign of a quadriceps tendon rupture is a dent above the kneecap. In addition, the leg can no longer be stretched properly and standing is no longer possible without any problems.
Sometimes it happens that you can no longer lift your leg when it is stretched. In some patients, at the moment the tear occurs, there is a sudden sharp pain and a murmur is noticeable. However, this is not the case for everyone affected.
During the physical examination, the doctor can first determine the palpable dent and then clearly see that the kneecap has slipped towards the lower leg. The gap in the course of the tendon can be detected with an ultrasound examination (sonography).
With the help of an X-ray, the displaced position of the kneecap is also visible and the diagnosis of a quadriceps tendon rupture can be made unequivocally.
A quadriceps tendon rupture can cause a variety of complications. First of all, 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 malpositions and joint wear.
Severe ruptures can be accompanied by sensory disturbances and occasionally also signs of paralysis in the area of the injury. In the case of hasty or particularly intense movements, there is a risk that the tendons will tear completely. The restricted mobility usually also restricts the well-being and quality of life of those affected.
If treatment is delayed too long, the tendons contract and the risk of further complications increases. Complications such as bleeding, infections or tearing of the suture are possible during surgical interventions. Rarely does thrombosis or the formation of scars occur. Risks also come from the prescribed medication.
In some cases, painkillers can cause side effects. Interactions are also conceivable if other medicines are taken at the same time or if there are other diseases. Allergic reactions to the agents and materials used cannot be ruled out.
Treatment & Therapy
The quadriceps tendon rupture can be treated surgically or conservatively (without surgery), depending on its severity. If the tear is incomplete, i.e. the tendon is still partially attached, then conservative treatment is possible.
The leg must be immobilized for several weeks using a splint in an extended position. 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 a surgical procedure, the two ends of the tendons are rejoined and sewn using a special stitching technique.
This surgery should take place as soon as possible after the tendon rupture, as the tendons tend to tighten up like rubber bands (retraction) and suturing them together becomes more difficult the longer you wait. Even after the operation, the leg must be immobilized in an extended position.
Quadriceps tendon rupture takes about 4 weeks to heal after surgery, while conservative treatment takes at least 6 weeks before the leg can bear weight again. In both cases, the muscle must be strengthened with physiotherapy exercises after the therapy has been completed in order to restore the condition before the quadriceps tendon rupture.
Preventing a quadriceps tendon rupture is limited because it mostly happens in accidents. If you know that your tendons are wearing down due to a disease, avoiding excessive exercise can help prevent a quadriceps tendon rupture.
Follow-up care for quadriceps tendon rupture is important. It is ideally discussed with the orthopaedist, sports physician or physiotherapist. Specially qualified sports teachers or fitness trainers are also competent contacts in this context. Two pillars are important in aftercare. On the one hand, the four-headed thigh extensor (quadriceps femoris), which has usually been significantly weakened by the tendon rupture, needs to be consistently rebuilt.
On the other hand, it is also crucial to do this with optimal protection of the sensitive structures of the tendon being treated. The attending physicians and therapists give the decisive information with regard to the permitted load. Regular follow-up examinations complement the solid aftercare. Strength training is the effective way to rebuild the important muscle in the front of the thigh.
The tendon must not be overloaded under any circumstances, so that the risk of another tear is kept as low as possible. This means that the full range of motion must not be used, especially with regard to the flexion of the joint. In flexion, the pull on the muscle is greatest, and the same is true for the tendon structures. It is also important to gently stretch the thigh muscles again and again after training. This creates length in the affected muscles and thus reduces tension on the tendon.
You can do that yourself
Quadriceps tendon rupture is usually treated surgically. After that, the patient can do a lot by helping himself in everyday life to ensure that the regeneration runs optimally and the condition before the tear is restored as best as possible.
There are two main factors with which the patient can make a decisive contribution to recovery and well-being. On the one hand, the doctor will set a time after the operation when flexion of the knee joint is not allowed. It must be strictly observed by the patient. Bending too early can put too much strain on the sewn tendon, so that another tear is to be feared, which may not be able to be surgically treated as well the second time.
On the other hand, self-help can also be continued after the phase of the ban on bending. She refers to the fact that the patient has a weakened musculature on the top of the thigh, which was caused by the rupture of the tendon and the ban on movement resulting from the operation. Here it is important to train the muscles again in order to restore the balance of the muscles in the thigh and to regain old strength and mobility. Here it is important that exercises are first instructed by the physiotherapist. In consultation with the physiotherapist, the patient can also do exercises at home after a while or visit a gym.