Considerations in spontaneous quadriceps tendon rupture repair in end-stage renal disease patients: A case report

• Published in: International journal of surgery case reports Vol. 86; p. 106298
• Main Authors: Hartono, Franky, Besinga, Karina E., Tjie, Hendra, Marpaung, Daniel, Ananditya, Tessi, Gabriel H.R, Nicholas
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01-09-2021; Elsevier
• Subjects: Case Report; End-stage renal disease; Extensor mechanism; Spontaneous quadriceps tendon rupture; Extensor mechanism; Spontaneous quadriceps tendon rupture; End-stage renal disease
• DOI: 10.1016/j.ijscr.2021.106298
• EISSN: 2210-2612

Spontaneous quadriceps tendon rupture (SQTR) is a rare injury to the knee extensor mechanism that is usually associated with systemic diseases such as end stage renal diseases (ESRD) and it is more prevalent in the elderly. Due to the underlying pathology, quadriceps tendon rupture warrants special considerations and management in its repair.
We present two cases of quadriceps tendon rupture in end-stage renal disease (ESRD) patients. The first case; a 57 years old female who had bilateral SQTR and is undergoing hemodialysis. The second patient, a 26 years old male had unilateral quadriceps tendon rupture caused by minimal trauma.
The first patient had a trans-osseous repair by direct suturing the quadriceps tendon stump to the proximal pole patella. The second patient was repaired with a modified Bunnel suture and anchor placement on the proximal pole patella. The first case had a re-rupture of the right quadriceps tendon and the second case has recovered with improved outcomes.
Spontaneous quadriceps tendon rupture is usually underlined by degenerative changes of the tendons. Special care is needed to address the pathologic tendon underlying SQTR. The current surgical literature still lacks the statistical data that shows which surgical approach is most optimal for SQTR in ESRD patients.
SQTR rupture is generally an injury of brittle tendons caused by underlying diseases. A multidisciplinary and comprehensive approach including a proper surgical approach and postoperative managements are crucial for good functional outcomes of the extensor mechanism.
•SQTR are commonly associated with brittle tendons due to systemic diseases.•A multidisciplinary and comprehensive repair is crucial for a good functional outcome for SQTR rupture in ESRD.•Surgical augmentations are needed for the brittle tendon of SQTR. But statistical data for the best surgical approach for SQTR in ESRD is still lacking.