Merck Manual

Please confirm that you are a health care professional

honeypot link

Knee Extensor Mechanism Injuries

(Quadriceps Tendon Tear; Patellar Tendon Tear)

By

Danielle Campagne

, MD, University of California, San Francisco

Last full review/revision Mar 2021| Content last modified Mar 2021
Click here for Patient Education
Topic Resources

Knee extensor mechanism injuries can involve the quadriceps tendon, patellar tendon, patella, or tibial tubercle. Surgical repair is usually required.

Extension of the knee involves the quadriceps muscles, which are attached to the patella by the quadriceps tendon; the patella is connected to the tibial tubercle by the patellar tendon. Forced flexion at the knee with a contracted quadriceps muscle can damage these structures. Injuries include

  • Quadriceps tendon tears

  • Patellar tendon tears

  • Patellar fractures

  • Tibial tubercle fractures

In healthy people, significant force is required to injure these structures; normal tendons are strong enough that the patella often fractures transversely before a tendon tears. However, people with certain conditions are at risk of tendon tears. These conditions include

In these at-risk people, the injury can result from minor trauma (eg, when descending stairs). The quadriceps tendon is injured more often than the patellar tendon, particularly in older people.

Symptoms and Signs of Knee Extensor Mechanism Injuries

The affected area is painful and swollen.

Patients with complete tendon tears cannot stand, do a straight leg raise while lying on their back, or extend their knee while seated.

Long-term complications (eg, loss of motion, weakness) are common.

Diagnosis of Knee Extensor Mechanism Injuries

  • Clinical evaluation

  • X-rays

  • MRI

Examination of the knee can suggest which structure is injured:

  • Quadriceps tendon tear: The patella is palpably displaced inferiorly (patella baja).

  • Patella tendon tear: The patella is displaced superiorly (patella alta).

  • Transverse patellar fracture: There is often a palpable gap between the two bone fragments.

However, swelling in the area can be significant and mask these findings so that the injury may be misinterpreted as a ligamentous knee joint injury with hemarthrosis. If patients have knee swelling and pain after an injury, clinicians ask patients to sit and try to extend their injured leg to test active knee extension or to lie on their back and raise the injured leg, keeping the leg straight.

Pearls & Pitfalls

  • Always test active knee extension if patients have knee swelling and pain after an injury.

Routine knee x-rays are taken. Patella alta and patella baja can be seen on knee x-rays. X-rays often show displacement or fracture of the patella but may appear normal. MRI confirms the diagnosis.

Treatment of Knee Extensor Mechanism Injuries

  • Surgical repair

Treatment of knee extensor mechanism injuries is surgical repair.

Click here for Patient Education
NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
Professionals also read
Test your knowledge
Snakebites
More than 60,000 bites and stings are reported to poison centers in the US each year, about 45,000 of which are snakebites (of which 7,000 to 8,000 are venomous and cause about 5 deaths). Which of the following types of snakes accounts for the majority of these bites and almost all deaths? 
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID

Also of Interest

Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
TOP