DesCripTionA 45-year-old man with history of chronic renal failure had sudden onset of severe pain in both his knees following which he was unable to walk and had severe pain in both lower thighs and knee joints. On examination he was pale looking and asthenic. Local examination revealed swelling of bilateral knee joints with restricted extension of knee joints. On palpation small defect was noted in the suprapatellar region, indicating the discontinuity of quadriceps tendon. MRI of bilateral knee joints was done, revealing patella baja (low-lying patella), moderate-joint effusions and full-thickness defect in quadriceps tendons at site of patellar attachment (figures 1 and 2). The patient did not have any other tendon ruptures at the time of presentation to hospital. Due to poor renal function status, the patient was not fit for surgical repair and was immobilised with long leg cast in extension for 8 weeks followed by crutch walker support and advised for follow-up.Bilateral quadriceps tendon tear is a very rare clinical entity. In 1949 Steiner and Palmer first reported a case of quadriceps tendon tear in a patient with renal failure. Trivial trauma can rupture bilateral quadriceps in patients with chronic renal failure, systemic lupus erythematosus, gout, diabetes, secondary hyperparathyroidism, pseudogout, alkaptonuria, severe osteomalacia and in patients with systemic steroid treatment. The cause of tendon tear has not been well established and various causative factors have been proposed like diminished local circulation, disturbed collagen synthesis, repeated microtrauma and reduced tendon elasticity by calcification.