Chronic Quadriceps Tendon Rupture-Surgical Treatment and Outcomes: A Systematic Review

Quadriceps tendon ruptures (QTR) lead to significant lower extremity weakness, gait abnormalities, and disability. Outcomes following surgical management of chronic QTR remain largely unknown. This study aimed to systematically review the management of chronic QTR to better understand the incidence, indications for repair versus reconstruction, complications, and outcomes. Studies published in PubMed, EMBASE, and the Cochrane Library reporting on patients with chronic QTR were identified. Inclusion criteria consisted of patients with chronic QTR (injuries ≥6 weeks) undergoing operative management, with reported injury mechanism, tear characteristics, surgical repair versus reconstruction, graft type (if used), postoperative complications, and outcomes. A total of 26 studies, consisting of 44 patients undergoing repair or reconstruction for chronic QTR, were identified. The mean patient age was 48.5 (range, 15-80) years, with 83% (n = 33/40) of patients being male. The mean interval between injury and surgery was 17.2 months (range, 6 weeks-303 months). Falls were the most frequently reported injury mechanism (59%, n = 16/27). Patient-related factors-primarily patient delay in seeking treatment-accounted for delayed management in 55% (n = 11/20) of patients. Tendon reconstruction using graft augmentation was performed in 46% (n = 20/44), most frequently with hamstring autograft (40%; n = 8/20). Quadriceps atrophy (n = 3) and superficial wound infection (n = 3) were the most commonly reported adverse outcomes, while no subsequent re-ruptures, revisions, or additional surgeries were reported. Postoperative active range of motion (ROM) was comparable in patients undergoing repair versus reconstruction (mean ROM = 0.0-124.4 degrees vs. 4.3-120.5 degrees, respectively). Chronic QTR was identified in 44 patients undergoing operative management, an average of 17.2 months following injury. The majority of patients were males, with a mean age of 48.5 years. Falls comprised the majority of injuries, while patient deferral in seeking treatment represented the most common reason for delay. Reconstruction was performed in 46% of cases, most commonly utilizing hamstring autograft. ROM was comparable irrespective of surgical management. Quadriceps atrophy and wound infection were the most commonly reported adverse outcomes, with no reported re-ruptures or revision procedures.