Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Sep 18, 2018; 9(9): 180-184
Published online Sep 18, 2018. doi: 10.5312/wjo.v9.i9.180
Spontaneous and simultaneous complete bilateral rupture of the quadriceps tendon in a patient receiving hemodialysis: A case report and literature review
Wassim Zribi, Mohamed Zribi, Ahmed Racem Guidara, Mohamed Ben Jemaa, Ameur Abid, Nabil Krid, Abdessalem Naceur, Hassib Keskes
Wassim Zribi, Mohamed Zribi, Ahmed Racem Guidara, Mohamed Ben Jemaa, Ameur Abid, Abdessalem Naceur, Hassib Keskes, Department of Orthopaedic Surgery and Traumatology, Habib Bourguiba University Hospital, Sfax 3000, Tunisia
Nabil Krid, Department of Orthopaedic Surgery and Traumatology, Marechal Leclerc Argentan Hospital, Argentan 61200, France
Author contributions: Zribi W and Zribi M performed the surgery; Guidara AR is the corresponding author, he wrote the great part of the manuscript; Ben Jemaa M, Krid N and Abid A contributed in gathering the data and writing the manuscript; Naceur A corrected some grammar mistakes and contributed in the improvement of English language; Keskes H corrected the hole manuscript and gave his permission for submitting.
Informed consent statement: The patient involved in this study gave her written informed consent authorizing use and disclosure of her protected health information.
Conflict-of-interest statement: None of the authors have any financial or other conflicts of interest that may bias the current study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Ahmed Racem Guidara, MD, Doctor, Surgeon, Department of Orthopaedic Surgery and Traumatology, Habib Bourguiba University Hospital, El Ain Street, Sfax 3000, Tunisia.
Telephone: +216-22-650267
Received: May 8, 2018
Peer-review started: May 8, 2018
First decision: June 5, 2018
Revised: June 18, 2018
Accepted: June 28, 2018
Article in press: June 28, 2018
Published online: September 18, 2018

The spontaneous and simultaneous rupture of both quadriceps tendons is uncommon and has rarely been reported in the literature. The current case involves a 43-year-old man with end-stage renal disease requiring hemodialysis for the past 20 years. The patient experienced bilateral knee pain and swelling and was unable to bear weight. Physical examination revealed bilateral quadriceps tendon defect above the patella and loss of active extension. Although plain radiographs of both knees showed no fracture or widening of the joint space, an inferiorly positioned patella was observed. Ultrasonography of the knees revealed a quadriceps tendon defect at the upper edge of each patella, while MR imaging revealed a tear in each quadriceps tendon from the superior poles of the patella. The patient then underwent surgical correction wherein the tendons were repaired using sutures passed through drill holes in the patella. The knees were immobilized with splints for 4 wk before starting physiotherapy. The patient subsequently regained full functional activity within 1 year.

Keywords: Quadriceps tendon, Tear, Krackow sutures, Renal failure, Hyperparathyroidism

Core tip: Spontaneous bilateral quadriceps tendon rupture is uncommon, while the symmetry of physical findings may make the diagnosis even more difficult. Testing the extensor mechanism must be an essential part of every knee examination. Early diagnosis and surgical repair are associated with the best outcomes. The most likely etiology of tendon ruptures in patients receiving hemodialysis is the fragility of the junction between the tendon and the bone resulting from long-standing and poorly controlled hyperparathyroidism.