Simultaneous bilateral quadriceps tendon rupture in a uremic patient

Quadriceps is a part of extensor mechanism, and it is a strong muscle bundle for knee joint movement. It rarely ruptures in the general population. We present a case with simultaneous bilateral quadriceps tendon rupture and discuss the causes. A 45-year-old man had a history of end stage renal disease and received regular hemodialysis treatment for more than 12 years. He met with a stumbling accident while walking down stairs that resulted in painful swelling in both knees, which disabled him from walking. In the beginning, the radiogram showed no fracture, but magnetic resonance imaging examination showed bilateral quadriceps tendon rupture. Primary quadriceps tendon repair was performed, and the result was satisfactory after serial rehabilitation program. He was noted to have hypercalcemia 3 months later, and hyperparathyroidism with hypertrophic parathyroid gland was found on sonogram. Thyroidectomy was done, and postoperative status was uneventful. The range of motion of both knee joints got satisfactory recovery. The blood calcium level was well in control with vitamin D and calcium carbonate. No seizure occurred. Simultaneous bilateral quadriceps tendon rupture after trivial injury is uncommon. If it does occur, then the presence of some chronic underlying disease should be thoroughly investigated. Early treatment has a better result than the delayed cases.