Simultaneous bilateral quadriceps tendon rupture in patient with chronic renal failure

Abstract

Simultaneous bilateral spontaneous rupture of the quadriceps tendon is a very rare condition and only a few cases have been reported in the literature. The etiology is not clear yet. But it occurs infrequently in patients with chronic metabolic disorders. A 30-year-old female patient with simultaneous bilateral spontaneous quadriceps tendon rupture visited our hospital. She had chronic renal failure and her parathyroid hormone level was elevated due to parathyroid adenoma. We report a surgical repair of both quadriceps tendons of a patient with chronic renal failure as well as management of hyperparathyroidism.

Keywords: End-stage renal failure; Parathyroid hormone; Quadriceps tendon.

Fig. 1

Gross photograph of left knee shows dimpling or defect of suprapatella lesion.

Fig. 2

Both lateral view (A: right knee, B: left knee) of knee standing position show obliteration of the quadriceps tendon with inferior patellar displacement without fracture. Dystrophic calcifications of the quadriceps femoris tendon are shown on both supra- patella area (black circle).

Fig. 3

T2 weight MRI of both knees. Quadriceps tendon is completely disrupted at the patellar attachment site (black arrow). On T2 weight sagittal MR imaging (A: right knee, B: left knee), joint space is enlarged with effusion fluid and extensive deep and superficial soft tissue edema is seen around quadriceps tendon.

Fig. 4

Neck ultrasonogram. Multiple well-demarcated multiple homogeneous hypoechoic mass are shown. Multiple parathyroid adenomas can be suspected. At 8 mm sized homogeneous hypoechoic nodule (A, white arrow). No cervical lymph node enlargement is seen (B).

Fig. 5

Intra operation gross photograph (A: pre-suture right knee, B: pre-suture left knee, C: post-suture right knee, D: post- suture left knee).