Simultaneous bilateral quadriceps tendon rupture in a patient with hyperparathyroidism undergoing long-term haemodialysis: A case report and literature review

Abstract

Simultaneous bilateral quadriceps tendon rupture is a rare injury that represents < 5% of all quadriceps tendon ruptures. It is generally associated with chronic metabolic disorders and is seen in patients with uraemia undergoing maintenance haemodialysis. The present case was a 46-yearold man who presented with pain and the inability to extend his knees following a minor accident. A physical examination combined with X-radiography and magnetic resonance imaging investigations resulted in a diagnosis of bilateral quadriceps tendon rupture. He had a history of uraemia and had received regular haemodialysis for 7 years. He had high levels of serum parathyroid hormone and he was diagnosed with secondary hyperparathyroidism. Following surgical repair of both quadriceps tendons, in addition to management of the secondary hyperparathyroidism, the patient regained full active mobility of both knee joints and was able to participate in normal activities of daily living.

Quadriceps tendon rupture in maintenance haemodialysis patients: Results of surgical treatment and analysis of risk factors

“…In addition, bone erosion at the site of tendon insertion may be a specific sign of tendon disease associated with severe secondary hyperparathyroidism in ESRD patients. Although the exact mechanism of injury remains unknown, most investigators agree that in chronic kidney disease secondary hyperparathyroidism plays a major role in the pathogenesis of tendon rupture [4,[26][27][28]. In our study we observed that cases had severe secondary hyperparathyroidism, expressed by significantly higher levels of iPTH and alkaline phosphatase, when compared to controls.…”

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.…”

Isolated spontaneous pectoralis minor tendon rupture in a patient with chronic renal failure

“…Axial, sagittal and coronal T1-weighted MRIs of the shoulder are usually recommended to confirm the diagnosis. Axial T2-weighted MRIs might help to reveal the pathology secondary to surrounding edema around the medial corocoid that extends into the muscle belly (12). In the current case, MRI was used to confirm the pectoralis minor tendon rupture.…”

“…Possible factors associated with tendon rupture in patients with chronic renal failure are uremic toxins, secondary amyloidosis, chronic metabolic acidosis, secondary hyperparathy roidism and hemodialysis (2,(12)(13)(14).…”