Tendon ruptures (Achilles, patellar, quadriceps)

Understanding this condition

A tendon rupture is the sudden tear of a tendon, most often on a background of pre-existing chronic tendinopathy (degenerative tendon). Three main locations in the lower limb:

— The Achilles tendon (most frequent), in patients aged 40 to 60, during a sporting start-up (squash, tennis, running). — The patellar tendon (below the kneecap), less common. — The quadriceps tendon (above the kneecap), mainly in older patients.

Symptoms

An immediate sensation of a "whiplash" or snapping at the back of the leg (Achilles) or at the front of the knee (patellar/quadriceps). Acute pain. Inability to raise onto the tiptoes (Achilles) or straighten the knee (patellar/quadriceps).

A gap may be felt along the tendon. The clinical diagnosis is often obvious.

How can it progress?

An untreated tendon rupture leaves a permanent loss of function: inability to rise onto the tiptoes, run, or jump (Achilles), or to extend the leg against resistance (patellar/quadriceps). The prognosis depends on the promptness of management.

Treatment options

Treatment can be surgical or non-surgical depending on the type of rupture, age, activity level, and time elapsed. For the Achilles tendon, non-surgical treatment (equinus walking boot) is possible in certain forms; surgery (suture) is preferred in athletes. For patellar and quadriceps ruptures, surgery is almost always indicated.

A prompt consultation after the injury allows the appropriate decision. Recovery always includes an immobilisation phase followed by prolonged rehabilitation.