The quadriceps tendon connects the femur (thigh bone) to the kneecap (patella). The “quads” is part of the extensor mechanism of the knee and is responsible for straightening the leg. A quadriceps tendon rupture or tear is an injury of the “quads” insertion on the patella leading to a disruption of the knee extensor mechanism.
A quads rupture is more common in patients > 40 years who participate in jumping or running sports. The classic mechanism of rupture involves a heavy load on the slightly bent knee with the foot on the ground. Health conditions that weaken the tendon are also implicated, such as diabetes, rheumatoid arthritis, or chronic kidney failure (especially if on dialysis). Direct trauma is also seen as a cause in younger patients.
Severe pain at the time of rupture is common. Patients often report a history of knee pain leading up to the rupture, which can be consistent with underlying tendinopathy. A palpable defect is observed just above the kneecap and the patient is unable to straight leg-raise.
The doctor will take a thorough history and perform a careful physical exam. An x-ray may show a patella baja, meaning that your kneecap is in a lower position than usual. Ultrasound or MRI are the confirmatory imaging tests of choice.
Most people with a complete tear of the quadriceps tendon require surgery to regain their function. Surgery is done on an outpatient basis, which means that you may go home a few hours after the procedure if you wish. Your surgeon will typically place sutures in your tendon, will pass those sutures through drill holes on the inferior pole of the patella and tie them. Alternatively, your surgeon can use suture anchors instead of tunnels. Your knee will be protected for a few weeks with a knee immobilizer, with an intent to fully weight bear after 6 weeks. A rehabilitation plan will be customized for you by your doctor and physical therapist.
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