Quadriceps Tendon Rupture Clinical Presentation

Updated: Jun 08, 2021
  • Author: James Edwin Lyle, MD; Chief Editor: Thomas M DeBerardino, MD  more...
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Presentation

History

Patients typically present with acute knee pain, swelling, and functional loss after a stumble, fall, or giving way of the knee. There may be no history of prior knee pain. However, younger patients with jumper's knee usually have a history of chronic activity-related pain above the patella that is exacerbated by jumping or kneeling. Specifically ask patients about any history of systemic disease, steroid use, infection, tumors, or prior surgeries. There may be a history of an audible pop at the time of injury.

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Physical Examination

Begin the physical examination by noting any obesity. Patients with recent ruptures have difficulty ambulating. Usually, obvious suprapatellar swelling, ecchymosis, and tenderness are present. Carefully evaluate lacerations. There may be a palpable defect in the suprapatellar area and a low-lying patella, but swelling initially may obscure this finding.

Testing for full, active extension against gravity is the most important aspect of the examination. This may make the defect more apparent. Extension lags of varying degrees are seen, depending on the amount of retinacular damage. In incomplete ruptures, the patient may be able to fully extend the knee from the supine position but not from the flexed position. If only tendinitis is present, no extension lag should be noted with any test position. Examine the contralateral knee to rule out bilateral rupture.

If the patient is not seen in the acute phase, diagnosing the rupture becomes more difficult, and it can be easily missed. Ramsey and Muller reported misdiagnosis in seven of 17 ruptures. [14]  Patients with quadriceps tears, especially elderly patients, have been identified as having had and having been treated for strokes, radiculopathy, and myelopathy. Many patients are thought to have only simple knee sprains during their examination in the emergency department and are not given appropriate immediate follow-up.

Pain and swelling decrease over time, and quadriceps function can improve. Patients may be able to ambulate but will do so with a gait demonstrating knee stiffness and elevation of the hip to accommodate the swing-through phase. In addition, patients may have frequent buckling of the knee and difficulty with stair climbing.

Results of neurologic examination are normal except for decreased quadriceps motor function and an absent patellar reflex. Again, full, active knee extension against gravity is the key component of the physical examination.

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