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      Simultaneous bilateral rupture of patellar tendons in diabetic hemodialysis patient: A case report

      case-report

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          Abstract

          Background:

          Bilateral rupture of the patellar tendon is a very rare injury, which takes place in relation to chronic systemic diseases. These injuries are known causes. Some of these causes are particular in patellar tendon rupture and another are in quadriceps tendon rupture.

          Case presentation:

          70-year-old diabetic man with simultaneous bilateral patellar tendon disruption of proximal insertion without trauma, receiving long-term hemodialysis.

          Conclusions:

          In the present study, we report a case of patellar tendon rupture that has two differences with literature: first, renal failure is a known risk factor for quadriceps tendon rupture, and secondly, the prevalent age of patellar tendon rupture is less than 40 years. Clinical picture, diagnosis, pathogenesis and treatment are discussed. Finally, the literature is reviewed based on previous studies.

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          Most cited references24

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          Achilles tendinopathy in diabetes mellitus.

          Fernando Felippe, Michael Pinzur, Caio Nery … (2008)
          Plantar forefoot ulcers in individuals with diabetes often lead to deep infection and lower extremity amputation. Increasing evidence suggests that the process is initiated by increased passive stiffness within the gastrocnemius-soleus musculotendinous unit. The goal of this investigation was to perform ultrasound examination of the Achilles tendon in a consecutive group of asymptomatic diabetic individuals to identify any inherent structural pathology that might be associated with the increased stiffness that appears to be associated with the development of diabetic forefoot ulcers. Seventy consecutive diabetic individuals with no past history of diabetic foot morbidity underwent ultrasonography of their Achilles tendons. Each patient was also tested for fasting glucose and glycosylated hemoglobin as a measure of diabetes control. Ten similarly aged non-diabetics with no history of Achilles tendinopathy served as controls. The ultrasonography revealed disorganized tendon fibers in 62 of 70 (89%) patients, and calcification within the Achilles tendon in 53 (76%) patients. The Achilles tendon thickness averaged 5.0 (range, 4 to 8) mm. There was no correlation between patient age and Achilles tendon thickness (r = 0.292, p = 0.014); however, there was a trend for duration of disease and Achilles tendon disorganization (p = 0.073). The oldest patients also appeared to demonstrate a trend for more ultrasound-measured Achilles tendinopathy. There was no correlation between fasting glucose or glycosylated hemoglobin and Achilles tendon alterations. This investigation confirms structural abnormalities within the Achilles tendon of diabetic individuals that might represent biologic changes affecting the inherent stiffness that leads to increased forefoot pressure and the development of plantar forefoot ulcers. This process appears to worsen with advanced age and does not appear to be related to diabetes control.
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            Complete quadriceps tendon ruptures.

            J Essenmacher, C C Reeck, B Rougraff (1996)
            Forty-four patients with 53 quadriceps tendon ruptures were studied retrospectively with an average follow up of 67.2 months (range: 24 to 155). The type of repair was not associated with differences in functional outcome, patient satisfaction, range of motion, or isokinetic testing. Patients with a delay in surgical treatment in comparison to those immediately repaired had significantly worse functional results (P < .05), lower satisfaction scores (P < .05), and lower isokinetic data for both the injured and uninjured extremities, however, their range of motion and comparative extensor power results were nearly identical. On reviewing all patients, the ultimate range of motion was within an average of 2 degrees of the uninjured side in nearly all patients. Based on the results of this study, all surgical methods can be expected to give comparable results as long as treatment is begun within 1 week of the injury. Regaining range of motion comparable to the uninjured side was not a problem in this series despite a delay in treatment.
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              Quadriceps and patellar tendon rupture.

              Leonhard Ramseier, M Heinzelmann, Martin Werner (2006)
              Ruptures of the patellar and/or quadriceps tendon are rare injuries that require immediate repair to re-establish knee extensor continuity and to allow early motion. We evaluated 36 consecutive patients with quadriceps or patellar tendon rupture between 1993 and 2000. There were 37 primary ruptures, 3 reruptures, 21 quadriceps and 19 patellar tendon ruptures. Follow up examination (>24 months postoperatively) included the patient's history, assessment of risk factors, clinical examination of both knees, isometric muscle strength measurements and three specific knee scores, Hospital for Special Surgery Score, Knee Society Score and Turba Score, and a short form SF-36. We evaluated 29 patients (26 men) with 33 ruptures (16 patellar tendon, 17 quadriceps tendon). Seven patients were lost to follow up. We found no difference between the range of motion and muscle strength when the injured leg was compared to the non-injured leg. Risk factors did not influence the four scores, patient satisfaction, pain, muscle strength or range of motion. Multiple injured patients had a significant reduction in muscle strength and circumference, however patient satisfaction did not differ to the non-multiple injured patient group.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Caspian J Intern Med
                Journal ID (iso-abbrev): Caspian J Intern Med
                Journal ID (publisher-id): CJIM
                Title: Caspian Journal of Internal Medicine
                Publisher: Babol University of Medical Sciences (Babol, Iran )
                ISSN (Print): 2008-6164
                ISSN (Electronic): 2008-6172
                Publication date (Print): Summer 2018
                Volume: 9
                Issue: 3
                Pages: 306-311
                Affiliations
                [1 ]Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
                [2 ]Firoozgar Clinical Research and Development Center, (FCRDC) , Iran University of Medical Sciences, (IUMS) , Tehran, Iran
                Author notes
                [* ]Correspondence: Alireza Yousof Gomrokchi, Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran, E-mail: arugomrokchi@gmail.com, Tel: 0098 2182141795, Fax: 0098 2182141795
                Article
                DOI: 10.22088/cjim.9.3.306
                PMC ID: 6121341
                PubMed ID: 30197779
                SO-VID: 279f1fba-730b-40c7-acb8-5f0a0650d094
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 23 April 2017
                Date revision received : 21 June 2017
                Date accepted : 3 July 2017
                Categories
                Subject: Case Report

                Keywords: bilateral,hemodialysis,patellar tendon,rupture
                Data availability:
                Keywords: bilateral, hemodialysis, patellar tendon, rupture

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