Bilateral simultaneous quadriceps ruptures in an elite bodybuilder: A case report of treatment success

Abstract

Tendon injuries in weightlifters is known to be associated with steroid use. Bilateral simultaneous quadriceps tendon rupture (BSQTR) is extremely rare with few cases reported in literature in young athletes. Unlike patellar tendon ruptures, they are more common in older age individuals. These injuries can jeopardize an athlete's career. In this paper, we report a very rare case of BSQTR in an elite bodybuilder who sustained a high mechanism trauma while squatting heavyweights. He sustained bilateral anterior cruciate ligament (ACL) injury and a left ankle fracture. All injuries were treated surgically except for the left ACL as it was asymptomatic on follow-up. The challenge in this case was to treat his injuries and to regain his baseline functional status in the shortest period of time. Following treatment, the patient had a satisfactory clinical outcome with focused rehabilitation. Despite the devastating trauma, the patient was able to progress throughout the treatment plan and has regained his baseline functional status in less than 18 months and has resumed his competitive bodybuilding career. From the available literature, this is the first case to be reported with such combined injuries that was treated and showed a satisfactory outcome in a short period of time.

Keywords: Bilateral quadriceps injury; Bodybuilding trauma; Squat trauma; Weight-lifting trauma.

Fig. 1

Legend: Anteroposterior and lateral radiographs of the left ankle showing lateral malleolus fracture.

Fig. 2

Legend: (A) sagittal proton density (PD) of the right knee showing complete quadriceps tendon injury, (B) a sagittal T2 cut showing ACL injury, (C) a coronal T2 cut showing an empty notch sign and signal intensity around the medial meniscus.

Fig. 3

Legend: (A) PD cut of the left knee showing high grade quadriceps tendon injury at musculotendinous junction, (B) another cut showing the extent of the injury with an associated ACL injury.

Fig. 4

Legend: Left knee sagittal MRI T1 (A), and T2 sequence (B) demonstrating a normally appearing left ACL. Right knee sagittal MRI T1 (C), and PD sequences (D) showing an injured ACL.

Fig. 5

Legend: Clinical photographs taken at 10 months (A) and 30 months post-surgery (B) demonstrating excellent recovery and aesthetic looking thighs. The later was taken shortly before a bodybuilding competition.