Spontaneous rupture of quadriceps tendon: A report of two cases and review of the literature

Abstract

Abstract Introduction Spontaneous rupture of the quadriceps tendon is rare. A sudden snap in the knee and feeling of giving way and occasionally falling are associated with rupture of the tendon. Subsequently, the loss of extensor mechanism of the knee limits ambulation. The aim of this report is to highlight this rare entity and to demonstrate that simple tendon repair could also give good results. Presentation of case The two patients were middle aged who were apparently healthy with active lifestyles prior to their injuries. The first patient is a 61-year-old lady who was descending the staircase when she suddenly felt her knee gave way. She supported herself on the rail and subsequently started ambulating with a stick until presentation. The second patient is a 57-year-old male who was doing a pre-game work out in a lawn tennis court when he felt a sudden pull on his right knee and he slumped. After some weeks, his pain subsided but he noticed poor clearance during gait. A big defect, just above the patella was found in the usual position of the quadriceps tendon in each patient. Simple end-to-end tendon repairs were done for both patients with excellent restoration of the extensor mechanism. Discussion Spontaneous rupture of a strong tendon such as quadriceps is not common. The sudden episode of pain, knee swelling, a gap in the quadriceps and loss of knee extension make clinical diagnosis unmistakable. However, radiological exclusion of patella fracture is important. Conclusion Restoration of the extensor mechanism of the knee is a sine qua non for effective ambulation. The quadriceps pull would always create a gap in the tendon and healing is only possible by surgical apposition of the tendon ends and in our cases by direct suturing.