Immobilization of Quadriceps Tendon Tear
For a quadriceps tendon tear, immobilization should be done with the knee in full extension using a rigid knee immobilizer or hinged brace locked in extension for 4-6 weeks, followed by progressive controlled motion with protection against excessive flexion. 1, 2
Initial Immobilization Protocol
- Immobilize the knee in full extension immediately after diagnosis or repair to protect the repair site and prevent gap formation 1, 2
- Use a rigid knee immobilizer or hinged knee brace locked in extension for the initial immobilization period 3, 2
- Place a small bump under the heel to provide slight recurvatum at the knee to maintain proper tension on the repair 2
- Complete immobilization should be maintained for approximately 6 weeks following surgical repair 4, 3
Weight Bearing Considerations
- Non-weight bearing or toe-touch weight bearing for the first 2 weeks following repair 3
- Progress to protected weight bearing with the immobilizer in place after 2 weeks 1, 3
- Full weight bearing in the immobilizer is typically allowed by 6 weeks post-repair 1, 3
Rehabilitation Timeline
- Begin isometric quadriceps exercises as early as the second postoperative day to limit muscle atrophy 1, 3
- Maintain immobilization for 6 weeks before initiating controlled active range of motion 1, 3
- Target goals:
Cautions and Considerations
- Early unrestricted motion after quadriceps tendon repair can lead to repair failure and should be avoided 4, 2
- Patients who started rehabilitation exercises too early generally achieved less satisfactory results 4
- Complete immobilization appears preferable for functional recovery, allowing better recovery of muscle force without compromising flexion 4
- Monitor for potential complications such as deep vein thrombosis, which can occur with prolonged immobilization 5
Surgical vs. Non-Surgical Management
- Complete quadriceps tendon ruptures with extensor mechanism deficit require surgical repair for optimal outcomes 2
- Partial tears with intact extensor mechanism may be managed non-operatively with immobilization 2
- Surgical repair should be performed as soon as possible after injury to achieve optimal outcomes 2
Early controlled motion after appropriate immobilization helps prevent complications such as decreased patellar mobility, limited flexion, persistent pain, and muscle weakness, while still protecting the repair 1. However, the evidence suggests that complete immobilization for the initial 6-week period provides better functional recovery and muscle force restoration 4.