Bilateral synchronous rupture of the quadriceps tendon

Background

Bilateral simultaneous rupture of the quadriceps tendon is a rare entity. They are often associated with degenerative changes of the tendons and predisposing conditions such as diabetes or excessive steroid use. They most commonly tend to occur in patients of 40 years of age or older.

Materials and methods

We describe a case of a 67-year-old man with simultaneous rupture of both quadriceps tendons.

Conclusion

The diagnosis can be difficult and often delayed or missed in the initial examination. We report bilateral quadriceps tendon rupture in a previously healthy patient with good post-operative functional outcome.     

Bilateral quadriceps tendon rupture — A case report

The diagnosis of rupture of the quadriceps tendon is made relatively infrequently and bilateral simultaneous rupture is a rarity. We report a case of spontaneous bilateral rupture of the quadriceps tendon in a patient with documented chronic renal insufficiency and secondary hyperparathyroidism. A predisposing cause to the condition as obtained in this case, has been described in cases previously published in the literature.     

Spontaneous bilateral quadriceps tendon rupture

Spontaneous bilateral quadriceps tendon ruptures are uncommon. We present a 30-year-old man with end-stage renal failure, who sustained this injury, and subsequently had surgical repair of both tendons on separate occasions. He has since regained full range of movement of both knees.     

Spontaneous rupture of the quadriceps tendon and patellar ligament during treatment for chronic renal failure.

The quadriceps tendon and patellar ligament rupture rarely, even when under great stress or trauma, but can rupture spontaneously in patients with chronic diseases such as gout, rheumatoid arthritis and renal disease. Several factors probably combine to weaken the tendon, including an impoverished local vascular supply, repeated microtrauma and secondary hypoparathyroidism with osteodystrophy. In the three cases reported here, one of which was bilateral, the patients were being treated for chronic renal disease; surgical repair of the tendons led to sound healing and a return to normal function of the joints.     

腓骨肌腱修复跟腱断裂24例的临床分析

目的分析腓骨长肌腱用于修复跟腱断裂的手术方法和经验。方法将腓骨长肌腱在远端处切断,经皮下隧道移位修复跟腱断裂24例。结果根据Arner-Lindholm评定标准,24例中优14例,良10例。未发生跟腱再次断裂。2例出现伤口感染,1例出现皮肤与跟腱粘连。结论对疑有跟腱断裂的患者未进行认真的体检是导致跟腱断裂误诊的重要原因。避免误诊、尽早手术及循序渐进的术后康复锻炼是提高疗效的有效措施。用腓骨长肌腱重建陈旧性和某些急性跟腱断裂是一种安全可行、疗效满意的手术方法。     

Fluoroquinolone therapy and Achilles tendon rupture

Fluoroquinolones have been associated with tendinopathies. The authors present three cases of Achilles tendinopathy in which the patients' symptoms were preceded by treatment for unrelated bacterial infections with ciprofloxacin. Although the exact mechanism of the relationship is not understood, those who engage in sports or exercise should be advised of the risk of quinolone-induced tendinopathy.     

Spontaneous Achilles tendon rupture in alkaptonuria

Alkaptonuria (AKU) is a rare inborn metabolic disease characterized by accumulation of homogentisic acid (HGA). Excretion of HGA in urine causes darkening of urine and its deposition in connective tissues causes dark pigmentation (ochronosis), early degeneration of articular cartilage, weakening of the tendons, and subsequent rupture. In this case report, we present a rare case of a patient presented with unilateral spontaneous rupture of Achilles tendon due to AKU. The patient developed most of the orthopedic manifestations of the disease earlier than typical presentations. Alkaptonuria patients should avoid strenuous exercises and foot straining especially in patients developing early orthopedic manifestations.Alkaptonuria (AKU) is a rare genetic metabolic disorder with an incidence of 1:250,000 in most populations. It is due to deficiency of homogentisate 1,2-dioxygenase (HGD), which is an enzyme involved in the phenylalanine and tyrosine degradation pathway.1,2 Homogentisate 1,2-dioxygenase deficiency results in accumulation of homogentisic acid (HGA), which is oxidized to benzoquinones that polymerize and form a dark pigment. The excess HGA binds to the connective tissues and cartilage. Ochronotic osteoarthropathy is used to refer to the musculoskeletal manifestation of AKU. Ochronosis is the darkening of connective tissues due to the deposition of HGA and/or its polymer in connective tissue. Over time this causes ochronotic osteoarthropathy.3 On microscopic examination yellowish (ocher-like) discoloration of the tissue is seen, but macroscopically the affected tissues appear bluish grey. This leads to weakness and early degeneration of articular cartilage and arthritis.2 Large quantities of HGA excreted in urine causes urine to darken upon standing due to oxidation or after exposure to alkaline agents.1 Rupture of Achilles tendon is an important clinical manifestation of AKU. There are few reports in the literature of spontaneous rupture of the Achilles tendon caused by AKU.4-6 We report a case of an AKU patient presented with a unilateral spontaneous rupture of Achilles tendon. The objective of this case report is to highlight the rare Achilles tendon rupture due to AKU, which can be a reference for physicians and surgeons in the prevention and/or delay of such a complication.     

跟腱撕裂的MRI诊断

目的探讨跟腱撕裂的MRI诊断价值。方法回顾性分析15例跟腱撕裂的MRI表现及临床症状。结果部分性跟腱撕裂4例,完全性跟腱撕裂11例。跟腱撕裂位于跟腱-跟骨附着部位上方2.5～10.7cm,平均(4.9±1.8)cm。主要MRI表现为跟腱增粗或扭曲变形、腱内信号增高、跟腱纤维束连续性部分或完全中断。结论 MRI能清晰显示跟腱撕裂的程度、位置等情况,对临床治疗具有重要参考价值。     

腓肠肌肌腱皮瓣修复术治疗陈旧性跟腱断裂

目的：探讨腓肠肌肌腱皮瓣修复术治疗陈旧性跟腱断裂的临床疗效。方法：2001年1月-2007年1月我院采用腓肠肌肌腱皮瓣修复术治疗陈旧性跟腱断裂15例,术后6周去长腿石膏后托进行功能康复训练,术后随访1年,采用Arner-Lindholm疗效评定标准评估。结果：13例患者伤口均为一期愈合,无感染、生硬和跟腱再次断裂等发生;2例肌皮瓣皮肤发生部分坏死,行植皮术后延期愈合。Arner-Lindholm疗效评定,优9例,良4例,差2例,优良率为86.67%。结论：采用腓肠肌肌腱皮瓣修复术治疗陈旧性跟腱断裂能较好地恢复跟腱的功能,近、远期疗效满意。     

Simultaneous bilateral spontaneous rupture of the quadriceps tendon. Apropos of a case of a hemodialysis patient with hyperparathyroidism and review of the literature

The bilateral simultaneous spontaneous rupture of the quadriceps tendons is a rare condition. Of the pathologies associated with this condition, in the literature, chronic renal failure with hyperparathyroidism is of special interest. In this context, the frequency of this lesion is related to the chronicity of the renal disease. We report a case treated surgically with a good functional result in a patient under dialysis with hyperparathyroidism.     

跟腱断裂的护理与康复

跟腱是人体较为粗大的肌腱，协助跳跃、奔跑和负重等运动。跟腱断裂多在运动中发生，患者受伤时多有被击中的感觉，部分断裂者可行走，但不能提踵，有的患者未给予重视自行处理，造成跟腱断裂处形成瘢痕硬结。     

跟腱断裂手术治疗60例临床观察

目的观察跟腱断裂手术治疗的临床疗效。方法对60例跟腱断裂患者进行手术治疗,对患者进行随访,随访时间平均1.8年,观察患者手术后功能恢复情况,采用Arner Lindholm评分进行评价。结果按Arner Lindolm评分,优45例（75%）,良11例（19.4%）,差4例（5.6%）。结论手术治疗跟腱断裂能够取得良好的临床效果,严格无菌操作、术中修复跟腱周围组织、牢靠的缝合、术后正确的康复对于跟腱的愈合很重要。