What is Quadriceps Tendon Tear

Quadriceps tendon tear is a partial or complete tear of the tendon between the quadriceps muscles and the kneecap (patella). Tendons connect muscles to bone.

The quadriceps muscles are located on the front of the thigh and are primarily used in straightening the knee. With a partial tear, the tendon is overstretched and some of the fibers are frayed. With a complete tear, the quadriceps muscle is detached from the kneecap. This is very rare.

What are the causes?

This condition can be caused by trauma, such as:

• A deep cut on your thigh that injures the tendon.
• Falling on your knee, which may result in breaking your patella.

The condition can also occur if you land from a jump flat on your foot with your knee bent, causing a quick and forceful tightening (contraction) of your quadriceps.

What increases the risk?

The following factors may make you more likely to develop this condition:

• Participating in:
  • Activities that involve jumping, such as basketball.
  • Activities in which your knee muscles contract suddenly and forcefully, such as doing jumps or moguls in downhill skiing.
• Having a weakened tendon from:
  • Prolonged (chronic) quadriceps tendinitis.
  • Long periods of not moving your knee (immobilization).
  • Repeated corticosteroid injections into the quadriceps tendon.
  • Medical conditions such as diabetes, lupus, or rheumatoid arthritis.
  • Degeneration over time. Most quadriceps tendon tears occur in males over 40 years of age.

What are the signs or symptoms?

Symptoms of this condition include:

• Hearing a “pop” sound or feeling a tear above your patella at the time of injury.
• Pain and tenderness over your thigh. The pain may get worse when you use the quadriceps muscles.
• Bruising.
• Difficulty walking, or a feeling of the knee giving way.
• A sagging kneecap or an indentation above your kneecap.
• Not being able to straighten your knee.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms and medical history.
• A physical exam. During the exam, your health care provider will:
  • Feel the area above your kneecap.
  • Test the motion and strength of your knee.
• Imaging tests to rule out other conditions and to confirm the diagnosis. These may include:
  • X-rays to check for a bone injury, such as a fracture.
  • Ultrasound or MRI to look at the muscles and tendons around your knee.

How is this treated?

This condition may be treated with:

• Medicines to help reduce pain and inflammation.
• RICE therapy. This includes resting, icing, applying compression, and raising (elevating) the injured area.
• A knee brace (immobilizer) to keep the knee straight while the tendon heals. Typically, the brace will be worn for about 6 weeks.
• Crutches to keep weight off of your injured leg.
• Physical therapy to improve strength and flexibility.

If the injury involves a complete tear of the tendon, surgery is usually needed.

Follow these instructions at home:

RICE Therapy

• Rest the injured leg.
• If directed, put ice on the injured area:
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Apply a compression bandage to the area as told by your health care provider.
• Elevate the injured area above the level of your heart while you are sitting or lying down.

If You Have a Knee Brace:

• Wear the brace as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the brace if your toes tingle, become numb, or turn cold and blue.
• Do not let your brace get wet if it is not waterproof.
• Keep the brace clean.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not use the injured limb to support your body weight until your health care provider says that you can. Use crutches as told by your health care provider.
• Do exercises as told by your health care provider.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Give your body time to rest between periods of activity.
• Be safe and responsible while being active to avoid falls.

Contact a health care provider if:

• Your pain and swelling continue or get worse, even with treatment and rest.
• You are unable to walk or stand without your knee feeling like it will give way.

Get help right away if:

• You are unable to straighten your knee from a bent position.

Quadriceps Tendon Tear Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your thigh. These exercises can also help to relieve pain, numbness, and tingling.

Exercise A: Knee flexion, active

1. Lie on your back with both knees straight. If this causes back discomfort, bend your healthy knee so your foot is flat on the floor.
2. Slowly slide your left / right heel back toward your buttocks until you feel a gentle stretch in the front of your knee or thigh.
3. Hold for __________ seconds.
4. Slowly slide your left / right heel back to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Knee extension, passive

1. Sit with your left / right heel propped on a chair, a coffee table, or a footstool. Do not have anything under your knee to support it.
2. Allow your leg muscles to relax, letting gravity straighten out your knee. You should feel a stretch behind your left / right knee.
3. If told by your health care provider, deepen the stretch by placing a __________ weight on your thigh, just above your kneecap.
4. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your thigh. Endurance is the ability to use your muscles for a long time, even after your muscles get tired. Do these exercises while wearing your brace if told by your health care provider.

Exercise C: Quadriceps, isometric

1. Lie on your back with your left / right leg extended and your other knee bent. If told by your health care provider, put a small pillow or rolled towel under your extended knee.
2. Gradually tense the muscles in the front of your left / right thigh. You should see your kneecap slide up toward your hip or see increased dimpling just above the knee. This motion will push the back of your knee down toward the surface that is under it.
3. For __________ seconds, hold the muscle as tight as you can without increasing your pain.
4. Relax the muscles slowly and completely in between repetitions.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Straight leg raises (hip flexors and quadriceps)

1. Lie on your back with your left / right leg extended and your other knee bent.
2. Tense the muscles in the front of your left / right thigh. You should see your kneecap slide up or see increased dimpling just above the knee.
3. Keep these muscles tight while you raise your leg 4–6 inches (10–15 cm) off the floor. Do not let your knee bend.
4. Hold the position for __________ seconds.
5. Keep the muscles tense and keep your knee straight as you lower your leg.
6. Relax the muscles slowly and completely after each repetition.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Wall slides (knee and hip extensors)

1. Lean your back against a smooth wall or door and walk your feet out 18–24 inches (46–61 cm) from it. Place your feet hip-width apart.
2. Slowly slide down the wall or door until your knees bend __________ degrees. Do not bend your knee farther than told by your health care provider. Keep your knees over your heels, not over your toes. Keep your knees in line with your hips.
3. Hold for __________ seconds. Stand up to rest for __________ seconds in between repetitions.

Repeat __________ times. Complete this exercise __________ times a day.