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Quadriceps Tendon Rupture S76.119A 843.8

quad tendon rupture 

synonyms: quad tendon rupture

Quad Tendon Rupture ICD-10

Quad Tendon Rupture ICD-9

  • 843.8   Sprains and strains of hip and thigh; other specified sites of hip and thigh
  • 727.65 Rupture of tendon nontraumatic: quadriceps tendon
  • 891.2 Open wound of knee, leg and ankle with tendon involvement

Quad Tendon Rupture Etiology / Epidemiology / Natural History

  • Uncommon
  • Generally occurs in patients over 40 years old. Peak in 6th and 7th decade.
  • Men more common than woman. Most common in black men.
  • 5% are bilateral.  Simultaneous bilateral ruptures generally occur with an associated systemic illness.
  • May occur with rapid quadriceps contraction with the knee flexed

Quad Tendon Rupture Anatomy

  • Knee extensor mechanism = rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius.
  • Quadriceps tendon has three layers. Superficial layer = rectus femoris. Intermediate layer = vastus medialis and lateralis. Deep Layer = vastus intermedius.
  • Quadriceps tendon has a hypovascular area 1-2cm superior to the patella. (Yepes H, JBJS 2008:90A:2135).

Quad Tendon Rupture Clinical Evaluation

  • Acute pain, inability to actively extend the knee
  • May have palpable suprapatellar defect in the quad tendon.
  • Inability to actively extend the knee indicates a disruption in the extensor mechanism (quad tendon, patella, patellar tendon)

Quad Tendon Rupture Xray / Diagnositc Tests

  • Knee films demonstrate inferior displacement of the patella.
  • MRI : generally not needed. Partial ruptures appear as hyperintense on T2-images.
  • Ultrasound: 100% sensitivity (Heyde CE, Knee Surg Sports Traumatol Arthrosc 2005;13:564).

Quad Tendon Rupture Classification / Treatment

  • Acute: repair. Generally repaired with transosseous suture through drill holes in the patella along with repair of the medial and lateral retinaculum.
  • Delayed repair is associated with lower functional outcomes, lower patient satisfaction.
  • Chronic: quad tendon must be mobilized and adhesions released. May require turn-down flap or augmentation for repair.

Quad Tendon Rupture Associated Injuries / Differential Diagnosis

  • Associated with renal disease, diabeties, RA, gout, obesity, hyperparthyroidism, SLE, osteomalacia, steroid use, fluroquinolones

Quad Tendon Rupture Complications

  • Lack of full extension
  • Knee stiffness
  • Infection
  • Re-rupture
  • DVT / PE

Quad Tendon Rupture Follow-up Care

  • Partial weight bearing for 6 weeks in knee immobilizer.
  • Begin passive flexion between 30º and 90º at first post-op visit, depending on repair strength. (West JL, AJSM 2008:36:316).
  • Patients will generally have some form of long-term quad weakness even after repair.
  • Post op Outomes: Mean range of motion = 123 degrees. 84% of working patients returned to their previous occupations. >50% could no longer participate in their preinjury recreational activities. 53% persistent quadriceps strength deficits (>20 percent) in the injured extremity.  (Konrath GA, JOT 1998;12:273).

Quad Tendon Rupture Review References

  • Rougraff BT, Orthopedics 1996;19:509
  • Ilan DI, JAAOS 2003;11:192
  • West JL, AJSM 2008:36:316
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