A most interesting case came across my desk the other day. A retired, yet active gentleman with a complete rupture of the rectus femoris. Now this isn't something one typically finds on an average day, so I directed my attention towards the research and what I might say to this fellow when he came in later.
I'm sure one of my first questions will simply be of curiosity as to how it all came about.
According to Wheeless' Textbook of Orthopedics I should expect to find "large hemarthrosis, freely mobile patella and an impressive loss of extensor function with intact knee flexion, inability to walk, palpable defect..." So, to say the least I expected he would be limping. To my surprise, he walked in just fine and described the problem as completely asymptomatic, save for the large bulge of retracted muscle that appeared with slight activation. MRI confirmed a complete rupture and a significant 17 cm retraction.
With a tear at the musculoskeletal junction it served to review literature on muscle and tendon rupture. The Journal of the American Academy of Orthopaedic Surgeons feature an article entitled, "Quadriceps Tendon Rupture" in which they note that an incomplete or partial tendon rupture could be treated conservatively, however a complete rupture required surgical repair. If neglected this injury could results in substantial disability.
BMJ case reports discussed delayed surgical treatment with good success rates, although full recovery would take 8-12 months. Perhaps this was not what he would want to hear, but at least I could offer a solution, be it a time consuming one.
On examination, I surmised, that there would surely be weakness, and decreased ROM, but again I was amazed and astonished that a month after the injury there was no appreciable difference in strength or ROM from one leg to the other.
With the patient asymptomatic and his remaining quadriceps muscles fully compensating for the lack of rectus femoris usability it was deemed unnecessary for him to undergo surgery at this time. Although, should he have chosen to have it repaired, we would gladly have facilitated such a process. With such a good prognosis he fairly ran out of the clinic back into his active lifestyle. I hope I don't see him again with future complications. With such a prominent muscle out of the game, I likely would have tended towards repair myself.
Resources:
http://olc.metrohealth.org/SubSpecialties/Trauma/Media/JAAOS/11.3.pdf
http://www.wheelessonline.com/ortho/rupture_of_the_quadriceps
http://casereports.bmj.com/content/2012/bcr.06.2011.4359.full
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