yogabook / pathologie / quadriceps tendon rupture and rupture of the patellar ligament

quadriceps tendon rupture and rupture of the patellar ligament

Definition of

The quadriceps tendon rupture is the tearing of the tendon of the quadriceps where it attaches to the patella. The patellar ligament is also incorrectly referred to as the patellar tendon, although it is not a tendon but a ligament, as the name indicates. Only the fact that around 50% of the fibers of the quadriceps run past the patella in the direction of the patellar ligament lends a certain plausibility to the term, but easily leads to confusion. These ruptures usually occur as a result of maximum voluntary tension, often against unexpected resistance, such as when trying to catch oneself when stumbling with the strength of the quadriceps or an external flexion of the knee joint when the quadriceps are tensed. Contact with the opponent may be responsible, causing an abrupt reversal of the direction of the lower leg with intensely concentric contracting quadriceps. The quadriceps tendon usually tears in the distal third, often at the cranial patellar pole, the patellar ligament usually at the caudal patellar pole. Pre-existing degenerative damage plays a role in most cases, as do underlying metabolic disorders such as diabetes mellitus, hyper-PTH, gout and renal insufficiency, which favor the degeneration of the tendon tissue. Corticosteroids, infiltrated locally or administered systemically, also promote this. The rupture usually occurs unilaterally and mostly in people over 40 years of age. The patellar ligament ruptures less frequently, as it is more stable than the quadriceps tendon; if it does, it is usually at the lower patellar pole and only rarely at the tibial tuberosity. Previous damage also plays a role here, including removal from the patellar ligament for the purpose of ligamentoplasty. This tear often affects younger people who have experienced a local traumatic impact. The complete rupture usually manifests itself in a complete loss of function of the extensor apparatus of the knee joint, depending on where the patella moves or not: the complete rupture of the quadriceps tendon leads to a low patella, the complete rupture of the patellar ligament leads to a high patella. A dent is usually palpable, which can be masked by swelling and hematoma after a short time. An ultrasound is usually sufficient; an MRI should not be necessary. Surgical treatment should be performed promptly so that the quadriceps does not contract further in an unfavorable manner. For six weeks after the operation, the patient should only use low weights on forearm crutches and limit knee flexion to 60 degrees for one month, after which 90 degrees can be flexed in the following two weeks. Complete immobilization is not recommended, partly because intra-articular adhesions can occur.

Cause

1. Maximum voluntary tension, possibly with forced reversal of direction during contraction
2. Previous corticosteroid injections or global administration

Predisposing

1. Degenerative previous damage
2. Diabetes mellitus, hyper-PTH, gout, renal insufficiency, psoriatic arthritis, RA, arteriosclerosis, long-term cortisone therapy

Diagnosis

1. Clinical: high or low patella, dent, functional test: Failure of the extensor function of the knee joint, even against gravity. If the retinaculi are not torn, the active extension deficit is often only approx. 10°, meaning that the knee joint can be extended to 10° before extension with moderate force.
2. Sono; X-ray to rule out avulsions and fractures

Symptoms

1. Sudden pain, tearing sensation
2. More or less complete functional failure of the extensor apparatus
3. Tear of the patellar ligament: patella alta (high patella). Tear of the quadriceps tendon: patella baja (low patella)
4. palpable dent (in the case of old tears, possibly filled with scar tissue)
5. Tumor, hematoma
6. with old cracks: Giving way phenomenon, perceived lack of strength

Complications

1. Intra-articular adhesions due to untimely treatment

Therapy

1. Puncture
2. OP
3. If possible: early functional follow-up treatment, otherwise cast or orthosis in extended position for 4-6 weeks
4. In the case of chronic damage to the tendon, for example due to long-term cortisone therapy or metabolic diseases: Reconstruction with tendon or fascia plasty or wire.
5. In the case of a child’s tear of the tibial tuberosity without avulsion: simple tendon suture so as not to impede the growth of the tibial tuberosity.

Asana practice

Similar to the patella fracture, the atrophy that has occurred as a result of rest must also be treated here. The indicated postures are therefore the same. In contrast to the patella fracture, however, in cases in which the patellar tendon rupture was not preceded by adequate trauma, degeneration of the tendon must be assumed, so that significantly more sustained strengthening of the tendon is required. Again, the strengthening of the tendon would take priority over the stretching of its muscle, the quadriceps, unless it was determined that the tension of the quadriceps was so increased that it must be considered a predisposition or cofactor of the tear.

Asanas

Strengthening

Asanas in 812: Strengthening the quadriceps
Asanas in 742: Strengthening the abductors
Asanas in 752: Strengthening the abductors
Asanas in 722: Strengthening the hamstrings
Asanas in 852: Strengthening the plantar flexors
Asanas in 862: Strengthening the supinators of the ankle
Asanas in 872: Strengthening the pronators of the ankle
Asanas in 737: Strengthening the exorotators of the hip joint
Asanas in 732: Strengthening the endorotators of the hip joint

Stretching

Asanas in 811: Stretching the quadriceps
Asanas in 741: Stretching the abductors
Asanas in 751: Stretching the abductors
Asanas in 721: Stretching the hamstrings
Asanas in 851: Stretching the plantar flexors
Asanas in 861: Stretching the supinators of the ankle
Asanas in 871: Stretching the pronators of the ankle
Asanas in 736: Stretching the exorotators of the hip joint
Asanas in 731: Stretching the endorotators of the hip joint