Bilateral patellar tendon rupture on lupus undergoing corticosteroids: a case report

Abstract

Background: Patellar tendon rupture is a rare condition, especially when it is bilateral. The most frequent associated pathologies are systemic lupus erythematosus, chronic renal failure, or treatments like corticosteroids. The aim of this case report is to draw attention to the non-specific clinical aspect of this condition, to recall its radiological signs, and highlight the diagnostic contribution of musculoskeletal ultrasound. Case presentation: A 39-year-old man was diagnosed with a systemic lupus erythematosus with cutaneous, pulmonary, cardiac, hematological, renal, and immunological manifestations. He was treated with high-dose corticosteroids. Within 3 months he presented with a total functional impotence of the knees. On physical examination, there was a gap in the right infrapatellar region, his patellae were abnormally ascended, and his left knee was swollen. Insall-Salvati ratio on knees conventional radiographies was 2.5 in the right and 2.25 in the left knee, assessing bilateral patella alta. Ultrasound revealed a complete and bilateral patellar tendon rupture. The treatment consisted in a surgical repair and physiotherapy. The patient was able to mobilize independently after 6 months. Conclusions: Bilateral patellar tendon rupture is exceptional. Systemic lupus erythematosus and corticosteroids are among trigger factors. Careful examination of the patellae should be done in front of knee extension deficit. Ultrasound plays a determining role in the diagnosis.

Simultaneous Bilateral Patellar Tendon Rupture in a Young Adult Male: A Case Report and Review of the Literature

“…Early tendon repair can prevent proximal patella tendon retraction, scarring, and diminished long-term function [ 16 ]. Primary tendon repair is commonly performed via suture repair on a healthy tendon with some authors advocating the use of wire cerclage on degraded tendons [ 14 , 17 ]. Postoperative rehabilitation and therapy is generally recommended, but there is no current consensus or standard therapy regimes [ 7 ].…”

Simultaneous Bilateral Patellar Tendon Rupture: A Systematic Review

“…One patient had both MRI and ultrasonography as secondary investigations. Only eight cases [2,24,[36][37][38][39][40][41] reported the Insall-Salvati ratio found during imaging. Of those presented, we found a mean Insall-Salvati ratio of 1.62 for the right patella and 1.60 for the left patella, which confirmed that patella alta is a high-yield finding in the diagnosis of patellar tendon rupture.…”

“…The big majority of the cases reported were treated with direct primary repair (40 patients), and over half of these cases required augmentation of some type, i.e., tendons, cerclage wires or tension band wiring [1][2][3]11,12,24,28,37,39,40,41,[46][47][48][49][50][51][52][53][54]. The most commonly used method for augmentation was using cerclage wires (12).…”

Imaging of Joint and Soft Tissue Involvement in Systemic Lupus Erythematosus

“…Tendon rupture is a severe, albeit rare, manifestation of SLE. In a recently published case report, El Ouazi et al showed the value of US and MRI in the diagnosis of bilateral patellar tendon rupture in a patient with SLE [ 50 ]. Hosokawa et al highlighted the case and the imaging findings of a SLE patient with spontaneous rupture of the flexor tendon of the little finger [ 51 ].…”