Bilateral quadriceps tendon rupture as the presenting manifestation of chronic kidney disease

Abstract

Bilateral painful knees with loss of extension in a patient with chronic kidney disease (CKD) may be due to spontaneous quadriceps tendon rupture. This rare complication is usually seen in patients on long term dialysis. We present a case of bilateral spontaneous quadriceps tendon rupture demonstrated by magnetic resonance imaging in a 20-year-old woman who on evaluation was found to have CKD.

Neglected bilateral rupture of the patellar tendon: A case report

“…4 more specifically In CKD patients on long term hemodialysis; hyperparathyroidism (by causing dystrophic calcification-weakening tendon and subperiosteal bone resorption-wekening osteotendinous junction), acidosis (disrupting structure of proteinpolysaccharide complex which is responsible for collagen maturation) and beta 2 amyloid deposition may be responsible for tendinopathy and rupture may occur with little force. 2,5 Treatment of underlying hyperparathyroidism (calcium and vitamin D analogs-will address metabolic bone disease as well; sometimes a total parathyroidectomy with autotransplantation of a parathyroid gland to avoid hypoparathyroidism) may prevent tendon ruptures. 5 The scarcity of bilateral ruptures as well as the symmetry of signs found on clinical examination may obscure the diagnosis.…”

“…2,5 Treatment of underlying hyperparathyroidism (calcium and vitamin D analogs-will address metabolic bone disease as well; sometimes a total parathyroidectomy with autotransplantation of a parathyroid gland to avoid hypoparathyroidism) may prevent tendon ruptures. 5 The scarcity of bilateral ruptures as well as the symmetry of signs found on clinical examination may obscure the diagnosis. 6 Functional impairment of knees with defective active extension direct the diagnosis which will be confirmed by a profile X-ray of the knees showing patella alta.…”

Quadriceps tendon rupture - treatment results

“…Since a quadriceps tendon rupture is a very rare injury, only solitary case reports [15][16][17] or small case series from 5 to 42 patients [18][19][20][21][22][23] can be found in literature. Our study sample, which included 29 patients operated in a ten-year-period in three clinical centers, may be considered a larger series.…”

Functional Results Following Surgical Repair of Simultaneous Bilateral Quadriceps Tendon Ruptures

“…5,6 Most of the studies describing these injuries are individual case reports. [7][8][9][10][11][12][13][14][15][16][17][18][19][20] Although not nearly as common, there have been recent case reports describing bilateral quadriceps ruptures in healthy individuals without any predisposing risk factors. [21][22][23][24][25][26] Regardless of medical history, nearly all cases (especially in recent literature) involved patients who underwent surgical repair.…”