Shawn D. Felton, EdD, LAT, ATC; Arie J. van Duijn, PT, MScPT, EdD
Florida Gulf Coast University, Fort Myers, FL 33965-6565, USA
The patient was a 69-year-old recreational golfer who injured his right . While walking between the 9th and 18th holes, he slipped on pine straw. Ultrasound images of the quadriceps tendon post-injury revealed a full-thickness tear of the Quadriceps tendon, Rectus Femoris and Vastus intermedius. The diagnosis was confirmed through MRI arthrogram imaging. The hypoechoic finding in the ultrasound exam demonstrated the imaging to be as precise in diagnosing a full thickness tear as the MRI. The patient underwent surgical repair of the Quadriceps Tendon and is currently progressing in rehabilitation.
The patient was a 69-year-old recreational golfer who injured his right knee by slipping on pine straw, forcefully flexing his right knee under full weight-bearing. He indicated immediate sharp anterior knee pain and the inability to move his right leg. Upon examination, he presented with a palpable deformity proximal to the apex of the patella and moderate swelling at the lateral knee. The patient was unable to produce a quadriceps contraction and Passive Range of Motion (PROM) was limited due to pain. At time of injury, the patient had been prescribed three rounds of steroidal anti-inflammatory drugs for sinus infections, and had a prior history of a 3rd degree quadriceps tear of his contralateral knee 12 years prior. Based upon these clinical findings, ultrasound imaging was performed at point-of-care showing full thickness mid-tendon tear of the rectus femoris (see Figures 1 & 2).The patient was referred to an orthopedic surgeon, who performed MRI imaging (see Figure 3), confirming an avulsion of the superficial aspect of the rectus femoris from its patellar attachment and retracted proximally 1.9 cm and a complete tear. Subsequently, the patient underwent immediate open repair of the quadriceps tendon and began rehabilitation after 6 weeks.
This case illustrates the effectiveness of point of care ultrasound imaging identifying rectus femoris tendon tear. Prior researchhas indicated a high degree of clinical accuracy of ultrasound imaging for identifying partial and full thickness quadriceps tendon tears, comparable to MRI [1,2]. It is imperative for the clinician to ensure both short and long axis images to properly evaluate the extent of tissue damage.
Statement of Ethics
This study was approved by the Institutional Review Board of Florida Gulf Coast University
The authors affirm they have no financial affiliation (including research funding) or involvement with any commercial organization that has a direct financial interest in any matter included in this manuscript, except as disclosed in an attachment and cited in the manuscript.
1. Pasta G, Nanni G, Molini L, Bianchi S.. Sonography of the quadriceps muscle: Examination technique, normal anatomy, and traumatic lesions. J Ultrasound. 2010;13(2):76-84.
2. Foley R, Fessell D, Yablon C, et.al.. Sonography of traumatic quadriceps tendon tears with surgical correlation. J Ultrasound Med. 2015 34(5):805-10.