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synonyms: quad tendon rupture
Quad Tendon Rupture ICD-9
- 843.8 Sprains and strains of hip and thigh; other specified sites of hip and thigh
- 727.65 Rupture of tendon nontraumatic: quadriceps tendon
- 891.2 Open wound of knee, leg and ankle with tendon involvement
Quad Tendon Rupture Etiology / Epidemiology / Natural History
- Uncommon
- Generally occurs in patients over 40 years old. Peak in 6th and 7th decade.
- Men more common than woman. Most common in black men.
- 5% are bilateral
- May occur with rapid quadriceps contraction with the knee flexed
Quad Tendon Rupture Anatomy
- Knee extensor mechanism = rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius.
- Quadriceps tendon has three layers. Superficial layer = rectus femoris. Intermediate layer = vastus medialis and lateralis. Deep Layer = vastus intermedius.
- Quadriceps tendon has a hypovascular area 1-2cm superior to the patella. (Yepes H, JBJS 2008:90A:2135).
Quad Tendon Rupture Clinical Evaluation
- Acute pain, inability to actively extend the knee
- May have palpable suprapatellar defect in the quad tendon.
- Inability to actively extend the knee indicates a disruption in the extensor mechanism (quad tendon, patella, patellar tendon)
Quad Tendon Rupture Xray / Diagnositc Tests
- Knee films demonstrate inferior displacement of the patella.
- MRI : generally not needed. Partial ruptures appear as hyperintense on T2-images.
- Ultrasound: 100% sensitivity (Heyde CE, Knee Surg Sports Traumatol Arthrosc 2005;13:564).
Quad Tendon Rupture Classification / Treatment
- Acute: repair. Generally repaired with transosseous suture through drill holes in the patella along with repair of the medial and lateral retinaculum.
- Delayed repair is associated with lower functional outcomes, lower patient satisfaction.
- Chronic: quad tendon must be mobilized and adhesions released. May require turn-down flap or augmentation for repair.
Quad Tendon Rupture Associated Injuries / Differential Diagnosis
- Associated with renal disease, diabeties, RA, gout, obesity, hyperparthyroidism, SLE, osteomalacia, steroid use, fluroquinolones
Quad Tendon Rupture Complications
- Lack of full extension
- Knee stiffness
- Infection
- Re-rupture
- DVT / PE
Quad Tendon Rupture Follow-up Care
- Partial weight bearing for 6 weeks in knee immobilizer.
- Begin passive flexion between 30º and 90º at first post-op visit, depending on repair strength. (West JL, AJSM 2008:36:316).
- Patients will generally have some form of long-term quad weakness even after repair.
Quad Tendon Rupture Review References
- Rougraff BT, Orthopedics 1996;19:509
- Ilan DI, JAAOS 2003;11:192
- West JL, AJSM 2008:36:316
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