It is not common for the quadriceps tendon to rupture and when it does it mostly presents in those older than 40 years. Certain diseases and previously existing degeneration in the knee extensor apparatus makes this condition more likely to occur. A rupture on one side is the most common occurrence and bilateral ruptures indicate there are very likely to be underlying causative factors. Patellar tendon ruptures are less frequent than ruptures of the quads tendon and present in younger people under 40. It is important to make an early diagnosis of this problem and operate as soon as possible afterwards as delay makes the outcomes poorer.
A typical action where a rupture of the quadriceps tendon is likely to occur is when the quads muscle is rapidly lengthening under stress and the foot is planted on the floor. A direct blow to the knee, a fall on the knee or a laceration to the area can all induce rupture. Ruptures are mostly likely to happen across an area of abnormal tissue in a tendon and this is suspected because a very small event can rupture a quadriceps tendon at times and that a large force does not rupture a normal tendon but nearby tissues instead. Conditions which increase the probability of rupture include arthritic diseases, long-time steroid use, infections, obesity and immobilisation. Knee steroid injections and various operations can facilitate tendon rupture.
Just above the upper kneecap pole is the commonest site for rupture of the tendon of the quadriceps, the rupture occurring through abnormal tissues. The structural make up of the tendon or the blood supply can be damaged by a variety of medical diseases. Changes in the blood vessels can be produced by diabetes and high bodyweight can produce fatty changes in the tendon structures and an increased level of forces through the tendon. Ruptured tendons have been investigated and shown microscopically to possess degenerative changes without significant inflammation. Poor supply of oxygen and insufficient nutrition are important precursors to tendon degeneration.
On presentation patients show a loss of the ability to use the knee functionally, swelling in the suprapatellar region and severe knee pain after a traumatic event such as a fall or stumble, or after the knee giving way without falling. There can be a clearly audible pop at the time and the patient may never have complained of knee pain before. Walking will be difficult due to pain and knee instability and a physical exam will show bruising, tenderness and the suprapatellar swelling. On manual examination a tissue gap may be found above the patella and the patella itself may lie rather lower than is normal.
In diagnosis of this condition it is important to determine the patient's ability to effect knee straightening against the force of gravity. A rupture can be indicated by the patient being unable to straighten their knee joint under their own power and this is known as an extension lag. Ruptures which are partial are more difficult to recognise and the patient's ability to knee straighten will vary with the level of quadriceps tendon damage. Misdiagnosis can be quite common and this can lead to the wrong treatment and inadequate follow up.
The knee pain and swelling will reduce over time and the function of the quadriceps may improve, with improved walking ability. However, patients will show a hip hitch to bring the leg through and walk on a straight knee to maintain stability. However, the knee may give way frequently and climbing stairs will be difficult. Early operation to repair the defect is the standard treatment for acute and complete ruptures of the quadriceps tendon, with chronic ones also mostly suitable for surgery. Partial tears can be immobilised in a cast in a fully extended position for three to six weeks with a gradual physiotherapy rehabilitation regime until good function is achieved.
Typical post-operative management is to place the knee in full extension in a plaster of Paris cylinder for a period of four to six weeks, allowing the patient to bear weight with a walking aid. Removal of the plaster is followed by application of a hinged brace which can be adjusted to allow progressively more flexion as healing progresses. Patients attend physiotherapy to regain the knee range of motion and strength until their knee is as good as the unaffected one. - 14130
A typical action where a rupture of the quadriceps tendon is likely to occur is when the quads muscle is rapidly lengthening under stress and the foot is planted on the floor. A direct blow to the knee, a fall on the knee or a laceration to the area can all induce rupture. Ruptures are mostly likely to happen across an area of abnormal tissue in a tendon and this is suspected because a very small event can rupture a quadriceps tendon at times and that a large force does not rupture a normal tendon but nearby tissues instead. Conditions which increase the probability of rupture include arthritic diseases, long-time steroid use, infections, obesity and immobilisation. Knee steroid injections and various operations can facilitate tendon rupture.
Just above the upper kneecap pole is the commonest site for rupture of the tendon of the quadriceps, the rupture occurring through abnormal tissues. The structural make up of the tendon or the blood supply can be damaged by a variety of medical diseases. Changes in the blood vessels can be produced by diabetes and high bodyweight can produce fatty changes in the tendon structures and an increased level of forces through the tendon. Ruptured tendons have been investigated and shown microscopically to possess degenerative changes without significant inflammation. Poor supply of oxygen and insufficient nutrition are important precursors to tendon degeneration.
On presentation patients show a loss of the ability to use the knee functionally, swelling in the suprapatellar region and severe knee pain after a traumatic event such as a fall or stumble, or after the knee giving way without falling. There can be a clearly audible pop at the time and the patient may never have complained of knee pain before. Walking will be difficult due to pain and knee instability and a physical exam will show bruising, tenderness and the suprapatellar swelling. On manual examination a tissue gap may be found above the patella and the patella itself may lie rather lower than is normal.
In diagnosis of this condition it is important to determine the patient's ability to effect knee straightening against the force of gravity. A rupture can be indicated by the patient being unable to straighten their knee joint under their own power and this is known as an extension lag. Ruptures which are partial are more difficult to recognise and the patient's ability to knee straighten will vary with the level of quadriceps tendon damage. Misdiagnosis can be quite common and this can lead to the wrong treatment and inadequate follow up.
The knee pain and swelling will reduce over time and the function of the quadriceps may improve, with improved walking ability. However, patients will show a hip hitch to bring the leg through and walk on a straight knee to maintain stability. However, the knee may give way frequently and climbing stairs will be difficult. Early operation to repair the defect is the standard treatment for acute and complete ruptures of the quadriceps tendon, with chronic ones also mostly suitable for surgery. Partial tears can be immobilised in a cast in a fully extended position for three to six weeks with a gradual physiotherapy rehabilitation regime until good function is achieved.
Typical post-operative management is to place the knee in full extension in a plaster of Paris cylinder for a period of four to six weeks, allowing the patient to bear weight with a walking aid. Removal of the plaster is followed by application of a hinged brace which can be adjusted to allow progressively more flexion as healing progresses. Patients attend physiotherapy to regain the knee range of motion and strength until their knee is as good as the unaffected one. - 14130
About the Author:
Jonathan Blood Smyth is the Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for physiotherapists in Sheffield visit his website.
No comments:
Post a Comment