Quadriceps Tendon Rupture

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: 51-year-old male with acute onset severe knee pain after attempting to snap a branch with a stomping mechanism while camping. Patient reported that the branch "hit him in the knee". Patient 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 #1 - Video View Video Left side of the picture is distal and LAX orientation f the quadriceps tendon and shows a 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. #2 - Video View Video Left side of the picture is distal and LAX orientation f the quadriceps tendon and shows a 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. #3 - Video View Video The quadriceps tendon was identified in short axis proximally with abrupt loss of architecture distally associated with mixed hyper and hypoechogenicity. Sagittal MRI of the knee Sagittal cut of the knee MRI confirming quadriceps tendon discontinuity/ rupture. Lateral radiograph of the knee Distal Quadriceps Long Axis Left side of the picture is distal and shows a 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 present. Distal Quadriceps Short Axis Short axis image of quadriceps tendon showing loss of tendon continuity Distal Quadriceps Long Axis 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 occurs most often in males >40 years old. Ruptures are classified as complete or partial and caused by an eccentric load of the extensor mechanism of the knee. On physical exam is it important to evaluate for palpable defects and assess the knee extensor mechanism. MRI evaluation may be used for surgical planning and to help differentiate between complete and partial tears if there is question after ultrasound evaluation. Conservative management with a knee immobilizer may be considered in a partial quadriceps tendon tear with an intact extensor mechanism, while surgical repair is required for complete ruptures.
NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

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