From the Guidelines
A quadriceps distal tendon rupture is a severe injury that can significantly impact mobility and function, with complete tears being more serious and typically requiring surgical repair to prevent permanent weakness and functional limitations. The severity of the injury depends on whether it's a partial or complete tear, with symptoms including pain, swelling, difficulty walking, inability to straighten the knee, and a visible gap above the kneecap 1.
Key Considerations
- Complete tears often result in permanent weakness and functional limitations if left untreated, emphasizing the need for prompt surgical intervention 1.
- Treatment for partial tears may involve immobilization with a brace for 4-6 weeks, followed by physical therapy for 3-4 months, while complete tears almost always require surgical repair within 2-3 weeks of injury for optimal outcomes 2.
- Recovery typically takes 4-6 months before returning to normal activities, with athletes potentially needing longer, and risk factors include previous steroid injections, certain medications like fluoroquinolone antibiotics, and conditions like diabetes or kidney disease that can weaken tendon integrity 3.
Rehabilitation and Management
- Immediate knee mobilisation and strength/neuromuscular training are crucial following ACL reconstruction, with a focus on isometric quadriceps strengthening exercises from the first postoperative week 2.
- Plyometric and agility training may further improve subjective function and functional activities compared with usual care, without any increase in laxity or pain 1.
- The uninvolved limb’s strength should be monitored and restored to baseline/optimal levels as indicated, highlighting the importance of a comprehensive rehabilitation approach 1.
Outcome Prioritization
- Morbidity, mortality, and quality of life are the primary outcomes to consider when managing a quadriceps distal tendon rupture, with the goal of minimizing complications and optimizing functional recovery. Given the potential for significant morbidity and impact on quality of life, a definitive recommendation based on the most recent and highest quality study 1 is to prioritize surgical repair for complete tears and a comprehensive rehabilitation approach to minimize complications and optimize outcomes.
From the Research
Severity of Quadriceps Distal Tendon Rupture
The severity of a quadriceps distal tendon rupture can be significant, often requiring prompt surgical intervention to achieve optimal functional results 4, 5.
- Complete ruptures are more severe and require primary operative repair, whereas partial ruptures may be treated nonoperatively if the extensor mechanism remains functional 4.
- The most common mechanisms of injury include eccentric contraction of the quadriceps and simple falls 6, 5.
- Predisposing factors such as preexisting comorbidities, including rheumatoid arthritis, systemic lupus erythematosus, and diabetes mellitus, can increase the risk of quadriceps tendon rupture 5.
Treatment and Outcomes
Treatment for quadriceps tendon rupture typically involves surgical repair, with techniques including transosseous tunnels and suture anchors 4, 7.
- Early functional mobilization with full weight-bearing and progressive range-of-motion exercises is recommended for rehabilitation following injury 5.
- Outcomes for surgical repair are generally excellent, with near-full recovery in range of motion and the majority of patients returning to pre-injury levels of function and work 4, 6.
- However, complications such as knee stiffness, quadriceps muscle atrophy, and tendon rerupture can occur, and delayed operative treatment is associated with worse outcomes and increased complication rates 4, 6.
Special Considerations
In cases of quadriceps tendon rerupture, surgical management can be challenging due to tissue degeneration, tendon retraction, and poor bone fixation 8.
- Novel surgical approaches, such as using autologous hamstring tendon for revision of quadriceps tears, have been described and may be suitable for large tendon gap defects or repairs requiring large-force transmission across the repair 8.