Quadriceps Tendinopathy

Abstract

The quadriceps can be considered a relative strong structure of the extensor apparatus of the knee; nevertheless, it can be affected and weakened by degenerative changes, under the influence of local and systemic factors. In some cases, progression of tendinopathy can lead also to spontaneous, partial, or complete rupture. For this reason, prevention and treatment of predisposing factors, as well as early recognition, objective grading, and monitoring of structural alterations, can be helpful in identifying those ones more susceptible to rupture. Symptomatic enthesopathy is rarely the unique cause of bilateral simultaneous and complete rupture of the quadriceps. Quadriceps tendon tear is a not so common injury, usually occurring in patients older than 40 years of age, frequently due to a fall during sudden quadriceps muscle contraction. Early recognition of this injury can be strategic to ensure a more rapid healing, as well as a better recovery and prognosis. For complete quadriceps tendon rupture, surgery is the treatment of choice, while in partial tears, an accurate assessment of the degree of the lesion and disability, or loss of function, can aid the clinician in deciding surgical versus conservative treatment. Conservative treatment of partial tears of the quadriceps tendon consists in a full extension brace for 6 weeks, followed by a protected range of motion exercises, that can guarantee a good outcome and regain of function in the follow-up. When surgical treatment is required, 6 weeks of postoperative immobilization with intense rehabilitation are indicated, for obtaining the best functional outcomes as well. All grades of tendinosis are usually treated conservatively as first-line therapy. Among conservative treatments, biophysical stimulations (extracorporeal shock waves and some so-called physical therapies), as well as autologous growth factors, surely represent some innovative, safe, and effective therapeutic strategies that are indicated in conjunction with rehabilitative programs, in order to obtain, besides anti-inflammatory and analgesic effects, a positive action on tendon tissue and its remodeling processes, for improving recovery.