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Quads Ripped from Bone

Oct 31, 2016

If your quadriceps tendon is ripped from bone, you are very likely to get quadriceps tendon tear. The normal activity of the quadriceps tendon is to work together with the frontal thigh muscles to straighten your leg. Slight tearing in the quadriceps tendon leads to difficulty in using your leg and a substantial tear will disable your leg and require surgery followed by physical therapy to repair. Quads ripped from bone are not common injuries and usually occur in older people engaged in sports involving jumping or running.

 

What Causes Quadriceps to Rip From Bone?

Quadriceps tendon tear can be caused by the following:

  • ŸSerious injury arising from a road traffic accident or a sporting-related accident
  • ŸSports activities involving repetitive jumping or running movements such as track and field events, football and basketball
  • ŸKnee injections with anti-inflammatory corticosteroids which can lead to tendon and muscle weakness

Symptoms of Quadriceps Tendon Tear

  • ŸInability to straighten the leg
  • ŸTenderness and pain localized above the knee
  • ŸWalking difficulty
  • ŸSnapping sound when the injury occurred
  • ŸSwelling above the knee
  • ŸMuscular cramps

Nonsurgical Treatment of Quadriceps Tendon Tear

Once your doctor examines your quads ripped from bone injury, he/she will determine the best treatment depending on:

  • Size and type of tear
  • Age
  • Activity level

In case of a small or partial tear, nonsurgical treatment will suffice.

R.I.C.E Method 

  • Rest: Avoid activities that may aggravate the tendon injury for the period when the symptoms remain.
  • Ice: Application of an ice pack to the injury region reduces the swelling and pain.
  • Compression: Wrap the knee with bandages when necessary.
  • Elevation: Keeping the leg in an elevated position reduces the swelling.

Use NSAIDs (Nonsteroidal anti-inflammatory drugs) such as naproxen and ibuprofen to relieve pain.

Immobilizing

Immobilizing involves wearing a brace to keep your knee straight and avoid movement. Your doctor will usually recommend that you use knee braces or immobilizers for three to six weeks. During this time, you will most probably need crutches to keep your body weight off your injured leg.

Physical Therapy

Physical therapy will commence when the initial swelling and pain subside. This will involve exercises designed to restore strength and get the leg back to action.

As you progress in your physical therapy, your therapist will incorporate more exercises to strengthen the injured quadriceps. Thereafter, your braces will be unlocked to allow you to move your legs in an increasing range of motions. You will progressively be assigned exercises until you and your doctor are certain that you are ready to get back to normal sports.

Surgical Treatment of Quadriceps Tendon Tear

In case you have serious quads ripped from bone, you will need surgery to fix the tendon. The decision for a surgery will be made on the evaluation of your overall condition.

During the surgical procedure, the torn tendon is reattached to the upper part of the kneecap. It is worth noting that best results are achieved when surgical intervention is carried out as soon as possible following injury. This reduces chances of scarring which would lead to shortening of the tendon.

Hospitalization

While surgical treatment may be performed on outpatient basis, in most cases it is necessary for the patient to spend a night in hospital following the procedure to allow for observation.

Rehabilitation After the Surgery

The First 2 Weeks After Surgery

Precautions

  • Get crutches and use them for weight bearing as tolerated (WBAT) whenever you move.
  • Wear a dial brace and lock it at all times except during therapeutic exercises.
  • Stick to the recommended range of motion.
  • Maintain dryness on the incision site and the sutures.

Range of Motion

Keep within 0°-30° of passive range of motion (ROM) unless your therapist advises otherwise.

Suggested Therapeutic Exercises

Hamstring sets, ankle pumps, glut sets, patellar sets, and quadriceps sets

2-6 Weeks After Surgery

Precautions and Range of  Motion

  • Continue using crutches, gradually allowing for weight progression and sticking to wearing the dial brace and keeping it locked except during therapeutic exercises.
  • Weeks 3 to 6: 0°-90° knee motion. No active knee extension
  • Your surgeon may alter these precautions and ROM limits depending on the status of recovery.

Suggested Therapeutic

Exercises

  • Knee extension with foot placed on a rolled up towel
  • ŸHeel slides
  • Gentle patellar movements
  • 4-way leg lifts 
  • Shifting weight on to surgical side while wearing brace

6 to 12 Weeks After Surgery

Precautions

  • Gradually progress on weight bearing using knee flexion but avoid going beyond 70° within 12 weeks following surgery.
  • Keep within the recommended ROM below.

Range of Motion

  • Week 7-8: 0°-115° knee motion without active knee (quadriceps) extension
  • Week 9-10: 0° to 130° knee motion with some active knee extension

Suggested Therapeutic Exercises

  • Knee flexion – prone
  • Patellar movements
  • Open chain hip strengthening
  • Stationary bike
  • Closed chain quadriceps stretch of 0°-40°
  • light squats
  • Core strengthening

12 Weeks After Surgery

Precautions

Avoid forceful contractions including:

  • Impact activities
  • Exercises involving movement compensations

Suggested Therapeutic

Exercises

  • Non-impact proprioceptive and balance drills
  • Gait drills
  • Hip and core strengthening
  • Stationary bike
  • Stretching for individualized muscle imbalances
  • Quad strengthening involving closed chain exercises that start with a short arc of motion and gradually progress to 70° knee flexion
  • Functional exercises including squats, lunges and step backs
  • Hip and core strengthening

4 Months After Surgery

Precautions

Soreness arising from these activities normally resolves within 24 hours. Look out for:

  • Swellings after activities
  • Limps when running

Suggested Therapeutic Exercises

  • Impact control exercises starting with two feet to two feet and moving on to one foot to other foot and then one foot to the same foot
  • Motion control exercises starting with single plane, low velocity activities and moving on to multi-plane, higher velocity activities
  • Specific sport/work proprioceptive and balance drills
  • Stretching for individual patient muscle imbalances 
  • Hip and core strengthening

How to Prevent Quadriceps Tendon Tear

Follow these tips to avoid getting quads ripped from bone:

  • Always warm up before serious exercises.
  • Improve the flexibility of your tendons by doing some stretches prior to engaging in sports activities.
  • Get sufficient recovery time between routines.
  • If you play sports such as football and basketball, wear the recommended safety equipment properly so as to support your knees.
  • Ensure that you keep fit so that your quadriceps tendons remain flexible, strong and enduring.
  • Get treatment for any recurring problems that may expose you to tendon injuries.