Presentation
Pain over the distal thigh region with difficulty walking. History of trauma with a direct blow over the anterior aspect of the distal thigh one month ago.
Patient Data
There is increased opacity in the region of the quadriceps tendon, which is suspicious of its tear.
There is linear radio-dense opacity in the same region, indicating some chronic changes leading to calcification.
No obvious fracture is noted.
The patellar attachment of the quadriceps tendon is ill-defined and discontinuous, suggesting a tear. There is fluid signal density in the supra-patellar region, indicating oedema.
There is a linear, hyperdense structure of calcific density in the region of the quadriceps tendon, suggesting some old process leading to calcification.
There is complete disruption of deep layer fibres and near complete disruption of superficial and middle layer fibres of the quadriceps tendon, with some of the fibres of the superficial and middle layer showing attachment to the patella. The quadriceps tendon is retracted backward and slightly upward. T1/T2 proton density fat-saturated (PDFS) high-signal intensity fluids are noted in between. Marked oedematous changes in the vastus medialis, vastus lateralis, vastus intermedius, rectus femoris, and sartorius muscles. Multiple blooming artifacts on GRE in Hoffa's fat pad and suprapatellar bursa are suggestive of haematoma.
There is mild knee joint effusion.
There is a discontinuity in the attachment of the quadriceps tendon into the upper pole of patella, suggesting its tear.
There is a hypoechoic collection that shows no vascularity on the colour Doppler study in the region between the distal edge of the quadriceps tendon and the upper pole of the patella, suggesting oedema.
The quadriceps tendon on the opposite side appears normal.
Case Discussion
This is a case of the near-complete tear of the quadriceps tendon.
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