Adult Ortho Cases 005

Knee Extensor Mechanism Injuries

A review of Xray and ultrasound (POCUS) evaluation of integrity of quadriceps tendon, patella tendon, and patella evaluating for tendon rupture and patella fracture.

Carrie Bissell MD, Aaron Fox MD, Kendrick Lim DO, and Angela Pikus MD curate and presents a series of Adult Orthopedic X-Ray Cases each month. First published on EMGuideWire.com and peer reviewed by Professor Michael Gibbs and Laurence Kempton, MD

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Trauma Summary cards

Quadriceps Tendon Rupture

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Patella Tendon Rupture

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Patella Fracture

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References

• Rippey J. Ultrasound Case 039 Quadriceps tendon rupture. LITFL
• LaRocco BG, Zlupko G, Sierzenski P. Ultrasound diagnosis of quadriceps tendon rupture. J Emerg Med. 2008 Oct;35(3):293-5.
• Nesselroade RD, Nickels LC. Ultrasound diagnosis of bilateral quadriceps tendon rupture after statin use. West J Emerg Med. 2010 Sep;11(4):306-9.
• Meester S, Lee S. Spontaneous bilateral quadriceps tendon rupture. Am J Emerg Med. 2018 Jun;36(6):1123.e5-1123.e7.
• Berrigan W, Geer R, Jelnick JS, Davis JE, Bunning R. Visual Diagnosis: Quadriceps Tendon Rupture. J Emerg Med. 2018 Oct;55(4):563-564.
• Garner MR, Gausden E, Berkes MB, Nguyen JT, Lorich DG. Extensor Mechanism Injuries of the Knee: Demographic Characteristics and Comorbidities from a Review of 726 Patient Records. J Bone Joint Surg Am. 2015 Oct 7;97(19):1592-6.
• Pengas IP, Assiotis A, Khan W, Spalding T. Adult native knee extensor mechanism ruptures. Injury. 2016 Oct;47(10):2065-2070.
• Lyons JG, Mian HM, Via GG, Brueggeman DA, Krishnamurthy AB. Trends and epidemiology of knee extensor mechanism injuries presenting to United States emergency departments from 2001 to 2020. Phys Sportsmed. 2023 Apr;51(2):183-192.
• Bui CN, Learned JR, Scolaro JA. Treatment of Patellar Fractures and Injuries to the Extensor Mechanism of the Knee: A Critical Analysis Review. JBJS Rev. 2018 Oct;6(10):e1
• Verhulst FV, van Sambeeck JDP, Olthuis GS, van der Ree J, Koëter S. Patellar height measurements: Insall-Salvati ratio is most reliable method. Knee Surg Sports Traumatol Arthrosc. 2020 Mar;28(3):869-875.
• Hall BT, McArthur T. Ultrasound diagnosis of a patellar tendon rupture. Mil Med. 2010 Dec;175(12):1037-8
• Phillips K, Costantino TG. Diagnosis of patellar tendon rupture by emergency ultrasound. J Emerg Med. 2014 Aug;47(2):204-6.
• Ogle K, Mandoorah S, Fellin M, Shokoohi H, Probasco W, Boniface K. Point-of-care Ultrasound Diagnosis of Bilateral Patellar Tendon Rupture. Clin Pract Cases Emerg Med. 2020 Jan 24;4(1):29-31. 

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This ongoing radiology interpretation series is proudly sponsored by the Emergency Medicine Residency Program at Carolinas Medical Center. The goal is to promote widespread mastery of CXR interpretation. There is no personal health information [PHI] within, and ages have been changed to protect patient confidentiality.