Bilateral simultaneous complete quadriceps rupture following chronic symptomatic tendinopathy: a case report

Abstract

Introduction: Quadriceps rupture is a disabling injury mostly seen in men over 40 years of age. Bilateral quadriceps rupture is a rare injury that is often secondary to predisposing medical conditions. Ultrasound is a cheap and reliable tool for diagnosis but is operator dependent. Thus, magnetic resonance imaging is the preferred method of investigation despite its cost and availability. Prompt diagnosis and early surgical repair are needed for an optimal end result.

Case presentation: We report the case of a healthy 54-year-old Caucasian male farmer who presented with bilateral simultaneous complete quadriceps rupture, which was managed surgically and he was followed up for three years. He was previously under our care for enthesopathy of the quadriceps on both sides. We believe that chronic enthesopathy of the superior pole of patella made his quadriceps susceptible to complete rupture on eccentric loading.

Conclusion: Only a few cases of bilateral simultaneous complete quadriceps rupture in patients with symptomatic enthesopathy have been previously reported. We stress the importance of warning patients of the risk of developing complete tendon rupture when they present with an enthesopathy around the knee.

Figure 1

Lateral radiographs of both knees. The initial X-rays revealed only the patellar spur at the superior pole of the patella and some calcification in the quadriceps tendon.

Figure 2

Magnetic resonance images of the knees. The magnetic resonance scan revealed disruption of the quadriceps at a level of 1.5 cm from the insertion into the patella on both sides, right more extensive than left. There was thickening of the quadriceps on both sides.

Figure 3

Follow-up pictures at three years after surgical repair. The well-healed operation sites on both knees. The active extension (straight leg raise) on both sides showing no significant extensor lags.