What is the quadriceps tendon and what is quadriceps tendonitis?

The quadricep muscles are a large group of four muscles in the front of the thigh that function to extend the knee.  These muscles are connected to the top of your patella (kneecap) by the quadriceps tendon, a strong and thick band of collagen tissue.  The kneecap is in turn connected to the tibia (shinbone) by the patellar tendon.

 

A significant amount of force is generated by the quadriceps muscles and transmitted through the quadriceps tendon with weightbearing.  Repetitive forces on the quadriceps tendon can lead to inflammation and then microtears in the tendon.  This condition most commonly occurs in athletes.  Basketball players, volleyball players, and any running athlete are the most commonly affected.

Certain risk factors may contribute to the development of quadriceps tendonitis.  These include certain antibiotics in the floxacin category (Levaquin, Cipro), as well as oral or injected steroids.  Training errors and especially overtraining are probably the most frequent risk factors.  There are also subtle anatomic differences amongst patients that may furthermore result in increased stress across the quadriceps tendon.

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Symptoms:

Patients most commonly present with pain just above the kneecap. Pain onset tends to occur gradually, during and after activity.  However, as inflammation worsens, pain can occur eventually even at rest.  Pain and stiffness after prolonged periods of sitting is a particularly common complaint.

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Diagnostic Testing:

X-ray is usually ordered to evaluate the knee joint and further evaluate for other bony pathology.  MRI may be ordered to rule out other causes of knee pain.

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Non-operative Treatment:

Nonoperative management is the mainstay of treatment for quadriceps tendonitis and consists of activity modification, physical therapy, and anti-inflammatory medications (as long as there are no contraindications with their use).  In addition to avoiding activities that cause pain, Dr. Steven Lee recommends avoiding jumping, running, kneeling, resisted knee extensions, deep squats, deep lunges, and deep leg presses (especially where the knee bends greater than 90 degrees).  Use of ice over the area of pain and rest may help with pain after activity.  Stopping the offending activities early in the disease course is crucial.  Patients who continue to try and exercise through the pain will only make the condition worse and will not only significantly prolong the recovery process, but also increase the chance for requiring surgery.

 

If appropriate, Platelet-Rich Plasma (PRP) injections (Click here for more information) may be very helpful in healing and remodeling the tendon.  Corticosteroid injections are NOT recommended here as the medication can weaken the tendon and increase chance of rupture.

 

Surgical Treatment:

Surgery is very rare and recommended only as a last resort.  The most common procedure involves cleaning the quadriceps tendon of inflamed tissue.  If there is an underlying cause of the condition, such as a bony spur or abnormal alignment of the knee cap, surgery may be considered to correct the malalignment.

 

Recovery Expecations:

Those undergoing surgery can expect to be kept in a knee brace for a few weeks following surgery.  The brace keeps the knee in full extension and can only be removed to shower.  Patients are usually allowed to be fully weight bearing while wearing the brace.  Physical therapy is usually started 2-3 weeks after surgery, and is designed to progressively increase knee range of motion and strength.  Patients can expect to wean their knee brace over a 6 week period of time as they progress with physical therapy.  Full recovery can take up to 4-6 months following surgery, depending on the severity.

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Immediate Post-Operative Instructions

Please refer to the following pages for more information:

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• What should I expect after surgery?

• What food or supplements should I have after surgery?

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*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice.  Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.

 

*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.