Quadriceps tendon delamination tear. A case report.

Abstract

Introduction

Partial quadriceps tendon ruptures are rare and they are usually managed non-operatively, provided that the extensor mechanism is intact. In case the extension mechanism is compromised, a more aggressive treatment is required, which includes surgical repair of the tendon. Partial quadriceps tendon tear with delamination of the undersurface is only reported once in the literature.

Αim

We present an extremely rare case of quadriceps tendon delamination tear, which was treated operatively with a very good midterm result.

Materials and methods

A 42 year old male power lifter presented to the emergency department (ED) on a wheelchair after he had lifted 110kg using the “clean and jerk” technique at the gym. He mentioned a right sided acute above knee pain. On examination, severe swelling of the knee joint was noted. No palpable gap could be felt at the superior pole of the patella. An extension lag of 30 degrees was identified, indicating a compromised knee extension mechanism.  Magnetic resonance imaging (MRI) and ultrasound scan (US) revealed a complete tear of vastus lateralis, vastus medialis and vastus intermedius tendons, whereas the rectus femoris tendon was intact. Surgical exploration confirmed the former imaging results, as the superficial layer of the quadriceps tendon was found to be intact. After a longitudinal incision of the rectus femoris tendon, we were able to visualize the rupture of the deep tendon layers. Operative treatment included transosseous tunnel repairing technique to secure the tendon to its attatchment site.

Results

On the sixth month follow up, the patient had full range of motion of the knee and a quadricep muscle strength of 5/5 according to oxford muscle scale.

Conclusion

Quadriceps tendon delamination tears are rare and they can be easily missed.  Proper examination and imaging is of paramount importance in order to provide the appropriate treatment.