Spontaneous Achilles Tendon Rupture in a Patient with Undergoing Long-Term Haemodialysis: a Case Report and Literature Review

Abstract

Chronic kidney disease and hemodialysis are well known risk factors for tendon rupture, although this is a rare situation. The present case was a 70-year old male who presented with a sudden onset of painful disability in the left posterior ankle. This occurred while he was climbing the stairs. A physical examination and imaging resulted in a diagnosis of Achilles tendon rupture. The patient had received regular haemodialysis for 12years. He developed secondary hyperparathyroidism as excepted sequelae of end stage renal disease. Following surgical repair, physiotherapy and management of associated risk factors, the patient regained full active mobility.

Spontaneous and simultaneous rupture of both Achilles tendons in a haemodialysis patient

“…Most spontaneous Achilles tendon ruptures in patients with chronic renal failure have been managed by a standard end-to-end suture or tendon reinsertion (table 1). 1 5 8–11…”

“…Given its strong nature,1–4 spontaneous rupture of the Achilles tendon is a rare condition1–3 5–7 that mainly affects particular fields, such as chronic metabolic disorders,2 4 5 8 chronic renal failure,1 5–11 corticosteroid treatment, fluoroquinolone administration,1–3 5–7 9 11 12 lupus and rheumatological disorders 1 2 5 6 8 11…”

“…For patients with chronic kidney disease, many predisposing factors for tendon rupture have been described in the literature, including secondary hyperparathyroidism, β2-microglobulin amyloidosis,1 5 6 8 9 12–15 malnutrition,5 8 12 13 chronic calcifying tendinopathy,1 9 10 15 accumulation of uraemic toxins that weakens and destroys the tendons,5 6 16 chronic acidosis,5 6 8 12 13 16 local circulatory impairment10 15 and neurological lesions 15…”

“…In this category of patients, the Achilles tendon is the second most common location of tendon rupture after the quadricipital tendon, followed by the patellar tendon 6 8. Some patients sustained tendon rupture after renal transplantation 17…”

“…So far, there have been few case reports describing spontaneous rupture of the Achilles tendon that were managed with different and various operative techniques: tendon reinsertion, tendon graft, end-to-end suture and suture anchors1 5 8–11 17 (table 1).…”