Quadriceps tendon rupture in maintenance haemodialysis patients: Results of surgical treatment and analysis of risk factors

Quadriceps tendon rupture in maintenance haemodialysis patients: Results of surgical treatment and analysis of risk factors

Abstract Background Reports of spontaneous quadriceps ruptures in end-stage renal disease (ESRD) patients are scarce, and the assessment of risk factors for tendon rupture is poorly addressed in the majority of the studies. The purpose of the present study is to report a series of patients on haemod...

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Bibliographic Details
Published in:Injury Vol. 45; no. 12; pp. 1970 - 1973
Main Authors: Malta, Luis Marcelo A, Gameiro, Vinicius S, Sampaio, Elisa A, Gouveia, Maria E, Lugon, Jocemir R
Format: Journal Article
Language:English
Published: Netherlands Elsevier Ltd 01-12-2014
Subjects:
Adult
End-stage renal disease
Female
Haemodialysis
Humans
Hyperparathyroidism
Hyperparathyroidism, Secondary - complications
Hyperparathyroidism, Secondary - physiopathology
Hyperparathyroidism, Secondary - surgery
Kidney Failure, Chronic - complications
Kidney Failure, Chronic - physiopathology
Kidney Failure, Chronic - therapy
Knee Joint - surgery
Male
Medical Records
Middle Aged
Orthopedics
Parathyroid Hormone - blood
Quadriceps
Quadriceps Muscle - injuries
Quadriceps Muscle - surgery
Reconstructive Surgical Procedures - methods
Renal Dialysis
Retrospective Studies
Risk Factors
Rupture, Spontaneous
Surgical treatment
Tendon rupture
Tendons - pathology
Tendons - surgery
Treatment Outcome
Quadriceps
Tendon rupture
End-stage renal disease
Surgical treatment
Haemodialysis
Risk factors
Hyperparathyroidism
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Summary:Abstract Background Reports of spontaneous quadriceps ruptures in end-stage renal disease (ESRD) patients are scarce, and the assessment of risk factors for tendon rupture is poorly addressed in the majority of the studies. The purpose of the present study is to report a series of patients on haemodialysis with spontaneous quadriceps tendon ruptures operated at our institution. The results of the surgical treatment are described and the potential risk factors associated with the rupture are analyzed. Methods Our study consisted of retrospective analysis of patient's charts. Clinical and laboratory findings of the operated group were compared to the ones of a control group of haemodialysis patients matched by age, gender, and time on haemodialysis, but without tendon rupture. Results Between 1998 and 2010, six ESRD patients with 11 spontaneous ruptures of the quadriceps tendon were treated at our institution. On postoperative evaluation all patients were able to walk without crutches after six months of follow-up, and there were no new ruptures. Positive serology for Hepatitis C was present in two cases (33%) but in none of the controls ( p = 0.034). Mean serum levels of intact parathormone (iPTH) and alkaline phosphatase were both higher in cases ( p = 0.013 and p = 0.034, respectively). In contrast, mean serum levels of albumin, ferritin and haemoglobin were all lower in cases ( p = 0.008, p = 0.043 and p = 0.016, respectively). Conclusion Reconstructive surgery is a good way to restore knee function in ESRD patients with quadriceps tendon ruptures. Our cases exhibited higher levels of iPTH and alkaline phosphatase than control patients, reinforcing the role of secondary hyperparathyroidism in tendon weakening. They also had a higher frequency of hepatitis C and lower levels of albumin and haemoglobin compared to controls, possibly implicating chronic inflammation as a potential risk factor for tendon rupture.
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ISSN:0020-1383
1879-0267
DOI:10.1016/j.injury.2014.09.008