Sonography of Traumatic Quadriceps Tendon Tears With Surgical Correlation

Abstract

Objectives Using surgical correlation as the reference standard, the purpose of this study was to assess the ability of sonography to detect quadriceps tendon tears that require surgical treatment (high‐grade partial tears and complete ruptures). Methods Two hundred thirty‐nine consecutive sonographic reports of the knee (May 2001 to October 2008) with subsequent surgical correlation were retrospectively reviewed for surgical intervention on the quadriceps tendon. All sonograms were blindly and retrospectively reviewed. Surgical findings were compared with results from the consensus review. Results from the original sonographic reports (nonretrospective interpretation) were also compared with the surgical findings. Results On the retrospective consensus review, the sensitivity (23 of 23), specificity (16 of 16), and accuracy (39 of 39) were 100% for identifying high‐grade partial tears or complete ruptures versus a normal quadriceps tendon. For the original, nonretrospective sonographic reports, 22 of 23 high‐grade partial tears or complete ruptures (96%) were correctly diagnosed. Conclusions Sonography is an effective tool for identifying quadriceps tendon tears that require surgical treatment (high‐grade partial tears and complete ruptures).

US of the Knee: Scanning Techniques, Pitfalls, and Pathologic Conditions

“…Partial tears will appear as focal hypoechoic disruptions of the fibrillary and laminar architecture of the tendon. US is also highly sensitive and specific for diagnosing high-grade partial and complete tears, both of which may require surgical management (6). Rupture of a healthy tendon is relatively rare, so quadriceps tendon rupture is usually the end result of a chronic process, with risk factors including age, repetitive microtrauma, genetics, systemic diseases, and medications (7).…”

Prevalence of the additional head of quadriceps femoris in the South Indian population: a cadaveric and radiological study

“…Although sonography is generally accepted as a useful means to diagnose quadriceps tendon injury, its reliability has been questioned. MRI has been considered more accurate in assessing the extent of soft tissue and tendon injuries 15 . In the present study, the concordance rate of observing the additional head in cadaveric dissection following MRI was 100% concluding that MR imaging of the additional muscle head has high sensitivity and specificity.…”

Musculoskeletal ultrasound: athletic injuries of the lower extremity

“…At the distal thigh, the quadriceps tendon is comprised of three layers. The superficial layer arises from the rectus femoris, the middle layer is comprised of the combined vastus medialis and vastus lateralis, and the deep layer arises from the vastus intermedius [ 17 , 19 , 20 ]. While the majority of the quadriceps tendon inserts at the anterosuperior patella, superficial rectus femoris fibers continue, attached to the anterior surface of the patella and join with the patellar tendon, referred to as the prepatellar quadriceps continuation [ 21 ].…”

“…Full thickness ruptures often occur 1-2 cm proximal to the insertion at the avascular zone; however, injury at the insertion with resultant cortical irregularity or even an echogenic, retracted and shadowing avulsion fracture may be present [ 19 , 20 ]. While ruptured tendon typically retracts with wavy fibers, in subtle or equivocal cases, dynamic maneuvers where the leg is passively flexed and extended, or where the patella is manually translated inferiorly, can elucidate whether proximal intact fibers move with the patella [ 19 , 20 ]. Separation of the prepatellar quadriceps continuation from the anterior patellar cortex with intervening hypoechoic fluid has also been described in the setting of anterior knee pain [ 21 ].…”