eMedicine Specialties > Orthopedic Surgery > Knee

Quadriceps Tendon Rupture: Workup

Author: James Lyle, MD, Consulting Surgeon, Department of Orthopedic Surgery, Hughston Clinic
Contributor Information and Disclosures

Updated: Mar 7, 2008

Workup

Laboratory Studies

  • A preliminary laboratory workup to rule out rheumatologic, endocrine, and renal disease may be indicated in suspicious, presumably healthy individuals with quadriceps tendon ruptures.
  • Consider a laboratory workup in all cases of bilateral rupture.

Imaging Studies

  • Several imaging studies are helpful to confirm the diagnosis of quadriceps tendon rupture.
  • Plain radiographs are usually the first imaging modality ordered.18
    • Several abnormalities may be seen on lateral radiographs. These include obliteration of the quadriceps tendon shadow, a suprapatellar mass, suprapatellar calcific densities, spurring of the anterior superior patella, joint effusion, patella baja, and anterior tilting of the superior patella. These findings may be quite subtle or even absent. Patella baja is diagnosed using the Insall-Salvati index, which is the ratio of the patellar tendon length to the length of the patella. This ratio should near 1.0 with no more than 20% variation.
    • On the axial view, the tooth sign, which represents vertical ridging of the osteophytes at the quadriceps insertion, may be seen on the anterior patella (see Image 2). In 1977, this sign was first described by Greenspan and colleagues as an incidental finding caused by tendon degeneration24 ; in 1980, DW Kelly and co-authors first reported it in association with a quadriceps tendon rupture.25
  • Use other imaging modalities next to clarify a questionable diagnosis or to differentiate complete and incomplete ruptures.
  • In complete ruptures, arthrography reveals extravasation of contrast material from the suprapatellar bursa into the soft tissues anterior to the patella, but it is an invasive procedure.26,27
  • Ultrasonography has high sensitivity and specificity in depicting complete quadriceps tendon ruptures.28
    • An area of hypoechogenicity is seen across the entire thickness of the tendon.
    • In partial tears, a focal hypoechoic defect is seen.
    • In tendinitis, tendon thickening is visualized.
    • Ultrasound is quick and noninvasive but is highly operator-dependent.
  • Magnetic resonance imaging (MRI) has probably become the imaging study of choice when there is any doubt about the diagnosis.
    • MRI can clearly depict the laminated structure of the quadriceps tendon.
    • Complete ruptures show transaction of all of the layers of the tendon.
    • Incomplete ruptures show discontinuities of individual layers, with the remaining layers intact (see Image 3).

Histologic Findings

Histologic study is usually not included in the preoperative workup. See Pathophysiology for histologic details.

More on Quadriceps Tendon Rupture

Overview: Quadriceps Tendon Rupture
Workup: Quadriceps Tendon Rupture
Treatment: Quadriceps Tendon Rupture
Follow-up: Quadriceps Tendon Rupture
Multimedia: Quadriceps Tendon Rupture
References
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References

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Further Reading

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Keywords

extensor mechanism disruption, tooth sign, patellar tendon ruptures, jumper's knee, unilateral quadriceps tendon ruptures, bilateral quadriceps tendon ruptures, quadriceps tendon tear

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Contributor Information and Disclosures

Author

James Lyle, MD, Consulting Surgeon, Department of Orthopedic Surgery, Hughston Clinic
James Lyle, MD is a member of the following medical societies: Christian Medical & Dental Society
Disclosure: Nothing to disclose.

Medical Editor

Phillip J Marone, MD, MSPH, Clinical Professor, Department of Orthopedic Surgery, Jefferson Medical College
Phillip J Marone, MD, MSPH is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Medical Association, American Orthopaedic Society for Sports Medicine, and Philadelphia County Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Shepard R Hurwitz, MD, Executive Director, American Board of Orthopaedic Surgery
Shepard R Hurwitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the Advancement of Science, American College of Rheumatology, American College of Sports Medicine, American College of Surgeons, American Diabetes Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Association for the Advancement of Automotive Medicine, Eastern Orthopaedic Association, Orthopaedic Research Society, Orthopaedic Trauma Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Carlos J Lavernia, MD, FAAOS, Adjunct Clinical Professor, Department of Orthopedic Surgery, University of Miami School of Medicine; Medical Director, Orthopedic Institute at Mercy Hospital
Carlos J Lavernia, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, Arthritis Foundation, Biomedical Engineering Society, Florida Orthopaedic Society, and Orthopaedic Research Society
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