What is the treatment for a torn quadriceps tendon?

Treatment of Torn Quadriceps Tendon

Complete quadriceps tendon ruptures require surgical repair to achieve optimal functional outcomes, while partial tears with intact extensor mechanism may be managed conservatively.

Diagnosis

• Diagnosis of quadriceps tendon tears is primarily clinical, characterized by knee pain, inability to actively extend the knee, and a palpable defect above the patella 1
• MRI is the gold standard imaging modality with high sensitivity (95%) and specificity (95%) for detecting tendon tears, degeneration, and partial tears 2
• Ultrasound is a useful alternative with good specificity but lower sensitivity compared to MRI 2
• Plain radiographs may show indirect signs such as patella baja (low-riding patella) but are primarily useful to rule out associated bony injuries 2

Treatment Algorithm

Complete Tears

• Surgical repair is mandatory for complete quadriceps tendon ruptures with extensor mechanism deficit 1, 3
• Surgery should be performed as soon as possible after injury to minimize complications and achieve optimal outcomes 1
• Two main surgical techniques are employed:
  1. Transosseous tunnel repair (most common) - using nonabsorbable sutures passed through drill holes in the patella 1, 3
  2. Suture anchor repair - using anchors placed in the superior pole of the patella 1
• Both techniques show similar functional outcomes, though suture anchors may allow for smaller incisions and shorter operative times 1
• Delayed surgical treatment is associated with worse outcomes and increased complication rates 1, 3

Partial Tears with Intact Extensor Mechanism

• Conservative management may be appropriate if the extensor mechanism remains functional 1
• Treatment includes:
  • Relative rest to prevent ongoing damage while maintaining some activity to prevent muscle atrophy 2, 4
  • Ice therapy for pain relief and reduction of swelling 2, 4
  • NSAIDs (oral or topical) for pain management 2, 4
  • Immobilization with a hinged knee brace 1

Post-Surgical Management

• Post-operative immobilization in extension for 3-10 weeks is typically recommended 3
• Early rehabilitation should be approached cautiously, as studies suggest that early mobilization may lead to less satisfactory results 5
• Complete immobilization appears preferable for better functional recovery and muscle force restoration 5
• Full recovery typically takes about 4 months before patients can return to daily activities 5

Outcomes and Prognosis

• With appropriate surgical treatment, 90% of patients achieve good to excellent subjective results 5
• Complete joint motion and normal quadriceps force is achieved in approximately 80% of cases 5
• Most patients (>90%) return to pre-injury levels of function and work following surgical repair 1
• Return to high-level athletics is less predictable, with only 50% of professional football players returning to competition after repair 6
• The overall rate of re-rupture after surgical repair is approximately 2% 3

Complications

• Common complications include:
  • Quadriceps muscle atrophy and strength deficit 5, 3
  • Knee stiffness 1
  • Heterotopic ossification (6.9% of patients) 3
  • Deep venous thrombosis or pulmonary embolism (2.5%) 3
  • Infection (1.1-1.2%) 3

Special Considerations

• Chronic tears with significant retraction may require augmentation techniques such as quadriceps tendon turndown 7
• For elderly patients or those with poor tendon quality, reinforcement techniques may be necessary during repair 3
• Concomitant tears in the medial and lateral retinacula should be identified and repaired during surgery 1