Simultaneous Ipsilateral Quadriceps and Triceps Tendon Rupture in a Patient with End-Stage Renal Failure

Abstract

Introduction Quadriceps tendon ruptures (QTR) frequently occur in patients with end-stage renal failure, while triceps brachii tendon ruptures (TTR) are less common. This is the first properly documented report of a simultaneous ipsilateral traumatic rupture of both of these tendons. Case Report A 50-year-old patient, on hemodialysis for end-stage renal failure, fell on his right side. He presented with sudden right knee and elbow pain, with functional impairment of both joints. X-rays showed avulsion-like osseous lesions on the olecranon and patella with a low-riding patella. Ultrasound confirmed complete quadriceps and triceps avulsion ruptures. Both lesions were treated surgically. Fixation was performed with anchors using the Krackow suture technique for both tendons. Postoperative clinical and radiological results were satisfactory, and follow-up was uneventful. The patient regained his preinjury functional level with a complete range of motion of both his knee and elbow. Discussion Isolated QTR and TTR are frequent lesions in chronic renal failure patients treated with hemodialysis. Simultaneous ipsilateral rupture of both tendons however is extremely rare and should therefore not be overlooked. Surgical treatment is recommended for complete ruptures.

Uremic Toxins and Ciprofloxacin Affect Human Tenocytes In Vitro

“…Based on an increasing number of case reports, hemodialysis has been suggested to be a risk factor for tendon ruptures [ 32 , 33 , 35 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ]. However, published reports concerning the direct impact of uremic toxins and a possible additive effect with CPX on tendon-derived cells were not available.…”

Treatment of Quadriceps Tendon Rupture in Hemodialysis Patients: A 2020 Update

“…This step can be completed according to the surgeon’s preference, but the Krackow type of suture has been the most used procedure. 4 , 7 , 30 Longitudinal drill holes are made in the patella, allowing the suture ends to be passed distally and tied with the necessary tension to bring the stump closer to its insertion point. 13 To promote healing of the tendon-bone junction, old ruptures or that associated with tissue degeneration may require additional reinforcement as previously described for the direct repair technique.…”

“…Resistant non-absorbable suture wires attached to these devices are tied to the proximal stump of the tendon and tensioned, approaching it in a way similar to that described for the transosseous suture technique. 19 , 30 The suture anchor repair is not the procedure most frequently used, but the number of published studies regarding this technique has grown substantially in the last decade. 19 , 30 , 32 Although there are no comparative clinical studies, 14 the advantages attributed to anchor repair are the shorter operative time, easier access to the implant site, preservation of the patella and higher mechanical resistance.…”

“… 19 , 30 The suture anchor repair is not the procedure most frequently used, but the number of published studies regarding this technique has grown substantially in the last decade. 19 , 30 , 32 Although there are no comparative clinical studies, 14 the advantages attributed to anchor repair are the shorter operative time, easier access to the implant site, preservation of the patella and higher mechanical resistance. 31 Despite this, a biomechanical study concluded that the transosseous suture is more resistant and cheaper than the suture anchor repair.…”