Tendon Injuries of Lower

Extremities
By Muskan Muhemmed
Achilles Tendon
Injury
Clinical presentation

• Popping or snapping
sound/sensation when the injury
occurs
• Sudden, severe pain in the
Achilles tendon
• Loss of plantar flexion power on
the affected side
• Deformity: calf swelling and/or
palpable interruption

https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.cosm.net.au%2Forthopaedic-surgery%2Fachilles-tendon-rupture
%2F&psig=AOvVaw0hry2fzClDkFEdz3tnrW-
a&ust=1669938648679000&source=images&cd=vfe&ved=0CBAQjRxqFwoTCMiR8KqN1_sCFQAAAAAdAAAAABAD
Diagnostics

• Ultrasound (best initial test)

• X-ray to rule out suspected bone
fractures (if ultrasound is not
available)
• MRI for confirmatory testing to
distinguish between a partial and
complete rupture

https://www.google.com/url?sa=i&url=https%3A%2F%2Fradsource.us%2Fachilles-tendon-rupture
%2F&psig=AOvVaw3O8U1zoBPSy2io2Cyu33SV&ust=1669938802320000&source=images&cd=vfe&ved=0CBAQjRxqFwoTCJCFqfuM1_sCFQAAAAAdAAAAABAE
Treatment
Conservative therapy
1. Rest, analgesia, serial casting
2. Rehabilitation
Surgical therapy
1. Open or percutaneous tendon repair
2. Casting
3. Rehabilitation
https://www.ndorms.ox.ac.uk/images/news/achilles-rupture/responsive_image?ratio=r16x9&scale=w1140
Quadriceps
Tendon Injury
Clinical features

• Pain and swelling of the knee

joint
• A palpable gap in the quadriceps
tendon
• Inability to extend the knee

https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle
%2Fpii%2FS0968016015000721&psig=AOvVaw0tIu8mtAFHajVdgvPDkq-
q&ust=1669939583666000&source=images&cd=vfe&ved=0CBAQjRxqFwoTCNiw7--
P1_sCFQAAAAAdAAAAABAJ
Diagnostics

• X-ray (AP and lateral view): lack

of quadriceps shadow, presence
of suprapatellar mass
• Ultrasound: hypoechogenic
section can be seen across the
tendon
• MRI: will show tear across all
three layers of the tendon https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.globalradiologycme.com%2Fsingle-
post%2F2017%2F03%2F27%2Fruptured-quadriceps-
tendon&psig=AOvVaw3sT3LJ8tVacjg6J4ofWPAG&ust=1669939887925000&source=images&cd=vfe&
ved=0CBAQjRxqFwoTCPCZuICR1_sCFQAAAAAdAAAAABAl
Treatment

• Surgical repair (suturing) of the

quadriceps tendon
• Incision in front of knee  strong
sutures into tendon, tying it back
down to patella
• After 6 weeks, strengthening
begins  injury heals after 10-12
weeks
https://orthoinfo.aaos.org/globalassets/figures/a00294f06.jpg
• Knee immobilizer after surgery to
keep knee straight for 6 weeks
(Physical therapy needed)
Patellar Tendon
Injury
Clinical features

• Pain and swelling of the knee

joint
• Palpable gap in the quadriceps
tendon
• Inability to extend the knee

https://www.google.com/imgres?imgurl=https%3A%2F%2Fwww.verywellhealth.com%2Fthmb%2FOXe903obSuk7d1AgMU8kmjAwEmM%3D
%2F1500x0%2Ffilters%3Ano_upscale()%3Amax_bytes(150000)%3Astrip_icc()%2Ftreatment-of-a-patellar-tendon-tear-25495911-
5c77359a46e0fb0001d83ca7.png&imgrefurl=https%3A%2F%2Fwww.verywellhealth.com%2Ftreatment-of-a-patellar-tendon-tear-
2549591&tbnid=GNFt9ztqsHH_PM&vet=12ahUKEwjE6_LilNf7AhXpl4sKHVQqDjwQMygIegUIARDuAQ..i&docid=VzNZpL2QKW-
baM&w=1500&h=1000&q=patellar%20tendonitis%20&ved=2ahUKEwjE6_LilNf7AhXpl4sKHVQqDjwQMygIegUIARDuAQ
Diagnostics

• X-ray (AP, lateral, axial): A high-

riding patella; calcification seen
in chronic causes
• Ultrasound: Hypoechogenic
section seen across the tendon
• MRI: Shows disrupted tendon
fibers with adjacent hemorrhage
or edema
https://www.caringmedical.com/wp-content/uploads/2020/04/patellar-bone-
spur.jpg
Treatment
• Partial tears: immobilization
• Complete tears: surgical end-to-end suturing of the patellar
tendon
- Two main types: partial or complete tears
• Complete and partial tears when unable to perform a straight
leg raise are always treated with surgery
• Incision on the front of the knee  strong sutures are placed
into the tendon and tied back down to the top of the patella.
• The patient is placed into a knee immobilizer keeping the knee
straight after surgery for 6 weeks, taking it off for physical
therapy.
• Full weight bearing after 1-2 weeks

https://upload.orthobullets.com/topic/3024/images/transoessous_tunnels..jpg
The End