What are the symptoms and treatment options for a quadriceps (muscle in the anterior thigh) tear?

From the Guidelines

A quadriceps tear is a serious injury that requires prompt medical attention, typically involving a course of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 400-800mg every 8 hours for 7-10 days to manage pain and inflammation, as well as eccentric quadriceps training which can be started from 3 weeks after injury, as it is safe and contributes to a bigger improvement [ 1 ].

Symptoms of a Quadriceps Tear

• Severe pain in the anterior thigh
• Swelling and bruising
• Weakness or instability in the knee
• Difficulty walking or bearing weight on the affected leg

Treatment Options

• Non-surgical management: NSAIDs, physical therapy, and bracing, with the addition of cryotherapy to decrease pain immediately after application up to 1 week postsurgery [ 1 ]
• Surgical intervention: may be necessary in severe cases, followed by a rehabilitation protocol
• Pain management: may be supplemented with acetaminophen 650-1000mg every 4-6 hours as needed, with a maximum daily dose not exceeding 4000mg It is essential to note that while cryotherapy is effective in decreasing pain, its application should be limited to the immediate post-injury period, up to 1 week [ 1 ]. Additionally, eccentric quadriceps training should be started from 3 weeks after injury to ensure safe and effective rehabilitation [ 1 ].

From the Research

Symptoms of Quadriceps Tear

• Acute pain 2
• Impaired knee extension 2
• Suprapatellar gap 2
• Inability to extend the knee 3
• Reduced ambulation 4
• Chronic disability including pain 4

Treatment Options for Quadriceps Tear

• Surgical repair with considerable post-operative rehabilitation 4
• Immobilization 4
• Physiotherapy 4
• Use of novel tri-compartment offloader knee braces providing knee-extension assist 4
• Conservative treatment for partial ruptures 5
• Direct primary repair with autogenous or synthetic tissue augmentation for acute ruptures 5
• Reconstruction with the aid of a muscle flap or allograft tissue for chronic insufficiency 5
• Use of a synthetic mesh for reconstruction and augmentation of the extensor mechanism 5
• Single stage bilateral end to end repair for simultaneous bilateral quadriceps tendon ruptures 6
• Cast immobilisation followed by supervised rehabilitation protocol 6
• Modified Mason-Allen technique and polypropylene mesh augmentation for mid-substance tear of quadriceps muscle 3

Factors to Consider in Treatment

• Extent of the loss of function (partial, complete) 5
• Duration of the injury (acute vs chronic) 5
• Quality and availability of primary tissue 5
• Patient's general health 5
• Patient's likely functional requirements 5
• History of anabolic steroid use 6