Quadriceps Tendon RuptureMANAGEMENT

MUSCULOSKELETAL AND RHEUMATOLOGIC PRESENTATIONS · 12 SECTIONS

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524 items

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01Approach to the Critical Patient/attcp32

Immediate priorities

›Orthopedic urgency recognition

›Complete rupture: no active knee extension, palpable suprapatellar gap

›Prompt orthopedic consultation in the ED for all suspected complete tears

›Delayed diagnosis leads to tendon retraction, more complex surgery, worse outcomes

›Bilateral rupture alarm

›May mimic spinal cord injury or Guillain-Barre syndrome

›Strongly associated with systemic metabolic disease: CKD, hyperparathyroidism, gout, diabetes

›Immediate neurovascular and metabolic assessment required

›Open extensor mechanism injury

›Open wound over tendon requires urgent operative management

›Tetanus status and antibiotic coverage

Escalation triggers

›Critical findings requiring immediate action

›Neurovascular compromise distal to injury

›Absent or diminished distal pulses

›Compartment syndrome signs: pain with passive stretch, tense compartment

›Bilateral simultaneous rupture

›Emergent metabolic workup: BMP, PTH, calcium, phosphorus

›Orthopedic consultation for both knees

›Hemodynamic instability

›Assess for associated injuries or blood loss

›Hemarthrosis rarely causes significant blood loss in isolation

Key decision points

›Complete vs partial tear determination

›Complete tear: inability to perform straight leg raise, palpable gap

›Surgical repair required, ideally within days to 2 weeks

›Orthopedic consultation before discharge

›Partial tear: some preserved extension against gravity but not resistance

›May be managed nonoperatively if low-grade

›High-grade partial tears often require surgery

›MRI for characterization when uncertain

›Chronic vs acute presentation

›Chronic tears (>6 weeks): tendon retraction, more complex reconstruction

›Urgent referral even for chronic presentations to prevent further retraction

02History/hx54

Mechanism and onset

›Classic mechanism

›Sudden eccentric quadriceps contraction against a flexed knee

›Fall, stumble, or misstep (most common)

›Sports activity: landing from a jump, deadlifting

›Spontaneous rupture with minimal or no trauma

›Suggests underlying metabolic or connective tissue disorder

›Higher suspicion in dialysis patients or those on chronic steroids

Symptom characterization

›Core presenting symptoms

›Acute severe anterior knee or suprapatellar pain

›Immediate onset at moment of injury

›"Pop" or "giving way" sensation

›Inability to bear weight or walk normally

›Inability to straighten the knee

›Complete inability to perform straight leg raise in complete rupture

Prior knee and tendon history

›Relevant past musculoskeletal history

›Prior quadriceps tendinopathy or partial tears

›Prior episodes of tendon pain or stiffness

›History of tendinopathy symptoms suggesting chronic degeneration

›Previous extensor mechanism surgery or total knee arthroplasty

›Altered anatomy increases risk

›Prior contralateral tendon rupture

Risk factor history

›Systemic disease history

›Chronic kidney disease and dialysis status

›Dialysis vintage and secondary hyperparathyroidism status

›Elevated iPTH and alkaline phosphatase associated with rupture

›Metabolic comorbidities

›Diabetes mellitus

›Gout and prior gout flares

›Rheumatoid arthritis, SLE

›Connective tissue and vascular disease

›Peripheral vascular disease

›Osteogenesis imperfecta, Ehlers-Danlos syndrome

›Obesity

Medication history

›Medications increasing tendon rupture risk

›Fluoroquinolones: ciprofloxacin, levofloxacin

›FDA boxed warning for tendinitis and tendon rupture

›Risk greatest in patients older than 60, on concurrent corticosteroids, or with renal failure

›Concomitant fluoroquinolone and corticosteroid use: aIRR 19.36 for tendon rupture

›Systemic corticosteroids

›Chronic use weakens tendon collagen

›Local corticosteroid injections around the tendon

›Other implicated agents

›Aromatase inhibitors (case reports)

›Statins (weaker evidence)

Review of systems

›Bilateral rupture exclusion symptoms

›Contralateral knee pain or weakness

›Bilateral rupture occurs in up to 5% of cases

›Back pain, radiculopathy, saddle anesthesia, bowel or bladder dysfunction

›To exclude spinal cord or cauda equina pathology if bilateral weakness

›Renal symptoms

›Uremia, dialysis history, urine output changes

›Endocrine symptoms

›Polyuria or polydipsia suggesting diabetes

›Bone pain suggesting hyperparathyroidism

03Physical Exam/exam43

Vitals and general

›Stability and general assessment

›Vital signs

›Heart rate, blood pressure, oxygen saturation

›Hemodynamic instability rare in isolated rupture

›Ability to bear weight or ambulate

›Complete rupture typically prevents normal gait

Knee inspection and palpation

›Suprapatellar region examination

›Visible suprapatellar swelling and ecchymosis

›Soft tissue defect may be visible above the patella

›Pathognomonic finding: palpable suprapatellar gap 1-2 cm above superior pole of patella

›Patella position

›Patella baja or infera: low-riding patella compared to contralateral side

›Compare patella height bilaterally

›Hemarthrosis

›Intra-articular effusion from hemarthrosis common

Functional testing

›Extensor mechanism assessment

›Straight leg raise test

›Inability to raise extended leg off the bed: complete rupture

›Hallmark finding for complete rupture

›Active knee extension against gravity

›Partial tears may allow extension with gravity eliminated but not against resistance

›Grade extension strength to characterize partial vs complete

›Active knee extension against resistance

›Complete failure: complete rupture

›Reduced strength: high-grade partial tear

Contralateral knee and neurovascular exam

›Contralateral and distal assessment

›Contralateral knee examination

›Bilateral rupture up to 5% of cases

›Assess for same triad: pain, gap, extension loss

›Neurovascular exam of lower extremity

›Distal pulses: dorsalis pedis, posterior tibial

›Sensation: dermatomes L3-L5

›Motor function: dorsiflexion, plantarflexion

PITFALLS

›Diagnostic errors to avoid

›Misdiagnosis as contusion or strain

›Initial misdiagnosis rate approaches 50% in some series

›Always palpate for suprapatellar gap

›Missing partial tears

›Preserved but weak extension does not exclude significant tear

›MRI required when clinical exam equivocal

›Missing bilateral rupture

›Always examine contralateral knee

›Consider metabolic workup in bilateral presentation

04Differential Diagnosis/ddx36

Extensor mechanism injuries

›Patellar tendon rupture

›ICD-10 M66.361 (right), M66.362 (left)

›Pain and gap are infrapatellar

›Patella alta on X-ray vs patella baja in quadriceps rupture

›Patellar fracture

›ICD-10 S82.001

›Six times more common than tendon ruptures

›Direct blow mechanism, palpable crepitus, visible on X-ray

›Quadriceps strain or contusion

›ICD-10 S76.111

›Preserved though painful extension

›No palpable gap; bruising common

Bony injuries and instability

›Fractures and dislocations

›Femoral neck or shaft fracture

›ICD-10 S72.001, S72.301

›Inability to bear weight; pain with log roll; visible on X-ray

›Knee dislocation or multiligament injury

›ICD-10 S83.006

›Gross instability; assess for vascular injury

›Ankle-brachial index if knee dislocation suspected

Neurologic mimics

›Neurologic causes of extension weakness

›L3-L4 radiculopathy

›ICD-10 M54.4

›Weakness of knee extension but no palpable gap

›Positive neurologic findings; no acute trauma

›Spinal cord pathology or cauda equina syndrome

›ICD-10 G83.4

›Consider if bilateral weakness without clear traumatic mechanism

›Bowel or bladder dysfunction, saddle anesthesia

Joint pathology

›Intra-articular causes

›Septic arthritis

›ICD-10 M00.061

›Effusion, fever, inability to bear weight; no palpable tendon gap

›Hemarthrosis from ligament injury

›ICD-10 M25.061

›Effusion present but extensor mechanism intact

05Laboratory Tests/lt30

Metabolic workup

›Renal and metabolic panel

›Basic or comprehensive metabolic panel

›Creatinine and BUN for CKD screening

›Calcium and phosphorus for secondary hyperparathyroidism assessment

›Electrolytes: hyperkalemia risk in CKD patients

›Parathyroid hormone level

›Indicated if CKD or suspected hyperparathyroidism

›Elevated iPTH associated with tendon degeneration in dialysis patients

›Alkaline phosphatase

›Elevated in secondary hyperparathyroidism

›Supports metabolic bone disease diagnosis

Inflammatory and systemic labs

›Inflammatory markers and metabolic disease

›Uric acid

›Elevated in gout: associated with tendon weakening

›HbA1c or glucose

›Diabetes mellitus screening and control assessment

›ESR and CRP

›If concern for inflammatory arthropathy or infection

›Not specific for rupture diagnosis

›Complete blood count

›Baseline; low hemoglobin seen in CKD patients

›Leukocytosis if concurrent infection suspected

Pre-operative considerations

›Surgical clearance labs

›Coagulation profile

›PT, INR if anticoagulation use or liver disease

›Type and screen

›For patients proceeding to urgent surgical repair

›ECG consideration in pre-operative CKD patients

›Hyperkalemia-related changes: peaked T waves, widened QRS

›Baseline ECG for patients older than 40 with significant comorbidities

06Diagnostic Tests/dt66

Scoring Systems

›Functional outcome scoring (post-operative use)

›Lysholm Knee Score

›Evaluates pain, instability, locking, swelling, stair climbing, squatting

›Not validated for ED diagnosis; used for post-operative outcome assessment

›International Knee Documentation Committee (IKDC) score

›Measures symptoms, function, sports activity

›Used for long-term rehabilitation monitoring

›No validated ED-specific scoring system for quadriceps tendon rupture

›Clinical triad (acute pain, palpable gap, inability to extend) is the diagnostic standard

›High clinical suspicion with low threshold for imaging is recommended

MRI

›MRI characteristics and indications

›Gold standard imaging modality

›Sensitivity, specificity, and positive predictive value of 1.0 for complete rupture

›Definitive characterization of partial vs complete tears

›Indications

›Clinical diagnosis uncertain

›Partial tear suspected: characterize extent before surgical planning

›Pre-operative planning for reconstruction type

›MRI findings in complete rupture

›Tendon discontinuity at or near the superior pole of the patella

›Tendon retraction proximal

›Fluid-filled gap in the tendon

›Bone marrow edema at insertion site

›MRI findings in partial tear

›Partial fiber disruption with intact superficial layer

›Intratendinous signal change without complete discontinuity

›When MRI not required

›Unequivocal clinical triad with planned prompt orthopedic consultation

›MRI may delay time to surgical repair if overused

›CT role in quadriceps tendon rupture

›Not first-line for tendon rupture diagnosis

›Poor soft tissue contrast for tendon visualization

›MRI and ultrasound superior for tendon assessment

›CT indications in this clinical context

›Suspected associated bony injury or fracture

›Complex periarticular fracture pattern requiring surgical planning

›CT findings that may support diagnosis

›Soft tissue density change in suprapatellar region

›Patella baja on sagittal reconstruction

›Absence of normal tendon shadow

Ultrasound

›Point-of-care ultrasound for quadriceps tendon

›Excellent ED bedside diagnostic tool

›Identifies tendon discontinuity, retraction, and hemarthrosis

›Dynamic assessment of tendon continuity in real time

›Useful for rapid bedside confirmation when clinical diagnosis equivocal

›Technique

›Linear high-frequency transducer (7.5-15 MHz)

›Longitudinal and transverse views of quadriceps tendon

›Dynamic flexion-extension to assess partial tears

›Compare contralateral knee

›Ultrasound findings in complete rupture

›Tendon discontinuity with acoustic shadow at rupture site

›Retracted tendon ends with intervening hematoma

›Loss of fibrillar tendon echotexture

›Ultrasound findings in partial tear

›Focal hypoechoic defect within otherwise intact tendon

›Partial fiber disruption

Plain radiography

›Lateral knee X-ray findings

›First-line imaging in the ED

›Bilateral views for comparison

›Identifies patella baja: low-riding patella compared to contralateral side

›Supporting X-ray findings

›Loss of normal quadriceps tendon shadow

›Suprapatellar soft tissue mass or swelling

›Hemarthrosis: suprapatellar effusion

›Excludes patellar fracture

07Disposition/dispo36

Admission indications

›Criteria for hospital admission

›Bilateral rupture

›Metabolic optimization required prior to surgical repair

›Electrolyte abnormalities in dialysis patients

›Nephrology or endocrinology co-management needed

›Significant comorbidities requiring optimization

›Dialysis patients with acute electrolyte derangements

›Uncontrolled diabetes or cardiovascular disease requiring pre-operative optimization

›Inability to safely mobilize with appropriate support

›No support system or home assistance

›Inability to use crutches or walker safely

Discharge criteria

›Safe discharge parameters

›Confirmed or suspected partial tear with preserved extension

›Knee immobilized in extension with immobilizer

›Reliable patient with access to follow-up within 48-72 hours

›Complete tear with same-day orthopedic consultation completed

›Surgical plan established

›Patient able to mobilize safely with crutches

›Pain adequately controlled with oral medications

›Written discharge instructions provided

›Return precautions clearly explained

Consultation and follow-up

›Mandatory consultations and follow-up

›Orthopedic surgery consultation in the ED for all complete ruptures

›Urgent surgical repair is the standard of care

›Class I expert consensus recommendation

›Orthopedic follow-up timing

›Complete tears: 48-72 hours if not admitted

›Partial tears managed conservatively: 1-2 weeks

›Metabolic specialist referral for bilateral rupture

›Nephrology if CKD or dialysis-related

›Endocrinology if hyperparathyroidism or metabolic bone disease

Observation indications

›Observation unit consideration

›Diagnostic uncertainty awaiting MRI

›When clinical exam equivocal and ultrasound non-diagnostic

›Pain control requiring parenteral analgesia

›Transition to oral regimen before discharge

08Treatment/t69

Immediate ED management

›Analgesia

›Non-opioid first-line analgesia

›Acetaminophen 1000 mg orally every 6-8 hours

›Ibuprofen 400-600 mg orally every 6-8 hours if no contraindication

›Avoid if CKD, bleeding risk, or surgeon requests pre-operative avoidance

›Opioid analgesia for severe pain

›Morphine 2-4 mg IV every 4-6 hours as needed

›Oxycodone 5-10 mg orally every 4-6 hours as step-down

›Adjunct analgesia

›Ice pack to knee: 20 minutes on, 20 minutes off

›Elevation of affected limb

Immobilization

›Knee immobilization in full extension

›Knee immobilizer (preferred for isolated rupture)

›Immobilize in full extension 0 degrees

›Allows for easy removal for reassessment

›Long-leg posterior splint alternative

›0 degrees of extension

›Used if significant swelling or instability

›Weight-bearing restriction

›Non-weight-bearing or toe-touch weight-bearing with crutches

›Crutch instruction before discharge

Surgical repair (definitive management)

›Complete tear: surgical repair

›Timing of repair

›Ideally within days to 2 weeks of injury

›Acute repair associated with significantly better outcomes

›Delayed repair (chronic tear) requires more complex reconstruction

›Surgical techniques

›Transosseous suture repair

›Traditional gold standard technique

›Sutures passed through bone tunnels in the patella

›Suture anchor repair

›Comparable outcomes to transosseous technique

›Shorter operative time in comparative studies

›Augmentation for complex or poor-quality tissue

›V-Y plasty for lengthening in retracted chronic tears

›Allograft or autograft for mid-substance tears or revision cases

Nonoperative management

›Partial tears: nonoperative protocol

›Low-grade partial tear criteria

›Preserved active extension against gravity

›MRI confirms intact deep layer of tendon

›Immobilization protocol

›Knee immobilizer in full extension for 4-6 weeks

›Progressive weight-bearing as tolerated after 2-4 weeks

›High-grade partial tear consideration

›Often require surgical repair despite partial intact fibers

›Orthopedic decision based on functional loss and MRI grading

Post-operative rehabilitation protocol

›Rehabilitation phases

›Phase 1: 0-6 weeks post-operative

›Immediate protected weight-bearing in orthosis locked in extension

›Passive ROM initiated early to prevent stiffness

›Avoid active extension for approximately 6 weeks

›Phase 2: 6-12 weeks

›Progressive strengthening program initiated

›Active-assisted ROM exercises

›Orthosis weaned progressively

›Phase 3: 3-6 months

›Full strengthening and functional rehabilitation

›Return to sport or heavy activity

›97% return to work at long-term follow-up

›Average active flexion approximately 133 degrees at long-term follow-up

DVT prophylaxis

›Thromboprophylaxis

›VTE risk assessment

›Surgical patients: DVT rate approximately 2.5% post repair

›Immobilization increases VTE risk

›Pharmacologic prophylaxis options

›Low molecular weight heparin: enoxaparin 40 mg subcutaneous daily

›Initiated post-operatively per orthopedic surgeon direction

›Mechanical prophylaxis

›Compression stockings to contralateral leg during immobility

09Special Populations/sp47

Pregnancy

›Quadriceps tendon rupture in pregnancy

›Epidemiology in pregnancy

›Extremely rare; case reports only

›Altered biomechanics and weight gain increase extensor mechanism stress

›Imaging considerations

›Ultrasound is preferred first-line imaging: no ionizing radiation

›MRI without gadolinium acceptable if ultrasound inconclusive

›Avoid CT if possible; use only if bony injury requires exclusion

›Surgical and anesthetic considerations

›Multidisciplinary team: orthopedics, obstetrics, anesthesia

›Timing of surgical repair depends on gestational age and stability

›Regional anesthesia preferred where feasible

›Analgesia in pregnancy

›Acetaminophen: safest analgesic in all trimesters

›NSAIDs: avoid after 20 weeks gestation (risk of premature ductal closure)

›Opioids: use with caution; neonatal opioid syndrome risk with prolonged use

Geriatric

›Considerations in patients older than 65

›Epidemiology in geriatric patients

›Peak incidence age 40-70 years; majority of cases in this demographic

›Higher prevalence of comorbidities: CKD, diabetes, gout, PVD

›Increased risk of chronic tendon degeneration underlying acute rupture

›Analgesia considerations

›NSAIDs: increased risk of renal toxicity, GI bleeding, cardiovascular events

›Prefer acetaminophen as first-line

›Opioids: increased risk of delirium, falls, respiratory depression

›Reduce opioid doses by 25-50% in frail elderly patients

›Surgical risk considerations

›Pre-operative cardiac and pulmonary assessment

›Higher complication rates post-operatively: infection, wound healing

›Rehabilitation progress slower; functional recovery expectations adjusted

›Fall prevention

›High fall risk during recovery with crutches

›Physical therapy assessment for safe mobilization

›Home safety evaluation before discharge

Pediatrics

›Quadriceps tendon rupture in pediatric patients

›Epidemiology in pediatric patients

›Extremely rare before skeletal maturity

›Distal femoral physis avulsion more common than tendon rupture in skeletally immature

›Tendon rupture if seen: associated with systemic disease (juvenile arthritis, SLE, CKD)

›Imaging considerations

›Plain X-ray first to exclude physeal injury or avulsion fracture

›MRI without contrast preferred for soft tissue characterization

›Avoid CT to minimize radiation exposure

›Treatment considerations

›Orthopedic consultation mandatory for any extensor mechanism disruption in a child

›Growth plate involvement changes surgical approach significantly

›Systemic disease workup if spontaneous or low-energy mechanism

10Background/b55

Epidemiology

›Incidence and demographics

›Incidence approximately 1.37 per 100,000 persons per year

›Uncommon but clinically significant injury

›Less common than patellar tendon rupture

›Demographics

›Predominantly males older than 40 years

›Male predominance: approximately 80-90% of cases

›Peak incidence in the fifth and sixth decades of life

›Misdiagnosis rates

›Initial misdiagnosis rates approach 50% in some series

›High index of suspicion required in ED practice

›Bilateral rupture

›Occurs in up to 5% of cases

›Strongly associated with systemic metabolic disease

Pathophysiology

›Mechanisms of tendon failure

›Normal anatomy

›Quadriceps tendon inserts at the superior pole of the patella

›Composed of three to four layers from rectus femoris, vasti muscles

›Bears tensile loads up to 8 times body weight during dynamic activity

›Degenerative pathway

›Chronic tendinopathy with collagen disorganization precedes most ruptures

›Hypovascular zone 1-2 cm proximal to patellar insertion is most vulnerable

›Rupture typically occurs at the osteotendinous junction

›Metabolic contributors to tendon degeneration

›Secondary hyperparathyroidism: excess PTH causes collagen weakening

›Calcium pyrophosphate crystal deposition in tendons (gout, pseudogout)

›Diabetes mellitus: advanced glycation end products impair collagen crosslinking

›CKD/uremia: accumulation of uremic toxins in tendon matrix

›Fluoroquinolone toxicity mechanism

›Inhibition of tenocyte proliferation and collagen synthesis

›Induction of matrix metalloproteinase activity

›Mitochondrial toxicity in tenocytes

›Acute failure mechanism

›Eccentric quadriceps load against a fixed flexed knee overwhelms weakened tendon

›Rupture propagates through zone of degeneration

Therapeutic Considerations

›Evidence base for surgical repair

›Acute surgical repair outcomes

›Good to excellent outcomes expected in the majority of patients after acute repair

›Re-rupture rate approximately 2% after acute repair

›DVT rate approximately 2.5%; heterotopic ossification rate 6.9%

›97% of patients return to work at long-term follow-up

›Transosseous vs suture anchor repair

›Comparative studies show comparable outcomes between techniques

›Suture anchors may offer shorter operative time

›No significant difference in re-rupture rate between methods

›Timing impact on outcomes

›Acute repair (within 2 weeks): best functional outcomes

›Delayed repair requires V-Y plasty or graft augmentation

›Each week of delay increases reconstruction complexity

›Fluoroquinolone management

›Discontinue fluoroquinolones immediately if tendon symptoms develop

›FDA boxed warning in effect for all fluoroquinolone antibiotics

›Systemic disease management

›CKD patients: optimize PTH, calcium, phosphorus before and after surgery

›Dialysis patients: higher re-rupture risk; augmentation often recommended

11Patient Discharge Instructions/pdi29

copy discharge instructions

›Quadriceps Tendon Rupture - Discharge Instructions

›What happened to you

›You have been diagnosed with a quadriceps tendon rupture or injury

›The quadriceps tendon connects the thigh muscles to the kneecap

›This injury requires orthopedic follow-up and likely surgical repair

›Your knee brace or immobilizer

›Keep the knee immobilizer on at all times including when sleeping

›Do not attempt to bend the knee until cleared by your orthopedic surgeon

›Adjust straps for comfort but maintain full extension of the knee

›Weight-bearing and mobility

›Non-weight-bearing or toe-touch weight-bearing with crutches only

›Do not put your full weight on the affected leg

›Use crutches for all walking until seen by orthopedic surgeon

›Pain management at home

›Acetaminophen (Tylenol) 500-1000 mg every 6-8 hours as needed

›Ibuprofen 400-600 mg every 6-8 hours with food if prescribed and no kidney problems

›Ice pack 20 minutes on, 20 minutes off to the knee

›Elevate the leg above heart level when resting to reduce swelling

›Your follow-up appointment

›You must see an orthopedic surgeon within 48-72 hours (complete tear) or 1-2 weeks (partial tear)

›Delayed treatment significantly worsens surgical outcomes

›Bring your discharge paperwork and imaging results to your appointment

›Return to the emergency department immediately if

›Severe increase in pain, redness, or warmth in the knee or leg

›Calf swelling or pain (possible blood clot)

›Numbness, tingling, or color change in the foot or toes

›Fever above 38.5 degrees Celsius

›Wound or skin breakdown over the knee

›Increasing inability to extend the knee or new weakness

12References/r27

Guidelines and key sources

›Primary clinical references

›Arnold EP, Sedgewick JA, Wortman RJ, Stamm MA, Mulcahey MK. Acute Quadriceps Tendon Rupture: Presentation, Diagnosis, and Management. JBJS Reviews. 2022. PMID 35130193

›Core review establishing incidence 1.37 per 100,000 per year and clinical triad

›Ilan DI, Tejwani N, Keschner M, Leibman M. Quadriceps Tendon Rupture. Journal of the American Academy of Orthopaedic Surgeons. 2003. PMID 12828449

›Misdiagnosis rates approaching 50%; surgical repair outcomes data

›Ciriello V, Gudipati S, Tosounidis T, Soucacos PN, Giannoudis PV. Clinical Outcomes After Repair of Quadriceps Tendon Rupture: A Systematic Review. Injury. 2012. PMID 22959496

›Systematic review of surgical outcomes: re-rupture, DVT, heterotopic ossification rates

›Pengas IP, Assiotis A, Khan W, Spalding T. Adult Native Knee Extensor Mechanism Ruptures. Injury. 2016. PMID 27423309

›Risk factors: fluoroquinolones, corticosteroids, aromatase inhibitors

Pharmacologic and metabolic references

›Drug safety and metabolic disease references

›Morales DR, Slattery J, Pacurariu A, et al. Relative and Absolute Risk of Tendon Rupture With Fluoroquinolone and Concomitant Fluoroquinolone/Corticosteroid Therapy. Clinical Drug Investigation. 2019. PMID 30465300

›aIRR of 19.36 for tendon rupture with fluoroquinolone and corticosteroid combination

›Chang CK, Chien WC, Hsu WF, et al. Positive Association Between Fluoroquinolone Exposure and Tendon Disorders. Frontiers in Pharmacology. 2022. PMID 35387340

›Population-based cohort confirming fluoroquinolone tendon injury risk

›Wu W, Wang C, Ruan J, et al. Simultaneous Spontaneous Bilateral Quadriceps Tendon Rupture With Secondary Hyperparathyroidism in a Patient Receiving Hemodialysis. Medicine. 2019. PMID 30855501

›Bilateral rupture mechanism in CKD with hyperparathyroidism

›Malta LM, Gameiro VS, Sampaio EA, Gouveia ME, Lugon JR. Quadriceps Tendon Rupture in Maintenance Haemodialysis Patients. Injury. 2014. PMID 25441174

›Risk factor analysis and surgical outcomes in dialysis patients

Surgical technique references

›Operative technique and outcome studies

›Jammal M, Weil Y, Kanaann M, Mosheiff R, Oulianski M. Comparative Outcomes of Trans-Osseous Tunnels Versus Suture Anchors for Acute Quadriceps Tendon Rupture. Injury. 2026. PMID 41724016

›Comparable outcomes between transosseous and suture anchor repair techniques

›Danaher M, Faucett SC, Endres NK, Geeslin AG. Repair of Quadriceps and Patellar Tendon Tears. Arthroscopy. 2023. PMID 36332853

›Augmentation strategies for complex and chronic tears

›Boudissa M, Roudet A, Rubens-Duval B, Chaussard C, Saragaglia D. Acute Quadriceps Tendon Ruptures: A Series of 50 Knees With Average Follow-Up More Than 6 Years. OTSR. 2014. PMID 24529850

›Long-term outcomes: average active flexion 133 degrees; 97% return to work

›Flores D, Atinga A, Beaulieu C, Alaia EF, Probyn L. Extensor Apparatus of the Knee: Anatomy and Injury Patterns. Skeletal Radiology. 2026. PMID 42059955

›Imaging anatomy and MRI characteristics of quadriceps tendon rupture

Learn More: Quadriceps Tendon Rupture→

Comprehensive Clinical Review

Structured, evidence-informed, long-form analysis for deeper understanding.

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

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