How does a Quadriceps tendon tear happen?

Quadriceps tendon tear is an injury that occurs when the tendon attaches the quadriceps muscle to the patella or kneecap tears. The disability may result if the injury is not promptly recognized and treated.

Causes of Quadriceps Tendon Tear:

  • Bad landing with high impact on knees and quadriceps muscles,
  • Direct blow on the anterior side of the knee,
  • Fall on the knee.

Risk factors include:

  • Weak quadriceps tendons,
  • Tendinitis,
  • Drug abuse has degenerative effects on muscle-tendon, such as-
    • Corticosteroid usage,
    • Fluoroquinolones (antibiotic) usage.

In addition, knee surgery and immobilization also increase the risk. Due to a decrease in strength and flexibility of the muscle and tendon.

Sign & Symptoms of Quadriceps Tendon Tear:

  • There is often a popping or tearing feeling at the time of the event,
  • Difficulty in walking,
  • unable to straighten the knee without help when the tendon is completely ruptured,
  • There is a dent/gap just above the patella, 
  • there is a bruise seen around the knee, 
  • The patella may sag or droop,
  • knee pain, swelling, and functional loss (loss of extension and also loss of stability), giving way of the knee.

Medical management:

When there are only partial ruptures the knee must be immobilized for some time, and Physiotherapy rehabilitation is crucial for recovery. The tendon must be surgically repaired if it is completely torn, and the surgery should be initiated as soon as possible (at least 72 hours after injury).

Physiotherapy Management:

Immediately after the injury, the RICE treatment is started. RICE includes:

  • Rest,
  • Ice,
    • Icing can be done through ice packs or a Cryo-air machine.
  • Compression,
    • Compression can be done by compression bandage, Kinesio taping, or the cryo-compression machine.
  • Elevation.
    • elevation can help to reduce the swelling. elevation can be achieved by placing the leg over 2 or 3 pillows (leg should be above the heart level).

Other Therapeutic Modalities:

Combo therapy (ultrasound and TENS),

  • Heat therapy by Hot packs,
  • TR-therapy,
  • Extracorporeal Shock Wave Therapy,

ROM exercises

  • Heel slides,
    Heel prop,
  • Ankle pumps,

Muscle Strengthening

  • Isometric Exercises, such as
    • Towel pressing under the straight knee.
  • Isotonic exercises, such as
    • Straight leg raise.
    • Sitting knee flexion.
    • Hip abduction.
    • Standing toe raise.
    • Wall slides.
    • Box squats.
    • Step-up/down.
  • Eccentric exercises.
  • Resistive training with the help of the Thera band.
  • Stationary bike.
  • Gym strengthening.
    • leg press.
    • hamstring curls.

Manual therapy

  • Soft tissue mobilization,
  • Joint Mobilization.
  • Patella mobilization.

Hydrotherapy

  • Pool running program

Gait training

  • Treadmill walking program forward and backward.
  • Elliptical training.

Proprioception and balancing exercises

  • A double leg balance exercise with a wobble board or balancing board.
  • single-leg balancing.

Advanced training such as

  • multi-directional field/court drills.
  • plyometric drills.
  • Sports-specific training.