Spontaneous Bilateral Rupture of The Extensor Tendons of The Knee in Patients with Chronic Kidney Disease. Case Reports

Spontaneous Bilateral Rupture of the Extensor Tendon

Abstract

Introduction: Bilateral rupture of the extensor tendons of the knee (quadriceps and patella tendons) are uncommon and usually occur as a result of trauma. Spontaneous bilateral tendon ruptures are a rarer injury and has been reported to occur in patients with chronic renal disease and secondary hyperparathyroidism. Patients usually present with sudden inability to actively extend their knee and walk. Over 50% of these injuries are usually missed so a high index of suspicion is required for early diagnosis. These case reports aim to create awareness among physicians and primary care givers about the condition and ensure early diagnosis and management

Case Presentation: We report two cases of spontaneous bilateral knee extensor tendon rupture involving the quadriceps tendon and patella tendon in a 30 year and 50-year-old males respectively. Both patients had chronic renal failure and were on chronic dialysis for a minimum 8 years and were being managed for secondary hyperparathyroidism. One patient had surgical repair and is doing well functionally but the other declined surgery.

Conclusion: Spontaneous knee extensor tendon rupture though rare, occurs in patients on chronic dialysis with secondary hyperparathyroidism. Physicians and primary care givers managing these patients must be aware and maintain a high index of suspicion in order to pick this condition since as seen in our first patient, early treatment is associated with good functional outcomes.