Quadriceps Tendon Tears
The quadriceps tendon connects the quadriceps muscle to the top of the kneecap, while the patellar tendon connects the bottom of the kneecap to the shinbone. Ruptures (tears) of the quadriceps tendon is a serious injury that impacts the knee’s extensor mechanism. The extensor mechanism controls the ability to straighten the knee, which is essential for activities such as walking, running, and jumping.
Quadriceps tendon ruptures are more common in males after age 40, in contrast to patellar tendon ruptures which typically occur in patients less than 40 years old. These tears are caused by a sudden and strong contraction of the quadriceps muscle from a jump or rapid change of direction while running or attempting to regain balance to avoid a fall. While these injuries typically occur in the setting of a fall in older patients, the actual tear occurs prior to the fall due to the strong contraction of the tendon trying to balance the knee. In patients with weakened tendons for systemic reasons, such as patients with diabetes or chronic steroids, tendons may rupture from less common mechanisms, such as a fall on the knee or a direct blow to the front of the knee.
Quadriceps tendon injuries occur on a spectrum, ranging from inflammation to complete tears.
- Quadriceps tendonitis: This involves inflammation of the tendon, and possibly small micro tears. The actual structural integrity of the tendon remains intact. This may cause pain with going up and down stairs, walking long distances, and running.
- Partial Tears: Partial tear typically occur from the same mechanism as complete tears, but only involve some of the tendon fibers. This can result in pain, instability, and weakness, with difficulty extending your knee. Treatment for these injuries is very patient and tear specific. Tears that include >50% of the tendon are more seriously considered for surgery in certain patients, though in-general, these tears are treated non-operatively.
- Complete Tears: A complete tear is either completely detached from the born (more common) or where the tendon itself ruptures into two torn pieces. This injury results in an inability to extend your knee. This leads to difficulty walking and going up and down stairs. Complete quadriceps tendon tears almost always require surgical repair to restore function and reduce pain.
- Sudden, sharp pain at the top of the knee can occur immediately upon injury.
- The knee may be bruised, tender, and swollen.
- Loss of the quadriceps tendon’s function that makes it difficult or impossible to straighten the knee to walk.
- In complete tears, there might be a noticeable gap above the kneecap where the tendon has ruptured.
Dr. Kaplan will take a detailed history of the injury, the patient’s symptoms and evaluate their risk factors. He will perform an orthopedic examination of the affected knee checking for swelling and looking for a gap in the tendon and assess ability to extend the leg. X-rays will be ordered to reveal fractures and other knee injuries. An MRI will be necessary to determine the type and extent of the rupture.
The primary treatment for severe quadriceps tendon ruptures is surgical repair. . This may be recommended for complete and large partial tears. During surgery, the damaged tendon is reattached to the bone using sutures or anchors. Surgery is best if performed as soon as possible after the injury.
The patient will need to wear a brace for several weeks after surgery and undergo physical therapy to regain strength and mobility in the knee. Recovery from quadriceps tendon repair surgery can take several months, with full recovery typically taking up to six months or longer. Most patients have excellent outcomes and can return to their normal activities.
Quadriceps tendon tears can be a painful and debilitating injuries that can affect the quality of life of those affected. However, with prompt diagnosis and appropriate treatment, most people can make a full recovery and return to their normal activities.
Schedule an orthopedic consultation
If you or a loved one has knee pain, contact Dr. Kaplan at NYU Langone Brooklyn office to schedule a consultation. Dr. Daniel Kaplan is a fellowship-trained orthopedic surgeon who specializes in sports medicine and shoulder surgery. He is also the chief of sports medicine at Bellevue Hospital and the chief of sports medicine at the VA hospital in Manhattan His expertise is in minimally invasive arthroscopic and advanced open reconstruction procedures to treat quadriceps tendon tears. Dr. Kaplan has the experience and expertise to diagnose and determine the optimal treatment for your quadriceps and patellar tendon injuries.
At a Glance
Dr. Daniel Kaplan
- Fellowship-trained Sports Medicine and Shoulder Surgeon
- Expertise in Complex Shoulder Hip and Knee minimally-invasive reconstruction procedures
- Assistant Professor of Orthopedic Surgery at NYU
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