Bilateral Spontaneous Quadriceps Tendon Rupture in a Patient With Renal Failure

Lombardi, Louis J.; Cleri, Dennis J.; Epstein, Edward

doi:10.3928/0147-7447-19950201-18

Cited by 33 publications

(12 citation statements)

References 22 publications

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“…Rupture of a healthy quadriceps tendon is rare 23 . Extensor mechanism injuries are more likely to occur in the presence of preexisting comorbidities, including rheumatoid arthritis, systemic lupus erythematosus (SLE), gout, chronic kidney disease, secondary hyperparathyroidism, diabetes mellitus, and peripheral vascular disease [3][4][5][6][7][8]24 .…”

Section: Etiologymentioning

confidence: 99%

“…Fatty infiltration and degeneration, collagen alterations, and vascular deficiencies have all been proposed as possible mechanisms for tendon weakening 1 . This apparent degeneration of the quadriceps tendon appears to be accelerated in the presence of underlying systemic illnesses [3][4][5][6][7][8][9] (Table I). As many as one-third of cases of bilateral rupture and one-fifth of cases of unilateral rupture have been attributed to underlying disease 1,25,26 .…”

Section: Risk Factorsmentioning

confidence: 99%

“…Q uadriceps tendon ruptures are uncommon and tend to occur in individuals who are $40 years of age 1,2 . The mechanism of injury is variable, and most cases are associated with preexisting medical conditions, such as gout, diabetes mellitus, or chronic kidney disease 1,[3][4][5][6][7][8] . Quadriceps tendon ruptures comprise a range of injuries, including partial rupture, complete unilateral rupture, complete bilateral rupture, and chronic rupture 1 .…”

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confidence: 99%

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Acute Quadriceps Tendon Rupture: Presentation, Diagnosis, and Management

et al. 2022

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The incidence of quadriceps tendon rupture is estimated to be 1.37 cases per 100,000 people/year, with a predilection for these injuries in patients who are ≥40 years of age.Quadriceps tendon ruptures are more likely to occur in the presence of preexisting comorbidities such as rheumatoid arthritis, systemic lupus erythematosus, gout, chronic kidney disease, secondary hyperparathyroidism, diabetes mellitus, and peripheral vascular disease. The most common mechanism of injury is a simple fall.Magnetic resonance imaging is the gold-standard test for diagnosing quadriceps tendon ruptures, with a reported sensitivity, specificity, and positive predictive value of 1.0.Complete tears require prompt surgical intervention; the most common technique is transosseous sutures passed through longitudinal patellar drill holes. Suture anchors have been proposed as an alternative method; they have shown superior biomechanical results in cadaveric models.Early functional mobilization with full weight-bearing and progressive range-of-motion exercises is recommended for rehabilitation following injury.

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Section: Etiologymentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

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confidence: 99%

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Acute Quadriceps Tendon Rupture: Presentation, Diagnosis, and Management

et al. 2022

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“…Patients who suffer from systemic illnesses are more prone to spontaneous rupture of their tendons, which results from the lower resistance of the tendons to contractions of the muscles. There have been several reports of spontaneous ruptures associated with a variety of diseases, including kidney diseases ( 4 - 6 ) .…”

Section: Introductionmentioning

confidence: 99%

Morphometric magnetic resonance imaging study of the quadriceps tendon in hemodialysis patients: comparison with non-dialyzed controls

et al. 2022

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Objective: To evaluate the knees of individuals with renal failure who are on hemodialysis, using magnetic resonance imaging (MRI), comparing them with those of a group of individuals with normal renal function. Materials and Methods: This was a cross-sectional, observational, controlled study conducted between August 2018 and February 2020. The cases consisted of 15 patients who had been on hemodialysis for ≥ 5 years and did not have a quadriceps tendon rupture. The controls consisted of 15 individuals with normal renal function who were matched (1:1) to the cases for sex, age, and physical activity level. The subjects in both groups underwent MRI of the right knee only. Results: The mean ages of the cases and controls were 50 ± 15 years and 49 ± 14 years, respectively. The median time on hemodialysis was 11 years (range, 10-14 years). Serum levels of parathyroid hormone, ferritin, alkaline phosphatase, phosphorus, and creatinine were higher among the cases than among the controls, whereas serum albumin and hemoglobin were lower (p < 0.05 for all). The MRI study showed a hyperintense signal in the quadriceps tendon in 11 of the cases and in three of the controls (p = 0.009). Knee joint effusion was observed in nine of the cases and in three of the controls (p < 0.05). The thickness, length, and width of the tendon did not differ between the groups. A hyperintense signal in the tendon was not associated with the time on hemodialysis; nor with the levels of intact parathyroid hormone, hemoglobin, or alkaline phosphatase. Conclusion: Patients on chronic hemodialysis, even those without a tendon rupture, show a hyperintense signal in the quadriceps tendon on MRI.

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“…9,10 Multiple studies have evaluated the mechanism of injury, diagnosis, epidemiology, and treatment methods of extensor tendon ruptures of the knee. [1][2][3][4][5]7,8,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Despite being two distinct injuries with different mechanisms, etiologies and patient populations, there is a tendency among orthopaedic surgeons to treat PT and QT ruptures as a single form of injury in terms of surgical technique and postoperative rehabilitation protocol which may have implications on the clinical outcomes. Considering the fact that QT ruptures are seen in an older population with a higher comorbidity, it is anticipated that each step of the biological tendon healing process would occur at a slower pace which may necessitate a longer postoperative rehabilitation program.…”

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confidence: 99%

Do Patellar Tendon Repairs Have Better Outcomes than Quadriceps Tendon Repairs? A Prospective Cohort Analysis

et al. 2022

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Patellar tendon (PT) and quadriceps tendon (QT) ruptures represent significant injuries and warrant surgical intervention in most patients. Outcome data are predominantly retrospective analyses with low sample sizes. There are also minimal data comparing QT and PT repairs and the variables impacting patient outcomes. The level of evidence of the study is level II (prognosis). From the prospective OME cohort, 189 PT or QT repairs were performed between February 2015 and October 2019. Of these, 178 were successfully enrolled (94.2%) with 1-year follow-up on 141 (79.2%). Baseline demographic data included age, sex, race, BMI, years of education, smoking status, and baseline VR-12 MCS score. Surgical and follow-up data included surgeon volume, fixation technique, baseline, and 1-year Knee Injury and Osteoarthritis Outcome Score-Pain (KOOS-Pain), Knee Injury and Osteoarthritis Outcome Score—Physical Function (KOOS-PS), and 1-year Patient Acceptable Symptom State (PASS) scores and complications. Multivariable regression analysis was utilized to identify prognosis and significant risk factors for outcomes—specifically, whether KOOS-Pain or KOOS-PS were different between QT versus PT repairs. There were 59 patients in the PT cohort and 82 patients in QT cohort. Baseline demographic data demonstrated that PT cohort was younger (45.1 vs. 59.5 years, p <0.001), included significantly fewer patients of White race (51.7 vs. 80.0%, p = 0.001), lesser number of years of education (13.9 vs. 15.2 years, p = 0.020), a higher percentage of “high” surgeon volume (72.9% vs. 43.9%, p = 0.001) and 25.4% of PT repairs had supplemental fixation (QT had zero, p <0.001). Multivariable analysis identified gender (female-worse, p = 0.001), years of education (higher-better, p = 0.02), and baseline KOOS-Pain score (higher-better, p <0.001) as the risk factors that significantly predicted KOOS-Pain score. The risk factors that significantly predicted KOOS-PS were gender (female worse, p = 0.033), race (non-White-worse, p <0.001), baseline VR-12 MCS score (higher-better, p <0.001), and baseline KOOS-PS score (higher better, p = 0.029). KOOS-Pain and KOOS-PS scores improved after both QT and PT repairs. Patient reported pain and function at 1 year were similar between PT and QT repairs after adjusting for known risk factors. Multivariable analysis identified female gender and low baseline KOOS scores as predictors for worse outcomes.

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Bilateral Spontaneous Quadriceps Tendon Rupture in a Patient With Renal Failure

Cited by 33 publications

References 22 publications

Acute Quadriceps Tendon Rupture: Presentation, Diagnosis, and Management

Acute Quadriceps Tendon Rupture: Presentation, Diagnosis, and Management

Morphometric magnetic resonance imaging study of the quadriceps tendon in hemodialysis patients: comparison with non-dialyzed controls

Do Patellar Tendon Repairs Have Better Outcomes than Quadriceps Tendon Repairs? A Prospective Cohort Analysis

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