Spontaneous bilateral quadriceps rupture - A case report

Bilateral simultaneous quadriceps rupture is a rare entity. Its occurrence without associated aetiology is even rarer. It has a bimodal age distribution, with majority of cases occurring in population older than 50 years. Its occurrence in younger population is unusual. Aetiology is trauma, long term steroid usage, fluoroquinolone injections at local site or associated co-morbidities such as chronic renal failure, diabetes, obesity, hyperparathyroidism, endocrine disorders and gout, which via different mechanism lead to weakening of tendon thereby predisposing it to rupture. Surgical repair is the treatment of choice; it ranges from direct repair using Bunnel or Krackow sutures in acute cases to repair via lengthening procedures in chronic cases as described by Scuderi and Codivilla. Distal fixation to patella is a matter of debate in today's time as suture anchors have emerged as an alternative to trans-osseous repair. Although various studies have demonstrated good outcomes with suture anchors, biomechanical studies comparing the two techniques have shown conflicting results. We present a case of spontaneous bilateral quadriceps rupture in a young female without associated identifiable pathology. Also, we attempt to describe the Codivilla repair technique and discuss recent trends in quadriceps repair.