Spontaneous bilateral rupture of quadriceps tendon and secondary hyperparathyroidism

Ruptura espontánea bilateral del tendón de cuádriceps en paciente con hiperparatiroidismo secundario

Bilateral and spontaneous rupture of the quadriceps tendon (QT) is a rare injury causing significant limitation of function [of the knee joint]. The etiology of this condition is not yet well established and an association with multiple factors has been described. It is strongly associated with [systemic] illnesses like hyperparathyroidism. A case is presented in a 25-year-old woman with chronic kidney disease on dialysis. She had a bilateral rupture of the QT clinically diagnosed and demonstrated by x-ray, ultrasound and magnetic resonance imaging. Endocrinology investigations revealed secondary hyperparathyroidism with classical bone sclerosis and resorption. This case evidences a clear clinical-radiological correlation of hyperparathyroidism with a high risk of QT injuries.

1. Shah MK. Simultaneous bilateral rupture of quadriceps tendons: Analysis of risk factors and associations. South Med J. 2002;95:860–6.

2. Thaunat M, Gaudin P, Naret C, Beaufils P, Thaunat O. Role of secondary hyperparathyroidism in spontaneous rupture of the quadriceps tendon complicating chronic renal failure. Rheumatology (Oxford). 2006;45:234–5.

3. O’Shea K, Kenny P, Donovan J, Condon F, McElwain J. Outcomes following quadriceps tendon ruptures. Injury. 2002;33:257–60.

4. Neubauer T, Wagner M, Potschka T, Riedl M. Bilateral, simultaneous rupture of the quadriceps tendon: A diagnostic pitfall? Report of three cases and meta-analysis of the literatura. Knee Surg Sports Traumatol Arthrosc. 2007;15:43–53.

5. Gao MF, Yang HL, Shi WD. Simultaneous bilateral quadriceps tendon rupture in a patient with hyperparathyroidism undergoing long-term haemodialysis: A case report and literature review. J Int Med Res. 2013;41:1378–83.

6. Pei Y, Hsieh P, Huang L, Chiang C. Simultaneous bilateral quadriceps tendon rupture in a uremic patient. Formosan Journal of Musculoskeletal Disorders. 2011;2:35–9.

7. Muratli H, Ç elebi L, Hapa O, Biçimoglu A. Simultaneous rupture of the quadriceps tendon and contralateral patellar tendon in a patient with chronic renal failure. J Orthop Sci. 2005;10:227–32.

8. Chang CY, Rosenthal DI, Mitchell DM, Handa A, Kattapuram SV, Huang AJ. Imaging findings of metabolic bone disease. Radiographics. 2016;36:1871–87.

9. Calvo E, Ferrer A, Robledo AG, Alvarez L, Castillo F, Vallejo C. Bilateral simultaneous spontaneous quadriceps tendons rupture: A case report studied by magnetic resonance imaging. Clin Imaging. 1997;21:73–6.