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      Spontaneous bilateral quadriceps tendon rupture: a case report

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          Abstract

          Quadriceps tendon rupture is an uncommon injury and mostly occurs among middle aged individuals that are involved in sports such as running or jumping. Spontaneous bilateral quadriceps tendon rupture is a rarer injury, however, can be debilitating. Patients with such injuries usually present with history of minor trauma, swelling and inability to actively extend the knee. Its occurrence secondary to minor trauma is mostly associated with chronic diseases and long-term use of certain medications. Occurrence of simultaneous bilateral quadriceps tendon rupture in the absence of trauma in a healthy patient with no known medical condition is yet to be reported and therefore requires a high index of suspicion for early diagnosis and effective management to avoid complications. The aim of this case report is to create awareness of the spontaneous occurrence of this injury in the absence of the reported risk factors. We report the unusual case of a 60-year old healthy man who presented with a spontaneous simultaneous bilateral quadriceps' tendon rupture in the absence of trauma and no medical risk factors. We report the unusual case of a 60-year old healthy man who presented with a spontaneous simultaneous bilateral quadriceps tendon rupture in the absence of trauma and no medical risk factors. Consent was taken from him to be used as a case report being a rare case. The man had full recovery after surgery and physiotherapy and was discharged home. Spontaneous bilateral quadriceps tendon rupture is a rare occurrence. The index case report is important as there was no history of trauma and it was bilateral.

          Most cited references12

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          The epidemiology of musculoskeletal tendinous and ligamentous injuries.

          This study describes the epidemiology of a range of adult musculoskeletal soft tissue injuries. Our institution is the only hospital treating adults with musculoskeletal trauma in a well-defined catchment population of about 535,000. Demographic details over 5 years were recorded prospectively. Eighteen injury types were studied including anterior cruciate ligament (ACL) rupture, acromioclavicular joint (ACJ) injury, Achilles, patellar and quadriceps tendon ruptures, hand tendon injuries and mallet finger. 2794 patients presented with ligamentous or tedinous injuries over 5 years. 74.2% of patients were male, giving an incidence of 166.6/100,000 per year for males and 52.1/100,000 per year for females. The mean age was 36.3 years: 33.1 in males, 43.6 in females. 1040 (37.2%) were knee injuries: 75.6% were male with mean age 32.9, compared with 35.3 in females. 947 cases were hand tendon injuries (33.9%): 72.1% were male, with mean age 34.5 compared with 42.0 in females. Meniscal injury of the knee was the commonest injury with an incidence of 23.8/100,000 per year. Other common injuries were hand extensor tendons (18/100,000 per year), ACJ injury (14.5/100,000 per year), Achilles tendon rupture (11.3/100,000 per year), mallet finger (9.9/100,000 per year) and ACL rupture (8.1/100,000 per year). Achilles, patellar and quadriceps tendon rupture and mallet finger were injuries of middle age; rotator cuff tears and biceps tendon rupture were commoner in the elderly but all other injuries predominated in young patients. All injuries were commoner in males. Most soft tissue injuries follow distribution curves previously described for fracture epidemiology but three new distribution curves are presented for the injuries which predominate in middle age.
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            Clinical outcomes after treatment of quadriceps tendon ruptures show equal results independent of suture anchor or transosseus repair technique used – A pilot study

            Biomechanical studies have shown the use of suture anchors (SA) to be superior to the traditional transosseous sutures (TS) in the repair of quadriceps tendon rupture (QTR). This study aimed to analyze and compare the functional outcomes of patients treated for quadriceps tendon ruptures using suture anchors or transosseous sutures. Patients having undergone suture anchor repair or transosseous suture repair for quadriceps tendon rupture between 2010 and 2015 at one of the two participating hospitals were included. Patients from site A underwent TS repair (TS group) while patients from site B underwent SA repair (SA group). Exclusion criteria included previous or concomitant injuries of the involved knee, penetrating injuries and pre-existing neurological conditions. Clinical outcome was assessed by subjective scores (Lysholm and Tegner Scores, International Knee Documentation Committee (IKDC) Score, Visual Analog Scale (VAS) for pain), quadriceps isokinetic strength testing, Insall-Salvati Index (ISI), and physical examination. Non-parametrical statistical analysis was conducted using the Mann-Whitney U test. Twenty-seven patients were included in the study of which 17 patients (63%) were available for follow-up (SA group: 9, TS group: 8). All patients were male with a mean age of 62.7 (SD: 8.8) and 57.9 (SD: 12.7) years for the SA group and TS group, respectively. The groups did not differ in terms of demographic characteristics. No clinically significant differences were identified between the two groups. There were no re-ruptures in either group. Treatment of quadriceps tendon rupture using suture anchors provides a clinically valid alternative treatment to the gold-standard transosseous suture repair.
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              Simultaneous bilateral rupture of the quadriceps tendon.

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                Author and article information

                Journal
                Pan Afr Med J
                Pan Afr Med J
                PAMJ
                The Pan African Medical Journal
                The African Field Epidemiology Network
                1937-8688
                23 September 2020
                2020
                : 37
                : 84
                Affiliations
                [1 ]Cedarcrest Hospitals Abuja, Abuja, Nigeria
                Author notes
                Corresponding author: Kelechukwu Mc’Clement Onuoha, Cedarcrest Hospitals Abuja, Abuja, Nigeria. mckelng@ 123456yahoo.com
                Article
                PAMJ-37-84
                10.11604/pamj.2020.37.84.22329
                7680233
                33244347
                b9e06af6-c26d-486f-a90a-0a0ede9ff38d
                Copyright: Kelechukwu Mc’Clement Onuoha et al.

                The Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 March 2020
                : 10 September 2020
                Categories
                Case Report

                Medicine
                quadriceps tendon rupture,proximal myopathy,transosseous
                Medicine
                quadriceps tendon rupture, proximal myopathy, transosseous

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