The quadriceps attach to the kneecap by way of the quadriceps tendon and function to extend the knee. When a rupture of the quadriceps tendon occurs, there is often immediate and complete disability in the leg. Surgical intervention is most beneficial when performed soon after the injury, so the patient should seek medical evaluation right away.
Anatomy
The four muscles of the front of the thigh, collectively referred to as the quadriceps muscles, function to extend or straighten the knee. The muscles attach to the patella, or kneecap, by way of a thick tendon called the patella tendon, or quadriceps tendon. Generally, when a rupture of the quadriceps occurs, it is at the juncture where the muscle becomes a tendon, or where the tendon attaches to the patella.
Mechanism of Injury
Most often a quadriceps rupture occurs in middle-age individuals participating in jumping activities, although it can also result from a fall or motor vehicle accident. According to the American Academy of Orthopaedic Surgeons, a quadriceps tear often occurs when there is a heavy load on the leg with the foot planted and the knee partially bent, as in an awkward landing from a jump while playing basketball. The quadriceps rupture can be partial, disrupting only some of the fibers, or complete, leaving no fibers intact.
Non-Surgical Treatment
If the quadriceps rupture is partial or incomplete, the physician might opt for the use of a long leg knee immobilizer for treatment. The knee is generally immobilized in a straight leg position for a period of four to six weeks, with crutches used to control weight-bearing for at least some of this time. This option is most often considered for very small tears, for less-active individuals, or for those who are not appropriate surgical candidates. Physical therapy is usually required at some point during the recovery.
Surgical Treatment
Most complete ruptures of the quadriceps are repaired surgically to reattach the patella to the quadriceps tendon. According to the American Academy of Orthopaedic Surgeons, individuals who require surgery do better if the repair is performed early after the injury, as this might prevent the tendon from scarring and tightening in a shortened position. This procedure is done through an open incision, so an overnight stay in the hospital often is required. Typically, the patient is placed in a long leg knee immobilizer for several weeks and physical therapy is initiated about two weeks after surgery.
Outcomes
According to the American Academy of Orthopaedic Surgeons, most people are able to return to their previous occupations, with slightly more than half having thigh weakness and soreness at the site of the tear. Rehabilitation is long and arduous regardless of whether surgery or conservative treatment is chosen. According to the Nicholas Institute of Sports Medicine and Athletic Trauma, it can be a full 12 months before the patient can return to normal activities, including sports.
