Quadriceps tendon rupture

MRI: Proton density Fat sat.
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Contributors: Cafer Zorkun M.D., PhD.

## Contents

* 1 Overview
* 2 Causes of Quadriceps Tendon Degeneration
* 3 Diagnosis
* 4 Diagnostic Findings
* 5 Additional Reading
* 6 External Links

## Overview

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Quadriceps tendon rupture is one of the major injuries. When it occurs the patella loses its anchoring support in the thigh. Without this anchoring effect of the intact quadriceps tendon, the patella tends to move inferiorly (towards the foot). Without the intact quadriceps tendon, the patient is unable to straighten the knee. If a rupture of the quadriceps tendon occurs, and the patient tries to stand up, the knee will usually buckle and give way because the body is no longer able to hold the knee in a position of extension (straight).

## Causes of Quadriceps Tendon Degeneration

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* Chronic renal failure
* Diabetes mellitus
* Gout
* Hyperparathyroidism
* Long term immobilization
* Infection
* Leukemia
* Metabolic disease
* Obesity
* Rheumatoid arthritis
* Steroid abuse
* Systemic lupus erythematosus (SLE)
* Tumors

## Diagnosis

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The examination consists of palpating the quadriceps tendon and the patella. Usually, when the tendon ruptures, the patella moves downwards towards the knee. At the same time, the hole between the ends of the ruptured tendon is palpable on the front of the thigh, just above the knee. X-rays of the knee reveal the abnormal position of the patella, indicating a rupture of the quadriceps tendon.

## Diagnostic Findings

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Images courtesy of RadsWiki

*   * Proton density

* Proton density Fat sat

## Additional Reading

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* Adolphson P. Traumatic rupture of the quadriceps tendon in a 16-year-old girl. A case report. Arch Orthop Trauma Surg. 1992;112(1):45-6.
* Anderson WE 3rd, Habermann ET. Spontaneous bilateral quadriceps tendon rupture in a patient on hemodialysis. Orthop Rev. Apr 1988;17(4):411-4.
* Aprin H, Broukhim B. Early diagnosis of acute rupture of the quadriceps tendon by arthrography. Clin Orthop Relat Res. May 1985;(195):185-90.
* Benecke P, Krug F, Wohlschlager C. A rare cause of rupture of the quadriceps tendon. Lancet. Oct 7 2000;356(9237):1236.
* Bianchi S, Zwass A, Abdelwahab IF. Diagnosis of tears of the quadriceps tendon of the knee: value of sonography. AJR Am J Roentgenol. May 1994;162(5):1137-40.
* Blasier RB, Ciullo JV. Rupture of the quadriceps tendon after arthroscopic lateral release. Arthroscopy. 1986;2(4):262-3.
* Canale ST, ed. Campbell's Operative Orthopaedics. vol 2. 9th ed. St Louis, Mo: Mosby; 1998:1428-33.
* De Franco P, Varghese J, Brown WW. Secondary hyperparathyroidism, and not beta 2-microglobulin amyloid, as a cause of spontaneous tendon rupture in patients on chronic hemodialysis. Am J Kidney Dis. Dec 1994;24(6):951-5.
* DeLee JC, Craviotto DF. Rupture of the quadriceps tendon after a central third patellar tendon anterior cruciate ligament reconstruction. Am J Sports Med. Jul-Aug 1991;19(4):415-6.
* Dhar S. Bilateral, simultaneous, spontaneous rupture of the quadriceps tendon. A report of 3 cases and a review of the literature. Injury. Jan 1988;19(1):7-8.
* Evans PD, Pritchard GA, Jenkins DH. Carbon fibre used in the late reconstruction of rupture of the extensor mechanism of the knee. Injury. Jan 1987;18(1):57-60.
* Fernandez-Baillo N, Garay EG, Ordonez JM. Rupture of the quadriceps tendon after total knee arthroplasty. A case report. J Arthroplasty. Jun 1993;8(3):331-3.
* Fujikawa K, Ohtani T, Matsumoto H, et al. Reconstruction of the extensor apparatus of the knee with the Leeds-Keio ligament. J Bone Joint Surg Br. Mar 1994;76(2):200-3.
* Greenspan A, Norman A, Tchang FK. "Tooth" sign in patellar degenerative disease. J Bone Joint Surg Am. Jun 1977;59(4):483-5.
* Haas SB, Callaway H. Disruptions of the extensor mechanism. Orthop Clin North Am. Oct 1992;23(4):687-95.
* Insall JN, Scott WN, eds. Surgery of the Knee. 3rd ed. New York, NY: Churchill Livingstone; 2001:1076-80.
* Jelaso DV, Morris GA. Rupture of the quadriceps tendon: diagnosis by arthrography. Radiology. Sep 1975;116(3):621-2.
* Jolles BM, Garofalo R, Gillain L, et al. A new clinical test in diagnosing quadriceps tendon rupture. Ann R Coll Surg Engl. Apr 2007;89(3):259-61.
* Kaar TK, O'Brien M, Murray P, et al. Bilateral quadriceps tendon rupture--a case report. Ir J Med Sci. Dec 1993;162(12):502.
* Kaneko K, DeMouy EH, Brunet ME. Radiographic diagnosis of quadriceps tendon rupture: analysis of diagnostic failure. J Emerg Med. Mar-Apr 1994;12(2):225-9.
* Kannus P, Józsa L. Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. J Bone Joint Surg Am. Dec 1991;73(10):1507-25.
* Katzman BM, Silberberg S, Caligiuri DA. Delayed repair of a quadriceps tendon. Orthopedics. Jun 1997;20(6):553-4.
* Kelly BM, Rao N, Louis SS. Bilateral, simultaneous, spontaneous rupture of quadriceps tendons without trauma in an obese patient: a case report. Arch Phys Med Rehabil. Mar 2001;82(3):415-8.
* Kelly DW, Carter VS, Jobe FW, et al. Patellar and quadriceps tendon ruptures--jumper's knee. Am J Sports Med. Sep-Oct 1984;12(5):375-80.
* Kelly DW, Godfrey KD, Johanson PH. Quadriceps rupture in association with the "tooth sign": a case report. Orthopedics. 1980;3:1206-8.
* Konrath GA, Chen D, Lock T. Outcomes following repair of quadriceps tendon ruptures. J Orthop Trauma. May 1998;12(4):273-9.
* Larsen E, Lund PM. Ruptures of the extensor mechanism of the knee joint. Clinical results and patellofemoral articulation. Clin Orthop Relat Res. Dec 1986;(213):150-3.
* Levy M, Goldstein J, Rosner M. A method of repair for quadriceps tendon or patellar ligament (tendon) ruptures without cast immobilization. Preliminary report. Clin Orthop Relat Res. May 1987;(218):297-301.
* Liow RY, Tavares S. Bilateral rupture of the quadriceps tendon associated with anabolic steroids. Br J Sports Med. Jun 1995;29(2):77-9.
* Lombardi LJ, Cleri DJ, Epstein E. Bilateral spontaneous quadriceps tendon rupture in a patient with renal failure. Orthopedics. Feb 1995;18(2):187-91.
* MacEachern AG, Plewes JL. Bilateral simultaneous spontaneous rupture of the quadriceps tendons. Five case reports and a review of the literature. J Bone Joint Surg Br. Jan 1984;66(1):81-3.
* Maniscalco P, Bertone C, Rivera F. A new method of repair for quadriceps tendon ruptures. A case report. Panminerva Med. Sep 2000;42(3):223-5.
* Matsumoto K, Hukuda S, Ishizawa M, et al. Partial rupture of the quadriceps tendon (jumper's knee) in a ten-year-old boy. A case report. Am J Sports Med. Jul-Aug 1999;27(4):521-5.
* Mont MA, Torres J, Tsao AK. Hypocalcemic-induced tetany that causes triceps and bilateral quadriceps tendon ruptures. Orthop Rev. Jan 1994;23(1):57-60.
* Naver L, Aalberg JR. Rupture of the quadriceps tendon following dislocation of the patella. Case report. J Bone Joint Surg Am. Feb 1985;67(2):324-5.
* Oni OO, Ahmad SH. The vastus lateralis derived flap for repair of neglected rupture of the quadriceps femoris tendon. Surg Gynecol Obstet. Oct 1985;161(4):385-7.
* Petersen W, Stein V, Tillmann B. [Blood supply of the quadriceps tendon]. Unfallchirurg. Jul 1999;102(7):543-7.
* Raatikainen T, Karpakka J, Orava S. Repair of partial quadriceps tendon rupture. Observations in 28 cases. Acta Orthop Scand. Apr 1994;65(2):154-6.
* Ramseier LE, Werner CM, Heinzelmann M. Quadriceps and patellar tendon rupture. Injury. Jun 2006;37(6):516-9.
* Ramsey RH, Muller GE. Quadriceps tendon rupture: a diagnostic trap. Clin Orthop Relat Res. May-Jun 1970;70:161-4.
* Rasul AT Jr, Fischer DA. Primary repair of quadriceps tendon ruptures. Results of treatment. Clin Orthop Relat Res. Apr 1993;(289):205-7.
* Rockwood CA, Green DA, Bucholz RW, eds. Fractures in Adults. vol 2. 4th ed. Philadelphia, Pa: Lippincott-Raven; 1996:2018-23, 2033-4.
* Rougraff BT, Reeck CC, Essenmacher J. Complete quadriceps tendon ruptures. Orthopedics. Jun 1996;19(6):509-14.
* Rust PA, Tanna N, Spicer DD. Repair of ruptured quadriceps tendon with Leeds-Keio ligament following revision knee surgery. Knee Surg Sports Traumatol Arthrosc. Jan 12 2008;
* Siwek CW, Rao JP. Ruptures of the extensor mechanism of the knee joint. J Bone Joint Surg Am. Jul 1981;63(6):932-7.
* Viola R, Marzano N, Vianello R. Rupture of the quadriceps tendon after arthroscopic lateral meniscectomy: a postoperative complication?. Arthroscopy. Jan 2001;17(1):E4.
* Walczak BE, McCulloch PC, Kang RW, et al. Abnormal findings on knee magnetic resonance imaging in asymptomatic NBA players. J Knee Surg. Jan 2008;21(1):27-33.
* Walker LG, Glick H. Bilateral spontaneous quadriceps tendon ruptures. A case report and review of the literature. Orthop Rev. Aug 1989;18(8):867-71.
* West JL, Keene JS, Kaplan LD. Early motion after quadriceps and patellar tendon repairs: outcomes with single-suture augmentation. Am J Sports Med. Feb 2008;36(2):316-23.
* Zeiss J, Saddemi SR, Ebraheim NA. MR imaging of the quadriceps tendon: normal layered configuration and its importance in cases of tendon rupture. AJR Am J Roentgenol. Nov 1992;159(5):1031-4.

## External Links

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* [http://goldminer.arrs.org/search.php?query=Quadriceps tendon rupture Goldminer: Quadriceps tendon rupt

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