Quadriceps tendon ruptures: a narrative review.

Background and Objective: Quadriceps tendon ruptures can occur in both the native knee and in knees which have undergone prior total knee arthroplasty (TKA). Complete ruptures require surgical treatment to optimize patient function. Debate exists surrounding the ideal repair technique for native ruptures, and there is little consensus regarding the optimal surgical treatment option for post-TKA ruptures. The objective of this narrative review is to provide an overview of quadriceps tendon ruptures occurring in both native knees and in the setting of TKA, with a focus on contemporary treatment options and their results. Methods: A narrative review of the relevant literature was performed in November 2024. English language articles published up to November 2024 which related to quadriceps tendon ruptures, involving both the native knee and the post-TKA knee, were reviewed. All types of published articles were considered. Key Content and Findings: Quadriceps tendon ruptures almost always occur in patients with antecedent tendon pathology. Primary repair of acute native quadriceps ruptures is supported by a large body of literature, and most patients have reasonable outcomes. The clinical outcomes of transosseous and suture anchor repair techniques seem to be comparable in this setting. Quadriceps ruptures, which occur in the setting of TKA, are much more difficult to treat. In this setting, the complication rates of primary repair, repair with augmentation, and reconstruction are high. Even with improvements in the contemporary reconstructive options, including allograft and synthetic mesh, outcomes remain suboptimal. More work is needed to improve outcomes for patients with post-TKA quadriceps tendon ruptures. Conclusions: Generally reliable results can be achieved when treating native quadriceps tendon ruptures with contemporary techniques. Quadriceps ruptures, which occur in the setting of TKA, on the other hand, are much more challenging to treat. Various surgical techniques have been explored and developed in an effort to improve outcomes. While modest improvements have been realized, these injuries remain problematic, with very high complication and failure rates, regardless of technique.