Distal Quadriceps Tendon Rupture

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Distal Quadriceps Tendon Rupture

Authors, Editors, Case Information Author: Derek Stokes, MD Affiliation: University of Utah Co Author(s): Dan Cushman, MD Senior Editor: Wesley Troyer, DO Clinical Vignette: A 51-year-old male presented with acute onset severe left knee pain after attempting to snap a branch with a stomping mechanism while camping. Patient reported that the branch "hit him in the knee". He was evaluated and placed in a hinged knee brace locked in extension at an outside ED and referred to clinic. Clinical evaluation 3 days later identified diffuse ecchymosis and palpable defect proximal to the left patella along with a knee extensor lag. Type of Probe Used: 15-4 linear transducer Unlabeled Long Axis View of the Quadriceps Tendon Insertion Unlabeled Long Axis View of the Quadriceps Tendon Insertion Labeled Long Axis View of the Quadriceps Tendon Insertion Labeled Long Axis View of the Quadriceps Tendon Insertion with complete disruption of the normal fibrillar architecture of the proximal stump of the quadriceps tendon (white asterisk) from the superior patellar attachment (yellow asterisk) with mixed hyper and hypoechogenicity present. Cortical irregularities of the superior aspect of the patella are also present. Unlabeled Short Axis View of the Distal Quadriceps Tendon Unlabeled Short Axis View of the Distal Quadriceps Tendon Labeled Short Axis View of the Distal Quadriceps Tendon Labeled Short Axis View of the Distal Quadriceps Tendon with complete disruption of the tendon fibers. #5 - Video View Video Long Axis Cine of the distal quadriceps tendon from proximal to distal with complete disruption of the normal fibrillar architecture of the proximal stump of the quadriceps tendon (white asterisk) from the superior patellar attachment (yellow asterisk) with mixed hyper and hypoechogenicity present. Cortical irregularities of the superior aspect of the patella are present. Left side of the picture is distal. #6 - Video View Video Long Axis Cine of the distal quadriceps tendon from medial to lateral with complete disruption of the normal fibrillar architecture of the proximal stump of the quadriceps tendon (white asterisk) from the superior patellar attachment (yellow asterisk) with mixed hyper and hypoechogenicity present. Cortical irregularities of the superior aspect of the patella are present. Left side of the picture is distal. #7 - Video View Video Short Axis Cine of the distal quadriceps tendon from proximal to distal with abrupt loss of architecture distally associated with mixed hyper and hypoechogenicity. Lateral radiograph of the injured knee Lateral radiograph of the injured knee with focal calcification/mineralization at the superior aspect of the patella in the expected location of the distal quadriceps tendon. Sagittal MRI of the injured knee Sagittal cut of the knee MRI with complete tear of the quadriceps tendon near the insertion with minimal retraction. Interpretation Image Interpretation: Long axis image and videos (distal to proximal): Complete disruption of the normal fibrillar architecture of the quadriceps tendon (white asterix) at the superior patellar (yellow asterix) with mixed hyper and hypoechogenicity present. Cortical irregularities of the superior aspect of the patella present. Short axis image and video (proximal to distal): The quadriceps tendon was identified in short axis proximally with abrupt loss of architecture distally associated with mixed hyper and hypoechogenicity. X-ray correlate: Focal calcification/mineralization at the superior aspect of the patella in the expected location of the distal quadriceps tendon. MRI correlate: Complete tear of the quadriceps tendon near the insertion with minimal retraction. Teaching Pearl: Quadriceps tendon rupture most often occurs in men over age 40 and is caused by eccentric loading of the knee extensor mechanism. Ultrasound can quickly identify complete disruption at the superior patellar pole, tendon retraction, hematoma, and avulsion fragments. It's important to examine the extensor mechanism carefully because preserved partial tear extension can mask a significant tear. Scan the entire tendon width in long and short axis, and refer complete ruptures or physical exam findings suggesting a disrupted extensor mechanisms urgently for surgical consultation. References: 1. Foley R, Fessell DP, Yablon CM, Nadig JD, Brandon C, Jacobson JA. Sonography of traumatic quadriceps tendon tears with surgical correlation. J Ultrasound Med. 2015;34(5):805-810. doi:10.7863/ultra.34.5.805 2. Arnold EP, Sedgewick JA, Wortman RJ, Stamm MA, Mulcahey MK. Acute quadriceps tendon rupture: presentation, diagnosis, and management. JBJS Rev. 2022;10(2):e21.00171. doi:10.2106/JBJS.RVW.21.00171 3. Billone LM, Allred SJ, Flores DV. US of acute tendon tears. Radiographics. 2024;44(12):e240060. doi:10.1148/rg.240060
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Authors, Editors, Case Information

Unlabeled Long Axis View of the Quadriceps Tendon Insertion

Labeled Long Axis View of the Quadriceps Tendon Insertion

Unlabeled Short Axis View of the Distal Quadriceps Tendon

Labeled Short Axis View of the Distal Quadriceps Tendon

#5 - Video

#6 - Video

#7 - Video

Lateral radiograph of the injured knee

Sagittal MRI of the injured knee

Interpretation

UPCOMING EVENTS

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