Delayed Diagnosis of Quadriceps Tendon Rupture

Abstract

Quadriceps tendon (QT) injury classically presents with pain, inability to actively extend the knee, and a palpable defect in the suprapatellar region. Unilateral eccentric contraction and hyperflexion after ground level fall are the most common mechanisms of injury. Delayed QT repair may require additional operative procedures and is associated with poorer post-operative functional outcomes, persistent knee extensor weakness, and decreased range of motion. This report demonstrates a case of delayed diagnosis of QT rupture after a fall with injury to the contralateral extremity. Initial evaluation and X-ray did not reveal the rupture. Six weeks later, after multiple re-admissions to the acute hospital from inpatient rehabilitation for sepsis, Physical Medicine and Rehabilitation (PM&R) was consulted and noted a QT rupture on exam. The rupture was confirmed on MRI and the patient underwent surgery within days. This case demonstrates the value of an interdisciplinary approach and involvement of PM&R throughout the care continuum.