MANUAL MINORS
A quadriceps tendon rupture is a severe injury affecting the tendon that connects the quadriceps muscle to the top of the patella. It typically occurs due to direct trauma, excessive strain, or a sudden movement involving a violent contraction of the muscle.
It is more common in older individuals or athletes performing explosive movements. Symptoms include intense pain in the front of the thigh, swelling, inability to extend the knee, and sometimes a palpable gap above the patella.
Diagnosis
Diagnosis is based on patient history and physical examination, where a palpable defect in the quadriceps tendon and inability to actively extend the knee are evident. X-rays may show a low-riding patella (patella baja), and MRI is the preferred study to confirm the rupture and assess its extent.
Differential Diagnosis
Condition | Key Differentiation |
Patellar Tendon Rupture | Inability to extend the knee, but with a high-riding patella (patella alta) on X-ray. |
Patellar Tendinitis | Anterior knee pain without severe functional deficit. |
Prepatellar Bursitis | Anterior swelling without loss of extension function. |
Quadriceps Muscle Tear | Localised pain in the muscle without significant functional deficit. |
Patellar Fracture | Severe pain, inability to move the knee, confirmed by X-ray. |
Emergency Management
In the emergency department, initial management involves immobilising the affected leg with a splint in full extension to prevent further damage, applying ice to reduce swelling, and administering NSAIDs for pain relief. Active knee movement should be avoided. The patient must be referred promptly to orthopaedics for surgical evaluation.
Definitive Treatment
Definitive treatment generally requires surgery to repair the quadriceps tendon, especially in cases of complete rupture. After surgery, the patient undergoes an extended rehabilitation program to regain strength and mobility. In cases of partial rupture, conservative treatment with immobilisation and gradual physiotherapy may be considered.
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