The quadriceps is a powerful group of muscles at the front of the thigh originating from the front of the pelvic bone and top of the thigh bone, the 4 muscles combine at the lower tendon to attach to the upper tibia (shin bone) via the patella (kneecap).
The quadriceps group is comprised of Vastus Medialis, Vastus Lateralis, Vastus Intermedius and Rectus Femoris. Not only is it an extremely powerful group of muscles but they are also responsible for the stability of the knee and balance.
Quadriceps Tendon Ruptures.
Partial tears of the quadriceps are generally treated conservatively with ice, immobilisation, support, physiotherapy and electrotherapy techniques (to accelerate the healing process) stretching and graded muscle exercise.
Full tears or ruptures however will require surgery.
Causes of a ruptured quads tendon are usually mechanical and often predisposed by a medical condition (which has caused the tendon to become weak in the first place.)
The tendon ruptures when the quads are under great strain such as jumping down from a height or lifting something heavy. Most commonly occurring in the over 40´s, conditions which may provoke a rupture include a past history of quadriceps tendonitis (particularly if this was treated with corticosteroid injections) and conditions which may affect the blood supply to the area such as Rheumatoid Arthritis, Gout, Diabetes, Infection, Renal Failure, Leukaemia and other metabolic diseases.
Sign and Symptoms include pain at the time of injury with tenderness above the kneecap and widespread bruising and swelling a few hours later. The injured patient will be unable to straighten the knee and have difficulty walking. The knee will also have changed appearance in that the kneecap will have sagged downwards with an indentation above it and the quadriceps muscles will appear bunched up the thigh.
Although the signs of a quads rupture seem pretty obvious, an X-Ray may still be required to determine the possibility of a patellar fracture and confirm the new position of the patella.
Repair of this injury requires surgery and the sooner the better as rehabilitation can be hampered by tightening and scar tissue if not attended to quickly. The surgery is either performed under a general anaesthetic or spinal block (epidural). The Surgeon will need to bring the patellar back up into position and reattach the tendon while keeping the correct tension in the repaired tendon. There are different techniques that can be used and your Surgeon may not decide which to use until they see the injury at the time of the operation. Some techniques may require metalwork to be removed at a later date.
Recovery can take some time as the knee must be immobilised for up to 8 weeks to allow the tendon to heal before starting Physiotherapy. A cast or knee brace will be fitted to allow the patient to walk partial weight bearing with crutches. Rehabilitation will start at the instruction of the Surgeon depending on the severity of the injury and the surgical techniques used in the repair.
As soon as the Physio is allowed to bend the knee the first priority is to reduce pain, swelling and inflammation all of which hinder the return of movement. Unfortunately it can be quite painful to regain the first 90 degrees of flexion but once past the “right-angle” rehabilitation usually moves forward more swiftly. The Physio will have many tools to help promote recovery including TENS, interferential diathermy, cold therapy, accessory movements of the patella, passive stretching in different positions depending on what is tolerable for the patient and eventually move on to muscle strengthening and gait re-education.
Much like an Anterior Cruciate Ligament repair, the recovery for this kind of reconstruction does take some time and the early stages of rehab are often not easy for the patient as the first couple of weeks of mobilisations can be painful however with the latest surgical techniques a good recovery and full function can be expected.
Tracey Evans – The Physiotherapy Centre
+34 609 353 805