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Quadriceps Tendon Tear

Your quad muscles are located at the front of your thigh, below your hip and above your knee. The quadriceps tendon attaches the five quadriceps muscles to top of the kneecap (patella). It is a strong band of tissue made up of contributions from all of the quadriceps muscles. The kneecap is attached to the shinbone (tibia) by the patellar tendon.

The quadriceps tendon, patellar tendon, and quadriceps muscles work together to straighten the leg from a bent position. You can imagine the tendons and muscles as a pulley mechanism, allowing you to run, kick, and jump.

What is a Quadriceps Tendon Tear?

Quadriceps tendon tears (or ruptures) are not very common. A tear can occur where the tendon attaches to the kneecap or more likely a few inches above the kneecap. Quadriceps tendon tears are classified as partial or complete.

Partial tear

In a partial tear, the tendon is frayed. This type of tear can make it difficult to walk and participate in your usual daily activities.

Complete tear

In a complete tear, the tendon is torn in two, the muscle is detached from the kneecap, and you are unable to straighten your leg. You may experience significant swelling and bruising and notice a concavity or gap in the area above the kneecap. In almost all cases, it is a disabling injury that requires surgery and physical therapy to regain full use of the knee.

Complete tears affect middle-aged men more than women and are caused by a sudden force that overloads the tendon such an awkward landing from a jump, a fall or direct hit on the front of the knee.

Risk Factors include:

  • People who are middle-aged are at a higher risk of a quadriceps tear.
  • Activity. People who participate in sports that require running and jumping are at a higher risk for this type of injury, especially if they are middle-aged.
  • Certain types of medications, such as corticosteroids and fluoroquinolone (an antibiotic), are associated with quadriceps tendon tears. Steroid use has been linked to increased muscle and tendon weakness.
  • The muscles and tendons supporting your knees can lose strength and flexibility after a prolonged period of inactivity.
  • Tendon Weakness. Tendon weakness can be caused by repetitive stress that causes tendinitis, inflammation, and microscopic tears.
  • Chronic disease. Diseases that disrupt the blood supply, such as renal (kidney) failure, gout, and rheumatoid arthritis can weaken tendons.

There is frequently a tearing or popping sensation in the quadriceps at the moment a tendon tear occurs. Afterwards, pain and swelling typically occur. If the rupture is a complete tear, you will not be able to straighten your knee. Other symptoms include:

  • A concavity or gap in the area above your kneecap
  • A sagging or drooping kneecap
  • Difficulty walking (the kneecap buckles or gives way)
  • Cramping, bruising, or tenderness

In order to diagnose a quadriceps tendon tear, Dr. Patel will conduct an orthopaedic examination of your knee including testing how well you can bend and straighten the knee. He will discuss your symptoms and medical history with you to identify risk factors and will want to know if you have previously injured your knee or a quadriceps muscle. He will order imaging studies including x-rays and magnetic resonance imagining (MRI) scan to confirm the diagnosis.

Treatment will typically depend on your age, activity level, and whether it is a complete or partial tear. Small, partial tears respond well to nonsurgical treatment such as immobilization (wearing a knee brace) and once the swelling has subsided, physical therapy. A complete tear will likely require surgery to reattach the torn tendon to the top of the kneecap.

In rare situations, significant time may go by before the diagnosis is made and this can be a difficult situation to manage as the tendon retracts. These chronic tears often require complex augmentation or reconstruction surgeries. Dr. Patel is one of the few surgeons who manages these complex situations. He has published on this topic and other surgeons often turn to Dr. Patel for his expertise in these cases.

Dr. Ronak M. Patel is a double board-certified orthopaedic surgeon and sports medicine physician. He completed his bachelor’s degree, medical degree, and residency training at Northwestern University. He, then completed his fellowship training at the Cleveland Clinic. He specializes in the treatment of complex knee, shoulder and elbow injuries and degenerative conditions. Contact him to schedule a consultation to learn more about how he can help you return to the life you love and the activities that make life worth living. He serves teens and adults in Chicagoland and NW Indiana.

At a Glance

Ronak M. Patel M.D.

  • Double Board-Certified, Fellowship-Trained Orthopaedic Surgeon
  • Past Team Physician to the Cavaliers (NBA), Browns (NFL) and Guardians (MLB)
  • Published over 49 publications and 10 book chapters
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