The quadriceps tendon is a strong piece of tissue at the top of the patella (kneecap) that connects the quadriceps muscles of the thigh to the patella. By connecting the thigh muscles to the kneecap, the quadriceps tendon allows us to bend and straighten our leg. Without a functional quadriceps tendon, it can be extremely difficult to walk. Patients who sustain a rupture of the quadriceps tendon will often report a traumatic episode such as a fall, buckling, or forced knee flexion. Ruptures of the quadriceps tendon will also commonly occur in active middle-aged and older patients who are involved in jumping and running. As we age, our tendons can degenerate and fray, predisposing us to tendon rupture. People with pre-existing quadriceps tendonitis (inflammation of the quadriceps tendon) are also at an increased risk of quadriceps tendon rupture. Infection and chronic renal failure can weaken the quadriceps tendon and predispose it to rupture. The use of certain medications such as steroids and some antibiotics may also weaken the quadriceps, and this too predisposes an individual to rupture of the quadriceps tendon.
Causes & Symptoms
The four quadriceps muscles in the thigh that are attached to the kneecap by the quadriceps tendon, are a fibrous, strong tissue. The quadriceps tendon is crucial for pulling the kneecap up to straighten the leg, and the bottom of the kneecap connects to the shin by the patella tendon. The quadriceps tendon is like a rope; it can fray and partially tear, weakening its strength. Disease, repetitive use, and degeneration can all destabilize the tendon and make it more prone to tears or ruptures.
Quadriceps tendon ruptures are a common sports injury; however, it can also occur during all manner of accidents. There are many quadriceps tendon tear causes, most of them involving a sudden, blunt blow to the front of the knee. For example, a fall onto the knee from a significant height will subject the tendon to tremendous force, potentially leading to a partial quadriceps tendon tear or a complete rupture. Complete quadriceps tendon ruptures can be caused by a sudden trauma to the knee. A fall or excessive strain can tear the tendon completely, disconnecting the quadriceps and patella. This is more likely to occur if the tendon is weakened or has partial tears or tendonitis.
Symptoms of a complete quadriceps tendon tear include:
- Inability to straighten the leg or knee
- Bruising and swelling above the knee
- An indentation above the knee
- Popping/tearing sensation when an injury occurs
- Kneecap drooping lower
- Difficulty walking (the knee may feel unstable)
Car accidents can also impart this kind of sudden, direct trauma. In addition, some chronic injuries (namely patellar tendinosis) may weaken the tendon over time, increasing the risk of a quadriceps tendon rupture. Certain sports are more likely to suffer a complete or partial quadriceps tendon tear. Football, basketball, volleyball, and other sports that involve large amounts of jumping are the most likely to lead to overuse injuries, weakening the tendon over time. Volleyball players are especially susceptible to quadriceps tendonitis, a condition colloquially known as “jumper’s knee”. In fact, a recent study estimated the prevalence of jumper’s knee among elite volleyball athletes to be as high as 50%! Once the tendon has been weakened in this way, a quadriceps tendon rupture or partial tear is most likely to occur at the beginning of a jump or during the landing, as the movement tightens the tendon. Individuals suffering from general chronic tendonitis in the knee may treat their symptoms with corticosteroid injections. Unfortunately, corticosteroid injections in the knee can cause further damage to the quadriceps tendon over time, increasing the risk of quadriceps tendon rupture. With this in mind, prevention is key to avoid further damage.
Who Gets a Quadriceps Tendon Rupture?
Anyone can develop a quadriceps tendon rupture, but some individuals are particularly susceptible to it. People who are more likely to develop quadriceps tendon ruptures are obese individuals, athletes, diabetics, and those who suffer from an illness, such as gout, rheumatoid arthritis, leukemia, long-term renal failure, and lupus. If an individual is at the ideal weight for their height, the body does not have to overcompensate. Being at a healthy weight means that the tendons are less likely to be injured. Athletes are also prone to quadriceps tendon ruptures due to their active lifestyle. Oftentimes, athletes have strenuous and intense workouts, and this adds strain to their quadriceps.
Diabetes occurs when a person has high blood sugar levels and is unable to produce the right amount of insulin to convert it properly. It is believed that those with diabetes are more likely to develop quadriceps tendon ruptures because blood flow is limited and there isn’t enough to sustain the area consistently.
How Does It Affect You? How Serious Is It?
After suffering a rupture or partial tear, there are several symptoms an individual may experience. At the time of injury, many people report feeling a sudden tear or pop in the knee. At times, this “pop” felt during a quadriceps tendon rupture may also be audible to observers. As mentioned earlier, the quadriceps tendon attaches to the kneecap, and a quadriceps tendon rupture servers this connection. As a result, the kneecap is no longer held in its typical position in front of the knee. Often, the kneecap may be positioned much higher than normal after a complete quadriceps tendon tear, due to the quadriceps tendon pulling the kneecap upward towards the thigh. General swelling, bruising, and soreness around the quadriceps tendon and the knee joint are also typical quadriceps tendon tear symptoms. Walking after a quadriceps tendon tear is possible, however, many patients will notice significant knee instability as well as severe pain. A doctor will first need to properly diagnose the injury before suggesting any appropriate quadriceps tendon rupture treatment.
Recommended Treatment & Rehabilitation
To rule out other conditions or injuries, your doctor will first physically examine the affected joint. During this physical examination, the doctor will guide you through a series of movements to pinpoint the location of the pain as well as test the stability, strength, and range of motion of the joint. After a full quadriceps tendon rupture, patients are unable to fully extend the knee, so this is one of several key factors the examination will check for. Your doctor will also inquire about athletic participation and medical history to better understand the underlying cause of the injury. Additional diagnostic imagery such as X-ray and MRI may be used to help determine the severity of the injury and rule out other possibilities. For example, a fracture of the quadriceps itself may closely imitate quadriceps tendon tear symptoms. These imaging tests will help rule out this possibility.
Once the injury has been properly diagnosed, the doctor will recommend appropriate quadriceps tendon tear treatment options. Over-the-counter medications can be used to manage pain and discomfort in the days following a less severe quadriceps tendon tear. Ice can be applied immediately following the injury to minimize swelling and the accumulation of fluid in the knee. Immobilization is often an effective treatment option for a smaller quadriceps tendon tear. Braces can be used to minimize the use of the knee joint and allow the tear to heal. It is important to also minimize activity during the recovery process to prevent re-injury or exacerbating the existing injury. The joint may need to be immobilized for up to six weeks, depending on the severity of the tear. Next, the doctor will recommend quadriceps tendon tear physiotherapy when it is appropriate to initiate. These quadriceps tendon exercises will focus on increasing the strength and range of motion of the knee joint. At first, a physiotherapist will guide the patient through the proper execution of these quadriceps tendon rehab exercises. Afterward, the therapist will design a personalized rehabilitation program the patient can follow independently at home during the quadriceps tendon recovery process. Over time, these quadriceps tendon exercises will strengthen the joint, increase joint stability, and minimize the risk of knee injuries moving forward. Unfortunately, even with rehabilitation exercises, there is a certain limit to what the knee can heal from on its own. A severe tear will require immediate medical attention and quadriceps tendon surgery.
Surgery is performed on an outpatient basis and cannot be repaired arthroscopically since the tendon is outside the joint. The goal of the surgery is to re-attach the torn tendon to the kneecap and to restore the normal function of the knee. Sutures are placed in the torn tendon which is then passed through the holes drilled in the kneecap. The sutures are then tied at the bottom of the kneecap to help pull the torn edge of the tendon back to its usual position. Surgical complications include weakness and loss of motion. In some cases, the re-attached tendon may detach from the kneecap or re-tear. Other complications such as pain, infection, and blood clot may be observed. Following surgery, a brace may be needed to protect the healing tendon. Complete healing of the tendon will take about 4 months.
Strengthening the legs will help support the knee joint during activity. You can also stretch the leg muscles daily to help relieve any lingering tension that could also be contributing to your knee pain.
Below are a few exercises you can add to your daily routine at home to strengthen and stretch your legs and help keep an injury like quadriceps tendonitis at bay:
Straight leg raise:
- Lie on your side with the bottom leg straight and the top leg bent in front with your foot flat on the floor.
- Place one hand over your pelvis for added stability.
- Lift the bottom leg up, keeping it straight.
- Keep the foot and kneecap pointed forward during movement.
- Return to the initial position.
- Complete 3 sets of 10-15 reps.
- Wrap a resistance band around your legs, just above your knees.
- Lie on your side with your back and glutes against the wall.
- Bend your knees and press your heels together.
- Lift the top leg until it reaches a natural stopping point (at about hip height when lying on your side), and without letting your pelvis rotate.
- With a slow and controlled motion, return to the initial position and repeat as directed.
- Complete 3 sets of 15 reps.
Foam roll quadriceps:
- Place a foam roller under your quads and balance on your elbows in a plank position.
- Brace your core and keep your lower back straight.
- Roll from just above the knee to right below the hip joint.
- Hold the foam roller over any tender areas for 10-20 seconds or until the pain lessens.
- For more emphasis on one leg, shift your body weight to one side or cross one leg over the other.
- Spend no more than 2 minutes on the foam roller.
Alternative & Homeopathic Treatment
Any time a knee injury occurs, it is always best to be evaluated and diagnosed by a physician. That being said, the two most common at-home remedies can be administered early-on to combat the symptoms of a quadriceps tendon rupture.
One home-based intervention that can help reduce the inflammation that sets in after a quadriceps tendon tear injury is the RICE method. This acronym, which stands for Rest-Ice-Compression-Elevation, represents a grouping of four treatments aimed at decreasing your pain and swelling. To properly utilize this method of remedies, the following tips should help:
- Rest the injured tendon until the pain and swelling have decreased. Ask your healthcare provider what activities you can perform while your tendon is in its recovery process.
- Apply ice on your tendon for 15-20 minutes every hour for 48 hours, or as directed. Use an ice pack, or put crushed ice in a plastic bag, covered with a towel. Ice helps prevent tissue damage and decreases swelling and pain.
- Compress the injury with an elastic band aid or a splint to help reduce the swelling.
- Elevate the injured area above the level of your heart as often as you can. This will help decrease swelling and pain.