BACKGROUNDPatellar tendon and anterior cruciate ligament (ACL) tear is an uncommon injury. Moreover, the mechanism of injury and the best surgical approach have not been established yet. We believe that case reports like ours contribute to a better understanding of the mechanism of injury and help the surgeon to decide whether to proceed in one-or twostage procedure. CASE PRESENTATIONA 47-year-old professional driver presented in the outpatient clinic of our department after sustaining an injury in his left knee. He was manually unloading a heavy package from his truck and while descending to the ground he felt a double 'pop' in his left knee and fell down. Physical examination revealed diffuse knee swelling. The knee was extremely tender, even in slight palpation, especially anteriorly and medially. A palpable defect of the patella tendon was detected, and active knee extension was impossible. Valgus stress demonstrated medial collateral ligament (MCL) disruption while Lachman-Noulis and pivot-shift test could not be performed because of the intense pain. The anteroposterior and lateral radiographs showed superior displacement of the patella without any other osseous pathology. Consequently, the patient was admitted in our department, under the diagnosis of patellar tendon and MCL tear.

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Spontaneous, bilateral, quadriceps tendon rupture is a rare injury. Many predisposing conditions have been reported that contribute to quadriceps tendon degeneration. We report a case of a 42-year-old farmer with spontaneous, bilateral, quadriceps tendon rupture and clear medical history. Clinical and laboratory investigations revealed no risk factors for tendon degeneration but the patient reported that he was exposed locally to methidathion 1 week before the rupture. Methidathion is an organophosphate insecticide commonly used in agriculture that is highly toxic via the dermal route. Methidathion induces lipid pre-oxidation and consequently alters quadriceps tendon blood supply and ultrastructure. The injury was treated with early surgical repair and final outcome was excellent 44 months postoperatively.

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1-5 Ankle sprain is often accompanied by chondral or osteochondral injuries that may result in persisted pain and disability. 6,7 This is the first case of pure ankle dislocation in the literature, with documented talus bone contusion. This finding is crucial for proper treatment planning in order to avoid complications like tibiotalar degenerative arthritis and talar avascular necrosis. Case ReportA 21 year-old volleyball player injured his left ankle during a second league game. The injury occurred after jumping up at the net and landing on the floor with a fully plantarflexed foot that was inverted during landing. (Fig.1 Physical examination in the emergency room showed a deformed ankle without neurovascular deficit of the foot. Radiographs of the ankle demonstrated ankle dislocation without concomitant syndesmotic injury or malleolar fracture.The ankle was reduced under general anaesthesia. After close reduction, a short leg cast was used for ankle immobilization. (Fig. 2) The patient was then further investigated with magnetic resonance imaging (MRI) to fully explore the structures that were injured. MRI demonstrated rupture of the anterior capsule and anterior talo-fibular ligament and talus bone contusion. (Fig. 3) The cast was kept on for two months. After the cast removal, the patient was referred to the physiotherapist and range of motion exercises were initiated along with partial weightbearing. Three months post-injury, full weight-bearing was permitted.The patient returned to the pre-injury level of activity at six months post-injury. At physical examination there were no signs of residual ligamentous laxity and no ankle effusion and tenderness.