A Simultaneous Rupture of the Patellar Tendon and the Con-tralateral Quadriceps Tendon in a Patient with Chronic Renal Failure Undergoing Long Term Hemodialysis

Abstract

Background: Quadriceps or patellar tendon rupture incidence is relatively low, especially simultaneous bilateral rupture, which usually reported as a complication of chronic systemic disorders such as renal failure.

Objective: Herein, we report a case of bilateral knee extensor mechanism ruptured in a patient with chronic renal failure on long standing hemodialysis.

Case presentation: A 38-year-old white male, a known case of chronic renal failure on long term hemodialysis, presented to our clinic with clinical signs of bilateral simultaneous knee extensor tendons rupture. After proper workup simultaneous quadriceps and contralateral patellar tendons rupture diagnosis was made. The patient was managed with surgical repair of the tendons and within few days after the surgery he started physiotherapy and rehabilitation program, using walking crutches partial weight bearing mobilization was allowed, and a gradual increase of knee flexion within brace was applied. He used the knee braces and the walking crutches for two months, to ensure complete healing of the repaired tendon with a sufficient strength to allow full weight bearing. At four-year follow-up, complete bilateral knee extensor tendons healing and both knees functional outcome was satisfactory.

Conclusion: A simultaneous rupture of quadriceps and contralateral patellar tendons is a rare event in patients with chronic renal failure undergoing long term hemodialysis. With early surgical intervention and good physiotherapy, the patient usually has good recovery of both knees function.

Keywords: Chronic renal failure; Hemodialysis; Patellar tendon rupture; Quadriceps tendon rupture; case report.

Figure 1. a) Right Knee XR, AP view, showed rupture of the patellar tendon; b) Left Knee XR, AP view, indicated rupture of the quadriceps tendon.

Figure 2. a) Right Knee MRI, T2WI sagittal view, showed rupture of the patellar tendon as indicated by the arrow b) Left Knee MRI, T2WI sagittal view, indicated rupture of the quadriceps tendon as indicated by the arrow

Figure 3. Postoperative Photograph, taken four years following surgery. Photograph of both knees taken four years following surgery shows satisfactory range of motion of both knees.