Quadriceps Tendon Tear

by / Tuesday, 18 June 2019 / Published in Blog, Sports Medicine

Tendons are strong cords of fibrous tissue that attach muscles to bones, and therefore constitute a very important part of the musculoskeletal system. Quadriceps is one of the strongest and bulkiest muscles in the body and is located in the anterior compartment of the thighs functioning as a sole extender of the knee joint to straighten the leg. The four quadriceps muscles meet just above the kneecap (patella) to form the quadriceps tendon and encase the patella, which is then attached to the shinbone (tibia) by the patellar tendon.

 

As one can imagine, physically demanding sports that involve running and kicking the ball can potentially damage the quadriceps tendon, especially football. Even small tears of the tendon can make it difficult to walk and participate in other daily activities, but a large tear can be severely disabling, most likely requiring surgery. Quadriceps tendon tears can be either partial or complete. The partial tears, as the name suggests do not completely disrupt the soft tissue. Complete tears, on the other hand completely split the soft tissue into two pieces, rendering the muscle unanchored to the bone.

Steroid use has been linked to increased muscle and tendon weakness

A quadriceps tear often occurs as a result of an injury which involves a heavy load on the leg with the foot planted and the knee partially bent. The force of the landing is too much for the tendon and it tears. This mechanism of injury is not uncommon in football or basketball. Tears can also be caused by falls, direct force to the front of the knee, and lacerations. There are a few conditions that can predispose one to a quadriceps tear. Tendinitis (inflammation of the tendon) is one such condition commonly seen in athletes that weakens the tendon and may even cause small tears. There are other systemic or local diseases that can weaken the tendons as well, such as chronic renal failure, hyperparathyroidism, gout, leukemia, rheumatoid arthritis, systemic lupus erythematosus (SLE), diabetes mellitus, infections, and metabolic diseases. Furthermore, steroid use has been linked to increased muscle and tendon weakness, the incidence of which may be higher in athletes. Some medicines, such as fluoroquinolones have also been shown to predispose to quadriceps tendon tears. Lastly, a sedentary lifestyle or prolonged immobilization can lead to loss of tendon strength and flexibility and predispose to tendon tears.

 

The symptoms of a quadriceps tear include an immediate popping sensation, severe pain, swelling, indentation at the top of the knee cap, muscle cramping and inability to straighten your knee and difficulty in walking. The diagnosis is based on clinical exam but confirmed on x-ray imaging. In some cases, MRI is also performed.

 

The treatment is based on the type and size of your tear, one’s activity level, and age. Nonsurgical treatment most often includes wearing a brace and physical therapy, and that is usually sufficient for small tears to heal up. An immobilizer or brace is often needed as well in order to keep the knee straight to help it heal. Physical therapy is very helpful to restore strength and range of motion. Injuries with complete tears will require surgery to repair the torn tendon. If you have a large partial tear or a partial tear associated with tendon degeneration, your doctor may also recommend surgery. This will likely depend upon your age, your activities, and your previous level of function. Postsurgical rehabilitation involves wearing an immobilizer, crutches, physical therapy, ice packs, and painkillers. Complete recovery takes at least 4 months and most repairs heal fully in 6 months, but it can take up to a year for a full recovery.

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