This is Barry Bellosis, one of the musculoskeletal radiology fellows at Stanford University. 51 year old male with pain above his right knee and decreased ability to extend his right leg. Concerned for quadriceps tendon rupture. The patient in this case presented with this axial t2 fat set imaging, demonstrating this hypo intense or black structures, and then also here demonstrating that retracted quadriceps tendon. The surrounding bright fluid about this tendon represents hematoma. Here on our sagittal t2 fat set imaging we can see that there is complete discontinuation of the proximal tendon right here to its patellar attachment, consistent with complete rupture of the quadriceps tendon. Here is a quick review over normal anatomy of the quadriceps tendon. As the name implies, it is composed of four muscles. We have the rectus femoris, which forms the superficial lamina. We have the vastus lateralis and medialis, which forms the middle lamina, and the vastus intermedius, which forms the deep lamina. The tear could involve one of the layers or three layers depending on severity, although rectus femoris muscle or tendon is the most commonly involved. Here we can just see that these muscles as we can see here is a rectus femoris and our vastus medialis. Here is our vastus lateralis and the vastus intermedius. All this converge to forms this quadriceps tendon right here. This is on a different patient with quadriceps rupture. On the top imaging we have a sequential axial t2 fat set imaging. In here we can see this partially retracted quadriceps tendon, this hypo intense or black linear bends. And when we go all the way down to the patella, here we can see some few remaining fibers that's attaching to the patella. On the sagittal t2 fat set imaging we can see that the superficial part here of the quadriceps tendon is retracted with some few remaining fibrous deep to the tendon or the deep lamina, as you can see both here and also here. This is consistent with high grade partial tear. When we are worried about quadriceps tendon, we need to evaluate both in the axial and the sagittal imaging.

2nd Edition, CASE 54

2nd Edition

Thigh

quadriceps tendon rupture

MRI imaging

rectus femoris

knee pain

tendon tear evaluation