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      Simultaneous spontaneous bilateral quadriceps tendon rupture with secondary hyperparathyroidism in a patient receiving hemodialysis : A case report

      case-report

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          Abstract

          Rationale:

          Simultaneous spontaneous bilateral quadriceps tendon rupture is a rare orthopedic injury; its initial diagnosis is misdiagnosed in up to 50% of patients with secondary hyperparathyroidism. Early diagnosis and surgical repair are important to achieve an excellent functional outcome.

          Patient concerns:

          We report a case of simultaneous spontaneous bilateral quadriceps tendon rupture associated with secondary hyperparathyroidism.

          Diagnosis:

          Magnetic resonance imaging showed that the quadriceps tendon was completely ruptured at the osteotendinous junction. We then found bilateral quadriceps tendon rupture during the operation.

          Interventions:

          The patient underwent successful tendon repair surgery.

          Outcomes:

          The 31-year-old female patient regained full active movement of both knee joints and was able to participate in her activities of daily living.

          Lessons:

          Simultaneous spontaneous bilateral quadriceps tendon rupture in a patient with secondary hyperparathyroidism (undergoing hemodialysis) is a rare orthopedic injury that can be easily overlooked at the initial presentation. Early diagnosis and surgical repair is important to achieve an excellent functional outcome. For patients with secondary hyperparathyroidism receiving hemodialysis, strict systematic treatment of hyperparathyroidism is needed to prevent rupture or re-rupture of the quadriceps tendon.

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          Most cited references17

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          Clinical outcomes after repair of quadriceps tendon rupture: a systematic review.

          Vincenzo Ciriello, Suribabu Gudipati, Theodoros Tosounidis … (2012)
          The existing evidence regarding the management of quadriceps tendon rupture remains obscure. The aim of the current review is to investigate the characteristics, the different techniques employed and to analyse the clinical outcomes following surgical repair of quadriceps tendon rupture. An Internet based search of the English literature of the last 25 years was carried out. Case reports and non-clinical studies were excluded. The methodological quality of the included studies was assessed using the Coleman Methodology Score. All data regarding mechanism and site of rupture, type of treatment, time elapsed between diagnosis and repair, patients' satisfaction, clinical outcome, return to pre-injury activities, complications and recurrence rates were extracted and analysed. Out of 474 studies identified, 12 met the inclusion criteria. The average of Coleman Methodology Score was 50.46/100. In total 319 patients were analysed with a mean age of 57 years (16-85). The mean time of follow-up was 47.5 months (3 months to 24 years). The most common mechanism of injury was simple fall (61.5%). Spontaneous ruptures were reported in 3.2% of cases. The most common sites of tear were noted between 1cm and 2 cm of the superior pole of the patella and, in the older people, at the osseotendinous junction. The most frequently used repair technique was patella drill holes (50% of patients). Simple sutures were used in mid-substance ruptures. Several reinforcement techniques were employed in case of poor quality or retraction of the torn ends of tendon. The affected limb was immobilised in a cast for a period of 3-10 weeks. Quadriceps muscular atrophy and muscle strength deficit were present in most of the cases. Worst results were noted in delayed repairs. Reported complications included heterotopic ossifications in 6.9% of patients, deep venous thrombosis or pulmonary embolism in 2.5%, superficial infection in 1.2% and deep infection in 1.1%. It appears that the type of surgical repair does not influence the clinical results. The majority of the studies reported good or excellent ROM and return to the pre-injury activities. The overall rate of re-rupture was 2%.
          Article 0 comments Cited 40 times – based on 0 reviews     Review now
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            Simultaneous bilateral rupture of quadriceps tendons: analysis of risk factors and associations.

            K Shah (2002)
            Simultaneous bilateral quadriceps tendon rupture is an uncommon injury that is frequently misdiagnosed. It has been associated with multiple medical conditions including renal disease, rheumatologic disorders, and endocrine disorders. All reported cases of simultaneous bilateral quadriceps tendon rupture were identified using MEDLINE. Each case was reviewed for information regarding the injury, and this information was analyzed. There were 66 cases of simultaneous bilateral quadriceps tendon rupture reported in the English-language literature. This review presents descriptive data on all the cases and analyzes the following factors surrounding rupture: age, sex, time before diagnosis, mechanism of injury, location of rupture, and associated chronic diseases. Most patients were treated surgically, followed by 4 to 6 weeks of immobilization, which resulted in a good outcome. Numerous associations were found and are discussed in this review. Patients with quadriceps tendon rupture should be evaluated for an underlying chronic disease.
            Article 0 comments Cited 26 times – based on 0 reviews     Review now
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              Simultaneous bilateral rupture of the quadriceps tendon.

              C A STEINER, L H PALMER (1949)
              Article 0 comments Cited 19 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Medicine (Baltimore)
                Journal ID (iso-abbrev): Medicine (Baltimore)
                Journal ID (publisher-id): MEDI
                Title: Medicine
                Publisher: Wolters Kluwer Health
                ISSN (Print): 0025-7974
                ISSN (Electronic): 1536-5964
                Publication date Collection: March 2019
                Publication date (Electronic): 08 March 2019
                Volume: 98
                Issue: 10
                Electronic Location Identifier: e14809
                Affiliations
                [a ]Department of Orthopedics
                [b ]Department of Respiration, Taizhou Municipal Hospital, Taizhou, Zhejiang, China.
                Author notes
                [∗ ]Correspondence: Fanghu Chen, Department of Orthopedics, Taizhou Municipal Hospital, Taizhou 31800, Zhejiang, China (e-mail: 2518113@ 123456qq.com ).
                Article
                Publisher ID: MD-D-18-07593 Accession ID: 14809
                DOI: 10.1097/MD.0000000000014809
                PMC ID: 6417630
                PubMed ID: 30855501
                SO-VID: e32815bb-f79d-4b41-a39a-36523daa6eb2
                Copyright © Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc.
                License:

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                Date received : 21 October 2018
                Date revision received : 30 January 2019
                Date accepted : 13 February 2019
                Categories
                Subject: 6800
                Subject: Research Article
                Subject: Clinical Case Report
                Custom metadata
                OPEN-ACCESS TRUE

                Keywords: hemodialysis,hyperparathyroidism,quadriceps tendon,rupture
                Data availability:
                Keywords: hemodialysis, hyperparathyroidism, quadriceps tendon, rupture

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