Pathology
- Mechanism is usually one of substantially loading the quadriceps mechanism
- Landing from jumping
- Weight training (heavy squats)
Symptoms
- Swelling around the quadriceps mechanism
- Inability to straight leg raise or initiate the quadriceps mechanism
- Tenderness and / or palpable defect at the level of the quadriceps tendon or patellar tendon
- X-ray findings:
- Patellar Tendon Rupture
- Patella Alta (high riding patella)
- Vertical distance between the inferior pole of the patella and the tibial tubercle is greater than 1.1* vertical patellar height
- On a true lateral x-ray, the inferior pole of the patella will not be at the level of Blumensaat’s line
- It may be possible to see the discontinuity of the patellar tendon fibres on plain x-ray
- Patellar Tendon Rupture
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- Quadriceps Tendon Rupture
- There may be Patella Baha (low riding patella) with the normally straight patellar tendon fibres appearing waving (without tension)
- The vertical distance between the inferior pole of the patella and the tibial tubercle may be significantly less than the normal 1.1* vertical patellar height
- For incomplete tears of the quadriceps or patellar tendons, there may not be any significant changes on x-ray. If a significant tendon injury cannot be ruled out clinically, then Ultrasound may be of benefit.
- Quadriceps Tendon Rupture
Management
- The management of ruptures (and high grade tears) of either the quadriceps or patellar tendon is surgery
- Lower grade injuries may be managed in a knee extension (Zimmer) splint and activity restriction until healing has occured