Ryan Thomas Foley MD, Presenter: Nothing to Disclose

David Paul Fessell MD, Abstract Co-Author: Nothing to Disclose

Using surgical correlation as the reference standard, the purpose of this study was to define the sonographic accuracy of ultrasound for diagnosing high-grade partial quadriceps tendon tears and complete ruptures.

Two hundred thirty-nine consecutive sonographic reports of the knee (May 2001 to October 2008) with subsequent surgical correlation were retrospectively reviewed for quadriceps tendon repair. Patients were excluded if the interval between ultrasound and surgery was greater than twenty days. Twenty-four cases (comprising twenty-one patients) were identified with an average time between sonographic evaluation and surgery of six days. Surgical findings were compared with the findings in the sonographic reports. High-grade partial tears were defined as those with a tear of greater than 50% of the width of the quadriceps tendon. Complete ruptures were defined as complete tendon disruption (full-thickness and full-width).

Twenty-three of twenty-four high-grade partial tears or complete ruptures were correctly diagnosed on the basis of dynamic sonography (sensitivity = 96%) compared to surgical results. One high-grade partial tear not detected on sonography and noted at surgery had a large hematoma that likely complicated the ultrasound interpretation.

Clinical findings in cases of suspected quadriceps injury may be limited due to pain, limited range of motion, and hematoma. Sonography, particularly with the use of dynamic scanning, is an effective clinical tool to rapidly identify high-grade partial tears and complete ruptures. For optimal outcome, such cases usually undergo prompt surgical repair.

Sonography can be useful in the diagnosis of quadriceps tendon tear, particularly in the acute setting, where clinical findings may be obscured and delay can result in less optimal functional outcome.

Foley, R, Fessell, D, Sonographic Evaluation of Quadriceps Tendon Tears with Surgical Correlation.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12034588.html