Simultaneous bilateral rupture of quadriceps tendons: analysis of risk factors and associations.ABSTRACT Background. Simultaneous bilateral quadriceps tendon In human anatomy, the quadriceps tendon connects the quadriceps femoris muscles to the superior aspects of the patella on the anterior of the thigh. rupture is an uncommon injury that is frequently misdiagnosed. It has been associated with multiple medical conditions See carpal tunnel syndrome, computer vision syndrome, dry eyes and deep vein thrombosis. including renal disease Renal disease Kidney disease. Mentioned in: Glycogen Storage Diseases hypertension High blood pressure Cardiovascular disease An abnormal ↑ systemic arterial pressure, corresponding to a systolic BP of > 160 mm Hg , rheumatologic disorders, and endocrine disorders. Methods. All reported cases of simultaneous bilateral quadriceps tendon rupture were identified using MEDLINE The online medical database of the U.S. National Library of Medicine (NLM) whose parent is the National Institutes of Health, Bethesda, MD. MEDLINE contains millions of articles from thousands of medical journals and publications. The consumer section of the site (http://medlineplus. . Each case was reviewed for information regarding the injury, and this information was analyzed. Results. There were 66 cases of simultaneous bilateral quadriceps tendon rupture reported in the English-language literature. This review presents descriptive data on all the cases and analyzes the following factors surrounding rupture: age, sex, time before diagnosis, mechanism of injury, location of rupture, and associated chronic diseases. Most patients were treated surgically, followed by 4 to 6 weeks of immobilization Immobilization Definition Immobilization refers to the process of holding a joint or bone in place with a splint, cast, or brace. This is done to prevent an injured area from moving while it heals. , which resulted in a good outcome. Conclusion. Numerous associations were found and are discussed in this review. Patients with quadriceps tendon rupture should be evaluated for an underlying chronic disease. ********** UNILATERAL RUPTURE of the quadriceps tendon is a common injury and has been well reported. (1) However, simultaneous bilateral rupture of the quadriceps tendons is uncommon. It generally occurs from a fall down stairs or is spontaneous. (2) Steiner and Palmer (3) reported the first case of simultaneous bilateral rupture of the quadriceps tendon in 1949. Since that initial report, 66 cases have been reported in the English-language literature, but there has never been a thorough review or analysis of all the cases in the literature. This paper is the first to review all the cases of simultaneous bilateral quadriceps tendon rupture since Steiner and Palmer's original description and to analyze the various associations with this injury. MATERIALS AND METHODS A MEDLINE search was done using the keywords bilateral, quadriceps quadriceps /quad·ri·ceps/ (kwod´ri-seps) having four heads. quad·ri·ceps n. The large four-part extensor muscle at the front of the thigh. adj. , tendon, rupture, spontaneous, and simultaneous in various combinations. Each article was reviewed to ensure the cases were bilateral and simultaneous. To ensure finding all the reported cases, the references in the articles acquired that were not found in the MEDLINE search were further investigated. After the review process, a total of 66 cases of simultaneous bilateral quadriceps tendon rupture were found in the literature, and the information regarding each case is recorded in the Table. Statistical analysis regarding various associations was done using the Fisher exact test. A P value of < .05 was used as the criterion for statistical significance. RESULTS Epidemiology Historically, bilateral quadriceps tendon rupture occurred most commonly in men more than 50 years old. (4,5) However, many of the cases reported recently in the literature are in younger individuals with chronic illnesses. (4,6) Of the 66 patients described, 53 (80%) were male and 13 (20%) were female. The youngest patient was 22 years of age and the oldest was 84. The mean age of all the patients was 51 years (median, 51.5 years). The mean age for female patients was 44 years old (range 22 to 76 years, median 39 years) while the mean age for males was 53 years old (range 22 to 84 years, median 54 years). Male patients were more likely to be older (P < .05). Sex was not related to type of chronic disease (P > .05). Age has been shown to predispose pre·dis·pose v. To make susceptible, as to a disease. patients to rupture). (6) Younger individuals were more likely to have chronic renal failure chronic renal failure Chronic kidney failure Nephrology A slow decline in renal function, which may be 2º to chronic HTN, DM, CHF, SLE, or sickle cell anemia and, if extreme, leads to ESRD, mandating kidney dialysis; an abrupt decline in renal function may be , gout gout, condition that manifests itself as recurrent attacks of acute arthritis, which may become chronic and deforming. It results from deposits of uric acid crystals in connective tissue or joints. , hyperparathyroidism Hyperparathyroidism Definition Parathyroid glands are four pea-sized glands located just behind the thyroid gland in the front of the neck. The function of parathyroid glands is to produce a hormone called parathyroid hormone (parathormone), which helps , or a previous history of rupture, whereas adolescents were more likely to be involved in direct trauma leading to rupture. (4,6) Older individua ls were more likely to have diabetes mellitus diabetes mellitus Disorder of insufficient production of or reduced sensitivity to insulin. Insulin, synthesized in the islets of Langerhans (see Langerhans, islets of), is necessary to metabolize glucose. In diabetes, blood sugar levels increase (hyperglycemia). , obesity or other unknown risk factors. (6) The results of this review showed that younger individuals were more likely to have chronic renal disease or an endocrine disorder, whereas older patients were more likely to be obese, hypertensive hypertensive /hy·per·ten·sive/ (-ten´siv) 1. characterized by increased tension or pressure. 2. an agent that causes hypertension. 3. a person with hypertension. , or have some other risk factor (P < .05). No known cause was reported in 12 cases. Mechanism of Injury Bilateral quadriceps tendon rupture is an injury that is associated with falling down stairs or spontaneously occurring while walking. (7-10) This review showed that 41 cases (65%) were attributed to falls and missteps, and 22 cases (35%) occurred spontaneously while walking. Older individuals were more likely to have ruptured tendons due to a fall (P < .05), whereas sex and type of chronic disease did not correlate with mechanism of injury (P > .05). Pathophysiology pathophysiology /patho·phys·i·ol·o·gy/ (-fiz?e-ol´ah-je) the physiology of disordered function. path·o·phys·i·ol·o·gy n. 1. Sudden violent contraction of the quadriceps muscles in the presence of a flexed knee joint and a fixed foot may lead to rupture. (7) However, McMaster (11) noted that normal tendons should not rupture under this stress. In the absence of trauma, generally an underlying condition leads to abnormal tendons that rupture under ordinary stress. Risk factors for quadriceps rupture include diabetes mellitus, advanced age, pararthyroidism, chronic renal failure, obesity, systemic lupus erythematosus Systemic Lupus Erythematosus Definition Systemic lupus erythematosus (also called lupus or SLE) is a disease where a person's immune system attacks and injures the body's own organs and tissues. Almost every system of the body can be affected by SLE. , steroid use, and gout. (8,12-15) The underlying pathophysiology that leads to rupture varies with the disease process. In this review, simultaneous bilateral rupture of the quadriceps tendon occurred most often in patients with renal disease (43%). Studies have reported a relationship between duration of hemodialysis hemodialysis /he·mo·di·al·y·sis/ (-di-al´i-sis) removal of certain elements from the blood by virtue of the difference in rates of their diffusion through a semipermeable membrane while being circulated outside the body; the process and duration of renal failure renal failure n. Acute or chronic malfunction of the kidneys resulting from any of a number of causes, including infection, trauma, toxins, hemodynamic abnormalities, and autoimmune disease, and often resulting in systemic symptoms, especially edema, with tendon ruptures tendon rupture, n tearing of a tendon that occurs when the forces placed upon the tendon exceed its tensile strength. . (16) This review showed that only duration of dialysis was related to spontaneous tendon rupture (P < .05). The underlying mechanism causing rupture in chronic renal failure is poorly understood. It is thought that chronic acidemia acidemia /ac·i·de·mia/ (as?i-de´me-ah) increased acidity of the blood. For those characterized by increased concentration of a specific acid, see at the acid. associated with chronic renal disease degenerates Band History The Premiere punk rock band, Degenerates originated in Grosse Pointe Park, Michigan in 1979 [1], during the formative years of the Detroit hardcore scene[2]. tendons. (2) Also, uremia uremia (y  rē`mēə), condition resulting from advanced stages of kidney failure in which urea and other nitrogen-containing wastes are found in the blood. may affect the structure of the protein-polysaccharide complex,
which is responsible for the maturation of collagen. (16) This
disruption may lead to rupture.
Endocrine disorders associated with rupture are hyperparathyroidism and diabetes. Secondary hyperparathyroidism secondary hyperparathyroidism Endocrinology ↑ Parathyroid activity with overproduction of PTH due to parathyroid hyperplasia in response to an extraparathyroid defect that results in ↓ Ca2+ Etiology Rickets, vitamin D deficiency, chronic renal failure associated with chronic renal disease was present in 16 cases (28%), while primary hyperparathyroidism primary hyperparathyroidism Parathyroid related hypercalcemia Endocrinology Parathyroid gland hyperactivity with excess PTH secretion because of hyperplasia or adenoma of 1 or more glands Clinical Calcium deposits may occur in bone, the GI tract, kidney, muscle, was present in only 3 cases (5%). Hyperparathyroidism causes clystrophic calcifications and sub-periosteal bone resorption Bone resorption is the process by which osteoclasts break down bone and release the minerals, resulting in a transfer of calcium from bone fluid to the blood. The osteoclasts are multi-nucleated cells that contain numerous mitochondria and lysosomes. , which weakens the osseotendionus junction and leads to tendon rupture. (6,16) An increase in parathyroid hormone parathyroid hormone or parathormone, a hormone secreted by the parathyroid glands that regulates the metabolism of calcium and phosphate in the body. (PTH PTH abbr. parathyroid hormone Parathyroid hormone (PTH) A chemical substance produced by the parathyroid glands. This hormone is a major element in regulating calcium in the body. ) and alkaline phosphatase alkaline phosphatase /al·ka·line phos·pha·tase/ (ALP) (fos´fah-tas) an enzyme that catalyzes the cleavage of orthophosphate from orthophosphoric monoesters under alkaline conditions. has been documented before rupture. (12,16,17) Diabetes mellitus was present in 6 cases (10%). Patients with diabetes have fibrinous fibrinous /fi·brin·ous/ (fi´brin-us) pertaining to or of the nature of fibrin. fibrinous pertaining to or of the nature of fibrin. necrosis necrosis /ne·cro·sis/ (ne-kro´sis) pl. necro´ses [Gr.] the morphological changes indicative of cell death caused by progressive enzymatic degradation; it may affect groups of cells or part of a structure or an organ. with calcifications and arteriosclerosis arteriosclerosis (ärtĭr'ēōsklərō`sis), general term for a condition characterized by thickening, hardening, and loss of elasticity of the walls of the blood vessels. with an inflammatory reaction found on pathologic analysis of their tendons. (6,8,15) Steroid use accounted for 3 cases of rupture (5%). Steroid use is thought to alter the structure of collagen, thus leading to tendon rupture. (18) Gout and pseudogout accounted for 3 cases (5%). Gout is believed to cause fibrinoid necrosis fibrinoid necrosis 'Smudgy' eosinophilic fibrin-like deposits, of degenerated collagen or ground substance, in arterial walls of Pts with malignant HTN and periarteritis nodosa; FN may also occur in the Arthus reaction, acute rheumatic fever, SBE, near peptic and chronic inflammation chronic inflammation n. Inflammation that may have a rapid or slow onset but is characterized primarily by its persistence and lack of clear resolution; it occurs when the tissues are unable to overcome the effects of the injuring agent. leading to tendon rupture. (6,10) Obesity was present in 9 cases (16%). Obesity is thought to cause fatty changes in the tendon. (4,6) Patients who are obese also place greater stress on their knees when flexed. It has been reported that older individuals are predisposed pre·dis·pose v. pre·dis·posed, pre·dis·pos·ing, pre·dis·pos·es v.tr. 1. a. To make (someone) inclined to something in advance: to rupture. (6) There were 34 cases of rupture in older individuals (age >50). Age-related changes in the tendon include fatty degeneration fatty degeneration n. The accumulation of fat globules within the cells of an organ, such as the liver or heart, resulting in deterioration of tissue and diminished functioning of the affected organ. , tendon sclerosis, tendon infiltration and fibrinoid degeneration fibrinoid degeneration or fibrinous degeneration n. A form of degeneration in which tissue, such as connective tissue or blood vessels, accumulates deposits of an acidophilic homogeneous material that resembles fibrin when stained. , and a decrease in the strength and number of collagen fibers collagen fiber or collagenous fiber n. An individual scleroprotein fiber composed of fibrils and usually arranged in branching bundles of indefinite length. Also called white fiber. . (4,6) Hypertension was present in 6 cases (10%). Hypertension has never been directly reported as a risk factor, but it may cause tendon rupture through its association with other conditions such as obesity and renal disease, or it may be related to age-related changes and athlerosclerosis. Multiple diseases were present in 25 cases. Patients with multiple diseases were younger (P < .05) and female (P < .05). However, multiple chronic diseases were not associated with location of injury, mechanism of injury, or time interval for diagnosis (P > .05). Clinical Findings Patients with bilateral quadriceps rupture most often complain of knee pain. There is a history of a fall onto flexed knees or a sudden, sharp pain above the patella patella (pətĕl`ə): see kneecap. , with inability to stand without assistance. Physical examination often reveals a palpable gap above the patella known as the "gap test" or "sulcus sign sulcus sign Orthopedics A joint laxity test used clinically to diagnose shoulder instability. See Laxity test, Shoulder instability. Cf Provocative test. ." Patients will be unable to actively extend the knee, but passive range of motion and active knee flexion flexion /flex·ion/ (flek´shun) the act of bending or the condition of being bent. flex·ion n. 1. The act of bending a joint or limb in the body by the action of flexors. 2. will be normal. Other physical signs include a mobile, free-floating patella, hemarthrosis, and absent patellar reflexes patellar reflex n. A reflex contraction of the quadriceps muscle resulting in a sudden involuntary extension of the leg, produced by a sharp tap to the tendon below the patella. . (19-21) Laboratory and Radiologic Findings No specific laboratory test is diagnostic of ruptures; however, laboratory testing may aid in identifying the underlying disease process. For patients less than 50 years of age, it is important to rule out endocrine, rheumatologic, and renal disease. The workup work·up n. Abbr. w/u A thorough medical examination for diagnostic purposes. for these diseases includes measurement of serum electrolytes, blood urea nitrogen blood urea nitrogen n. Abbr. BUN Nitrogen in the form of urea in the blood or serum, used as a indicator of kidney function. Blood urea nitrogen (BUN) , creatinine creatinine /cre·at·i·nine/ (kre-at´i-nin) an anhydride of creatine, the end product of phosphocreatine metabolism; measurements of its rate of urinary excretion are used as diagnostic indicators of kidney function and muscle mass. , glucose, thyroid function, uric acid uric acid (y r`ĭk), white, odorless, tasteless crystalline substance formed as a result of purine degradation in man, other primates, dalmatians, birds, snakes, and lizards. , alkaline
phosphatase, calcium, phosphorous phos·pho·rousadj. Of, relating to, or containing phosphorus, especially with a valence of 3 or a valence lower than that of a comparable phosphoric compound. , and antinuclear antibodies Antinuclear antibodies Autoantibodies that attack substances found in the center, or nucleus, of all cells. Mentioned in: Antinuclear Antibody Test . Radiologic workup can include plain radiographs, ultrasonography ultrasonography /ul·tra·so·nog·ra·phy/ (-so-nog´rah-fe) the imaging of deep structures of the body by recording the echoes of pulses of ultrasonic waves directed into the tissues and reflected by tissue planes where there is a change in , and magnetic resonance imaging magnetic resonance imaging (MRI), noninvasive diagnostic technique that uses nuclear magnetic resonance to produce cross-sectional images of organs and other internal body structures. (MRI 1. (application) MRI - Magnetic Resonance Imaging. 2. MRI - Measurement Requirements and Interface. ). Findings on plain films are nonspecific nonspecific /non·spe·cif·ic/ (non?spi-sif´ik) 1. not due to any single known cause. 2. not directed against a particular agent, but rather having a general effect. nonspecific 1. , but they help rule out other possible conditions such as a fracture. Nonspecific findings on plain films include effusion effusion /ef·fu·sion/ (e-fu´zhun) 1. escape of a fluid into a part; exudation or transudation. 2. effused material; an exudate or transudate. , calcifications, soft tissue defects, forward-tilting patella, or low-lying patella. (2,7,22) Also seen is a distal displacement of the patella with calcification calcification /cal·ci·fi·ca·tion/ (kal?si-fi-ka´shun) the deposit of calcium salts in a tissue. dystrophic calcification in the quadriceps or a bone fragment from avulsion The immediate and noticeable addition to land caused by its removal from the property of another, by a sudden change in a water bed or in the course of a stream. When a stream that is a boundary suddenly abandons its bed and seeks a new bed, the boundary line does not change. of the superior pole of the patella. Recently, ultrasonography has been used for diagnosing tendon disease and was used in 2 of the reported cases of rupture. (2,18) Ultrasonography can be done quickly at the bedside for immediate results, but it is operator dependent. Although MRI is a more expensive method of diagnosing a rupture than ultrasonography, MRL MRL Medical Record Librarian; now called Medical Record Administrator. MRL maximum residue limit. is the test of choice for preoperative pre·op·er·a·tive adj. Preceding a surgical operation. preoperative preceding an operation. preoperative care the preparation of a patient before operation. identification of anatomy, including the exact location of the rupture. It is the best noninvasive test for evaluating the surrounding soft tiss ues and ligaments, and it was used in 6 cases. (2,23-25) Diagnosis Diagnosis of bilateral quadriceps rupture is a clinical one. The history of a fall or bilateral knee pain with inability to actively extend the knee, along with a palpable gap in the supra-patellar region, is highly suggestive of suggestive of Decision making adjective Referring to a pattern by LM or imaging, that the interpreter associates with a particular–usually malignant lesion. See Aunt Millie approach, Defensive medicine. bilateral quadriceps tendon rupture. Ultrasonography and MRI can aid in uncertain cases or can be used for preoperative details. The definitive diagnosis of rupture is by direct visualization during surgery. Direct visualization allows localization Customizing software and documentation for a particular country. It includes the translation of menus and messages into the native spoken language as well as changes in the user interface to accommodate different alphabets and culture. See internationalization and l10n. of the rupture. The tendon can rupture at three sites: the osseotendinous junction, the musculotendionous junction, or within the tendon. Dhar (5) stated that the most common location for rupture was the musculotendinous junction. This review shows that 12 cases were in the musculotendinous junction, 23 cases in the osseotendinous junction, and 3 cases within the tendon. In 2 cases, each side had a different location of rupture. Others have stated that location of rupture is age dependent, with younger individuals having rupture within the tendon and older patients having rupture at the osseotendinous junction. This review of all reported cases, however, showed older patients were more likely to have rupture at the musculotendinous junction and younger individuals were more likely to have rupture at the osseotendinous insertion (P < .05). Further, spontaneous ruptures were more likely to occur at the osseotendinous junction (P < .05). Neither time interval before diagn osis nor sex was associated with location of tendon rupture (P > .05). Bilateral rupture may be misdiagnosed up to 50% of the time. (26) The differential diagnosis differential diagnosis n. Determination of which one of two or more diseases with similar symptoms is the one from which the patient is suffering. Also called differentiation. for knee pain is extensive, since the pain may be from soft tissue structures, ligaments, tendon ruptures (either quadriceps or patellar patellar of or pertaining to the patella. patellar cartilage a cartilaginous process borne on the medial side of the patella of horses and cattle. ), or bone fractures. Quadriceps ruptures have been misdiagnosed as neurologic neurologic /neu·ro·log·ic/ (-loj´ik) pertaining to neurology or to the nervous system. Neurologic Having to do with the nervous system. disorders such as stroke and paralysis, as well as an acute flare of rheumatoid arthritis rheumatoid arthritis Chronic, progressive autoimmune disease causing connective-tissue inflammation, mostly in synovial joints. It can occur at any age, is more common in women, and has an unpredictable course. and knee effusions and sprains. (26) The awareness of risk factors and clinical features associated with injury are important in correct diagnosis, proper treatment, and good functional outcome. Treatment It has been reported that immediate surgical intervention is imperative. In this review, there was 1 case in which nonoperative treatment alone led to full recovery, but the recovery time was longer. (27) In 3 cases, nonoperative treatment on one side resulted in full recovery, but recovery time was greater. (28,29) Nonoperative treatment includes immobilzation with a plaster splint splint, rigid or semiflexible device for the immobilization of displaced or fractured parts of the body. Most commonly employed for fractures of bones, a splint may be a first-aid measure that allows the patient to be moved without displacing the injured part, or it , cylindrical cast, or commercial immobilizer im·mo·bi·lize tr.v. im·mo·bi·lized, im·mo·bi·liz·ing, im·mo·bi·liz·es 1. To render immobile. 2. To fix the position of (a joint or fractured limb), as with a splint or cast. 3. . Surgery is generally viewed as the preferred treatment, and surgical intervention was done in all but 1 of the 66 cases (98%). Numerous surgical techniques have been described in the literature. (6,7,28) The technique used for repair depends on many factors such as the surgeon's preference and training. Postoperative post·op·er·a·tive adj. Happening or done after a surgical operation. postoperative after a surgical operation. postoperative care treatment involves immobilization in a cast and physical therapy after removal of the cast to regain range of motion and strength. The length of immobilization varies, though most advocate at least 6 weeks. In 43 cases, duration of plaster cast immobilization was 4 to 6 weeks. The shortest duration of immobilization was 2 weeks (by an elastic band), and the longest duration was 6 months (in a locked knee brace). (3,29) Outcomes Follow-up was mentioned in 80% of cases (53/66). A majority of those patients (57%) had a good outcome (full range of motion or strength). However, 10 patients (19%) had an extensor extensor /ex·ten·sor/ (-ser) [L.] 1. causing extension. 2. a muscle that extends a joint. ex·ten·sor n. A muscle that extends or straightens a limb or body part. lag, 7 (13%) walked with an assistive device assistive device Public health Any device designed or adapted to help people with physical or emotional disorders to perform actions, tasks, and activities. See Americans with Disabilities Act, Architectural barriers, Assistive technology. , and 6 (11%) had an extensor lag and used an assistive device at follow-up. Most patients (12 cases) were seen at 4 months for follow-up (range 30 days to 5 years, median 4 months). CONCLUSION In patients who have had a fall or who have spontaneous knee pain along with inability to actively extend the knee, a diagnosis of quadriceps tendon rupture should be suspected. This review showed associated factors that surround rupture. Patients who also had renal or endocrine disorders were younger. In younger patients, rupture more often occurred at the osseotendinous junction. Ruptures at the osseotendinous junction were associated with a fall as the mechanism of injury. Males with injury were younger. Older patients had ruptured tendons from falling down, whereas younger patients had spontaneous rupture. Patients with multiple diseases were younger. These associations are important to recognize and remember when evaluating suspected rupture. Also, patients presenting with quadriceps tendon rupture should be evaluated for an underlying chronic medical condition such as renal disease, diabetes, or rheumatologic disease, since the rupture may be the first sign of underlying illness.
TABLE
Reported Cases of Simultaneous Bilateral Quadriceps Tendon Rupture (N =
66)
Age/ Time Before
Reference Year Sex Mechanism Diagnosis
Steiner and Palmer (3) 1949 67/M NM 2 days
Goldenberg and Paterson (30) 1949 65/M Spontaneous 5 days
Wetzler and Merkow (31) 1950 46/M Spontaneous 47 days
Wilson (32) 1957 32/M Fall Same day
Scuderi (28) 1958 70/F NM NM
1958 68/M NM NM
Preston and Adicoff (14) 1962 33/M Spontaneous 8 mo
Dalal and Whittam (33) 1966 63/M Fall Same day
MacDonald (34) 1966 49/M Fall 5 mo
Levy et al (10) 1971 54/M Spontaneous Same day
Preston (21) 1972 43/F Fall 9 mo
Firooznia et al (8) 1973 62/M Fall NM
Brotherton and Ball (35) 1975 54/M Fall Same day
Norris and Levack (19) 1977 57/M Fall NM
Morein et al (36) 1977 39/F Fall NM
Newberg and Wales (37) 1977 71/M Fall NM
Pejic et al (38) 1977 64/M Spontaneous Same day
Siwek and Rao (39) 1978 82/M Fall Same day
Lotem et al (12) 1978 32/M Fall NM
1978 38/F Fall 4 mo
Stern and Harwin (15) 1980 60/M Fall Same day
Grenier and Guimont (40) 1983 39/M Spontaneous 1 day
Julius (4) 1984 58/M Fall Same day
MacEachern and Plewes (41) 1984 68/M Fall 4 wk
1984 84/M Fall 7 days
1984 54/M Fall Same day
1984 80/M Fall 6 days
1984 74/M Fall 1 day
Bhole et al (16) 1985 38/F Fall NM
1985 30/M Fall Same day
Bhole and Johnson (22) 1985 71/M Fall NM
Lavalle et al (42) 1985 28/M Spontaneous 5 days
Suman (43) 1985 68/M Fall NM
Young (44) 1985 57/M Fall Same day
Novoa et al (13) 1987 23/F Spontaneous NM
1987 30/M Spontaneous NM
Stephens and Anderson (2) 1987 22/M Fall Same day
Lauerman et al (9) 1987 26/F Fall 1 day
Dhar (5) 1988 75/M Fall 7 days
1988 61/M Fall 1 day
1988 82/M Fall Same day
Keogh et al (45) 1988 70/M Fall 14 wk
1988 71/F Fall Same day
1988 72/M Fall 10 days
Anderson and Haberman (27) 1988 24/M NM NM
Ribbans and Angus (6) 1989 76/F Fall 3 wk
Ryuzaki et al (46) 1989 50/M Spontaneous NM
Sagiv et al (20) 1989 78/M Spontaneous 3 days
Provelegios et al (47) 1991 46/F Fall 40 days
1991 35/F Spontaneous Same day
1991 33/M Fall Same day
1991 36/M Fall NM
1991 50/F Spontaneous Same day
Karr et al (53) 1993 53/M Fall Same day
De Franco et al (17) 1994 41/M Spontaneous Same day
Mont et al (48) 1994 22/F Spontaneous 3 days
Nabors and Kremchek (49) 1995 41/M Spontaneous NM
1995 43/M Fall 2 wk
David et al (50) 1995 32/M Spontaneous NM
Liow and Tavares (18) 1995 29/M Fall Same day
Lombardi et al (25) 1995 30/M Spontaneous 2 days
Oladipo et al (26) 1997 71/M Fall Same day
Calvo et al (51) 1997 39/M Spontaneous 3 wk
Abitar and Chuet (23) 1998 30/M Spontaneous NM
Dunnick (52) 2000 42/M Spontaneous Same day
Tedd et al (29) 2000 58/M Spontaneous 16 wk
Method Location
Reference of Repair of Tear
Steiner and Palmer (3) Op NM
Goldenberg and Paterson (30) Op Osseotend
Wetzler and Merkow (31) Op NM
Wilson (32) OP Osseotend
Scuderi (28) Nonop and op NM
Nonop and op NM
Preston and Adicoff (14) Op Osseotend
Dalal and Whittam (33) Op Osseotend
MacDonald (34) Op Osseotend
Levy et al (10) Op NM
Preston (21) Op Osseotend
Firooznia et al (8) Op Musculotend
Brotherton and Ball (35) Op Musculotend
Norris and Levack (19) Op Musculotend
Morein et al (36) NM NM
Newberg and Wales (37) Op NM
Pejic et al (38) Op Musculotend
Siwek and Rao (39) Op Musculotend
Lotem et al (12) Op Musculotend
Op Within tendon
Stern and Harwin (15) Op Musculotend
Grenier and Guimont (40) Op Osseotend
Julius (4) Op Musculotend
MacEachern and Plewes (41) Op NM
Op NM
Op NM
Op NM
Op NM
Bhole et al (16) Op Osseotend
Op Within tendon
Bhole and Johnson (22) Op Musculoted
Lavalle et al (42) Op Within tendon
Suman (43) Op Osseotend
Young (44) Op Musculotend
Novoa et al (13) Op NM
Op NM
Stephens and Anderson (2) Op Osseotend
Lauerman et al (9) Op NM
Dhar (5) Op Musculotend
Op NM
Op NM
Keogh et al (45) Op NM
Op NM
Op NM
Anderson and Haberman (27) Nonop NM
Ribbans and Angus (6) Op Osseotend
Ryuzaki et al (46) Op Osseotend
Sagiv et al (20) Op Osseotend
Provelegios et al (47) Op Osseotend
Op Osseotend
Op Osseotend
Op NM
Op NM
Karr et al (53) Op Osseotend
De Franco et al (17) NM Osseotend
Mont et al (48) Op Osseotend
Nabors and Kremchek (49) Op Osseotend
Op Osscotend and
musculotend
David et al (50) Op Osseotend
Liow and Tavares (18) Op Osseotend
Lombardi et al (25) Op Osseotend
Oladipo et al (26) Op Musculotend
Calvo et al (51) Op Osseotend and
within tendon
Abitar and Chuet (23) NM NM
Dunnick (52) Op NM
Tedd et al (29) Nonop and op NM
Chronic
Reference Disease
Steiner and Palmer (3) Obesity
Goldenberg and Paterson (30) NM
Wetzler and Merkow (31) History of rupture
Wilson (32) CRF
Scuderi (28) NM
NM
Preston and Adicoff (14) Primary hyperPTH
Dalal and Whittam (33) Obesity
MacDonald (34) NM
Levy et al (10) Gout, CRF
Preston (21) Primary hyperPTH
Firooznia et al (8) DM, obesity
Brotherton and Ball (35) DM
Norris and Levack (19) None
Morein et al (36) CRF, secondary hyperPTH, HD
Newberg and Wales (37) NM
Pejic et al (38) None
Siwek and Rao (39) None
Lotem et al (12) CRF, secondary hyperPTH, HD
CRF, secondary hyperPTH, HD
Stern and Harwin (15) DM
Grenier and Guimont (40) None
Julius (4) Obesity
MacEachern and Plewes (41) None
None
Obesity
None
DM
Bhole et al (16) Polycystic kidneys, HD, HTN
CRF, secondary hyperPTH, HTN
Bhole and Johnson (22) DM
Lavalle et al (42) Primary hyperPTH
Suman (43) None
Young (44) None
Novoa et al (13) CRF, SLE, steroid use
HD, kidney transplantation
Stephens and Anderson (2) CRF, secondary hyperPTH, HD,
obesity
Lauerman et al (9) CRF, secondary hyperPTH,
CAPD
Dhar (5) Obesity, HTN
Obesity
HTN
Keogh et al (45) Possible gout (hyperuricemia)
NM
NM
Anderson and Haberman (27) CRF, secondary hyperPTH
Ribbans and Angus (6) HTN
Ryuzaki et al (46) CRF, secondary hyperPTH, HD
Sagiv et al (20) NM
Provelegios et al (47) CRF, HD
CRF, secondary hyperPTH
CRF, secondary hyperPTH, HD
CRF, secondary hyperPTH, HD
CRF, secondary hyperPTH
Karr et al (53) CRF, secondary hyperPTH
De Franco et al (17) CRF, secondary hyperPTH,
HD, HTN
Mont et al (48) CRF
Nabors and Kremchek (49) None
Obesity
David et al (50) Steroid use
Liow and Tavares (18) Steroid use
Lombardi et al (25) CRF, HD
Oladipo et al (26) None
Calvo et al (51) None
Abitar and Chuet (23) CRF, secondary
byperPTH, HD
Dunnick (52) CRF, secondary
hyperPTH
Tedd et al (29) DM, pseudogout
Postoperative
Reference Regimen
Steiner and Palmer (3) Elastic band for 2 wk
Goldenberg and Paterson (30) Plaster casts for 3 wk
Wetzler and Merkow (31) Plaster casts for 8 wk
Wilson (32) Died
Scuderi (28) NM
NM
Preston and Adicoff (14) Plaster casts for 6 wk
Dalal and Whittam (33) Plaster casts for 6 wk
MacDonald (34) Plaster casts for 6 wk
Levy et al (10) Plaster casts for 6 wk
Preston (21) Plaster casts for 5 wk
Firooznia et al (8) NM
Brotherton and Ball (35) Plaster casts for 6 wk
Norris and Levack (19) NM
Morein et al (36) Plaster casts for 6 wk
Newberg and Wales (37) NM
Pejic et al (38) Plaster casts
Siwek and Rao (39) Plaster casts for 6 wk
Lotem et al (12) Plaster casts for 4-6 wk
Plaster casts for 6 wk
Stern and Harwin (15) Plaster casts for 6 wk
Grenier and Guimont (40) Plaster casts for 5 wk
Julius (4) Plaster casts for 4 wk
MacEachern and Plewes (41) Plaster casts for 7 wk
Plaster casts for 6 wk
Plaster casts for 6 wk
Plaster casts for 6 wk
Plaster casts for 6 wk
Bhole et al (16) Plaster casts for 4 wk, then
remove splints for 4 wk
Plaster casts for 4 wk, then
remove splints for 4 wk
Bhole and Johnson (22) Plaster casts for 6 wk
Lavalle et al (42) Plaster casts for 7 wk
Suman (43) Plaster casts
Young (44) NM
Novoa et al (13) Plaster casts for 6 wk
Plaster casts for 6 wk
Stephens and Anderson (2) NM
Lauerman et al (9) Plaster casts for 6 wk, then
knee immobilized for 6 wk
Dhar (5) Plaster casts for 6 wk
Plaster casts for 6 wk
Plaster casts for 6 wk
Keogh et al (45) Plaster casts for 4 k
Plaster casts for 6 wk
Plaster casts for 6 wk
Anderson and Haberman (27) Elevation and B compress
dressing for 5 days, tlsen
plaster casts
Ribbans and Angus (6) Plaster casts for 6 wk
Ryuzaki et al (46) NM
Sagiv et al (20) Plaster casts for 6 wk
Provelegios et al (47) Plaster casts for 6 wk
Plaster casts for 6 wk
Plaster casts for 6 wk
Plaster casts for 6 wk
Plaster casts for 6 wk
Karr et al (53) Plaster casts for 6 wk
De Franco et al (17) NM
Mont et al (48) Plaster casts for 6 wk,
then braces for 3 wk
Nabors and Kremchek (49) Plaster casts for 6 wk
FWB in locking
braces in ext
David et al (50) Plaster casts for 6 wk
Liow and Tavares (18) Plaster casts for 8 wk
Lombardi et al (25) Plaster casts for 6 wk
Oladipo et al (26) Braces for 6 wk
Calvo et al (51) Plaster casts for 6 wk
Abitar and Chuet (23) NM
Dunnick (52) NM
Tedd et al (29) Locked knee brace
Reference Outcome
Steiner and Palmer (3) AD after 5 wk
Goldenberg and Paterson (30) FROM at 4 mo
Wetzler and Merkow (31) FROM at 4 mo
Wilson (32) Died
Scuderi (28) NM
NM
Preston and Adicoff (14) FROM at 7 mo
Dalal and Whittam (33) Ext lag at 10 wk
MacDonald (34) Ext lag at 3 mo
Levy et al (10) AD at 4 mo
Preston (21) Ext lag at 2 yr
Firooznia et al (8) NM
Brotherton and Ball (35) FROM at 3 mo
Norris and Levack (19) Ext lag at 6 wk
Morein et al (36) FROM
Newberg and Wales (37) NM
Pejic et al (38) AD after 30 days
Siwek and Rao (39) FROM at 3 mo
Lotem et al (12) FROM
FROM at 3 mo
Stern and Harwin (15) FROM at 6 mo
Grenier and Guimont (40) FROM at 7 mo
Julius (4) FROM at 4 mo
MacEachern and Plewes (41) Ext lag after 9 mo
Ext lag and AD after 10 wk
Ext lag and AD after 6 mo
Ext lag and AD after 8 wk
AD after 4 mo
Bhole et al (16) FROM at 16 wk
FROM at 16 wk
Bhole and Johnson (22) Ext lag at 2 yr
Lavalle et al (42) FROM
Suman (43) FROM at 4 mo
Young (44) FROM at 11 mo
Novoa et al (13) NM
NM
Stephens and Anderson (2) FROM at 10 wk
Lauerman et al (9) Ext lag at 3 mo
Dhar (5) Ext lag and AD at 4 mo
FROM at 5 mo
Ext lag and AD at 6 wk
Keogh et al (45) Ext lag and AD at 5 yr
FROM at 5 yr
Ext lag at 4 mo
Anderson and Haberman (27) Ext lag at 6 mo and
FROM at 3 yr
Ribbans and Angus (6) Ext lag and AD at 3 mo
Ryuzaki et al (46) NM
Sagiv et al (20) FROM at 4 mo
Provelegios et al (47) FROM at 3 mo
FROM at 3 yr
FROM at 9 mo
FROM at 1 yr
NM
Karr et al (53) FROM at 2 yr
De Franco et al (17) NM
Mont et al (48) FROM at 1 yr
Nabors and Kremchek (49) FROM at 2 yr
AD at 6 mo
David et al (50) Ext lag at 1 yr
Liow and Tavares (18) Ext lag at 4 mo
Lombardi et al (25) FROM at 3 yr
Oladipo et al (26) FROM at 18 mo
Calvo et al (51) FROM
Abitar and Chuet (23) NM
Dunnick (52) NM
Tedd et al (29) AD at 6 mo
NM = Not mentionedfor 6 mo
Op = Operative
AD = assistive device
FROM = full range of motion
CRF = chronic renal failure
Nonop = nonoperative
PTH = parathyroidism
Ext = extensor
DM = diabetes
HD = hemodialysis
HTN = hypertension
CAPD = continuous ambulatory peritoneal dialysis
FWB = full weight bearing.
References (1.) Rougraff BT, Reeck CC, Essenmacher J: Complete quadriceps tendon ruptures. Orthopedics 1996; 19:509-514 (2.) Stephens B, Anderson G Jr: Simultaneous bilateral quadriceps tendon rupture: a case report and subject review. J Emerg Med 1987; 5:481-485 (3.) Steiner C, Palmer L: Simultaneous bilateral rupture of quadriceps tendon. Am J Surg 1949; 78:752-755 (4.) Julius AJ: Rupture of the quadriceps tendon. Neth J Surg 1984; 36:134-136 (5.) Dhar S: Bilateral, simultaneous, spontaneous rupture of the quadriceps tendon, a report of 3 cases and a review of the literature. Injury 1988; 19:7-8 (6.) Ribbans WJ, Angus PD: Simultaneous bilateral rupture of the quadriceps tendon. Br J Clin Pract l989 43:122-125 (7.) Walker LG, Glick H: Bilateral spontaneous quadriceps tendon ruptures: a case report and review of the literature. Orthop Rev 1989; 18:867-871 (8.) Firooznia H, Seliger G, Abrams R, et al: Bilateral spontaneous and simultaneous rupture of the quadriceps tendon. Bull Hosp Joint Dis 1973; 34:65-69 (9.) Lauerman WC, Smith BG, Kenmore PI: Spontaneous bilateral rupture of the extensor mechanism of the knee in two patients on chronic ambulatory peritoneal dialysis peritoneal dialysis n. The removal of soluble substances and water from the body by transfer across the peritoneum, utilizing a solution which is intermittently introduced into and removed from the peritoneal cavity. . Orthopedics 1987; 10:589-591 (10.) Levy M, Seelenfreund M, Maor P, et al: Bilateral spontaneous and simultaneous rupture of the quadriceps tendons in gout. J Bone and Joint Surg Br 1971; 53:510-513 (11.) McMaster P: Tendon and muscle ruptures, clinical and experimental studies on the causes and location of subcutaneous subcutaneous /sub·cu·ta·ne·ous/ (sub?ku-ta´ne-us) beneath the skin. sub·cu·ta·ne·ous adj. Abbr. s.c., SQ Located, found, or placed just beneath the skin; hypodermic. ruptures. J Bone and Joint Surg 1933; 15:705-722 (12.) Lotem M, Berheim J, Conforty B: Spontaneous rupture of tendons, a complication of hemodialyzed patients treated for renal failure. Nephron nephron: see urinary system. nephron Functional unit of the kidney that removes waste and excess substances from the blood to produce urine. Each of the million or so nephrons in each kidney is a tubule 1.2–2.2 in. (30–55 mm) long. 1978; 21:201-208 (13.) Novoa D, Romero R, Forteza J: Spontaneous bilateral rupture of the quadriceps tendon in uremia and kidney transplantation Kidney Transplantation Definition Kidney transplantation is a surgical procedure to remove a healthy, functioning kidney from a living or brain-dead donor and implant it into a patient with non-functioning kidneys. . Clin Nephrol 1987; 27:48 (14.) Preston F, Adicoff A: Hyperparathyroidism with avulsion of three major tendons: report of a case. N Engl J Med 1962; 266:968-970 (15.) Stern R, Harwin S: Spontaneous and simultaneous rupture of both quadriceps tendons. Clin Orthop 1980; 147:188-189 (16.) Bhole R, Flynn J, Marbury T: Quadriceps tendon ruptures in uremia. Clin Orthop 1985; 195:200-206 (17.) De Franco P, Varghese J, Brown W, et al: Secondary hyperparathyroidism, and not beta 2-microglobulin Beta 2-microglobulin Protein produced by B-cells; high concentrations in the blood are indicative of multiple myeloma. Mentioned in: Multiple Myeloma amyloid amyloid /am·y·loid/ (am´i-loid) 1. starchlike; amylaceous. 2. the pathologic, extracellular, waxy, amorphous substance deposited in amyloidosis, being composed of fibrils in bundles or in a meshwork of polypeptide , as a cause of spontaneous tendon rupture in patients on chronic hemodialysis. Am J Kidney Dis 1994; 24:951-955 (18.) Liow RY, Tavares S Tavares may refer to several things: Surname Tavares is a common surname in the Portuguese language, namely in Portugal and Brazil and other places – especially very common in the Cape Verde islands. It was originally a Toponym. : Bilateral rupture of the quadriceps tendon associated with anabolic steroids Anabolic steroids A group of drugs derived from the male sex hormone testosterone, most commonly prescribed to promote growth or to help the body repair tissues weakened by severe illness or aging. Some anabolic steroids are given as appetite stimulants. . Br J Sports Med 1995; 29:77-79 (19.) Norris M, Levack B: Bilateral simultaneous rupture of the quadriceps tendon: a case report. Injury 1977; 8:315-316 (20.) Sagiv P, Gepstein R, Amdur B, et al: Bilateral spontaneous rupture of the quadriceps tendons misdiagnosed as a "neurological neurological, neurologic pertaining to or emanating from the nervous system or from neurology. neurological assessment evaluation of the health status of a patient with a nervous system disorder or dysfunction. condition." J Am Geriatr Soc 1989; 37:750-752 (21.) Preston E: Avulsion of both quadriceps tendons in hyperparathyroidism. JAMA JAMA abbr. Journal of the American Medical Association 1972; 221:406-407 (22.) Bhole R, Johnson J: Bilateral simultaneous spontaneous rupture of quadriceps tendons in a diabetic patient. South Med J 1985; 78:486 (23.) Abitar S, Chuet C: Bilateral spontaneous avulsion of quadriceps tendons. Nephrol Dial Transplant 1998; 13:817 (24.) Barasch E, Lombardi L, Arena L, et al: MRI visualization of bilateral quadriceps tendon rupture in a patient with secondary hyperparathyroidism: implications for diagnosis and therapy. Comput Med Imaging Graph 1989; 13:407-410 (25.) Lombardi L, Cleri D, Epstein E: Bilateral spontaneous quadriceps tendon rupture in a patient with renal failure. Orthopedics 1995; 18:187-191 (26.) Oladipo O, Whitelaw G, Shah B: Bilateral simultaneous rupture of the quadriceps tendon. Am J Knee Surg 1997; 10:89-91 (27.) Anderson W III, Haberman E: Spontaneous bilateral quadriceps tendon rupture in a patient on hemodialysis. Orthop Rev 1988; 17:411-414 (28.) Scuderi G: Ruptures of the quadriceps tendon, study of 20 tendon ruptures. Am J Surg 1958; 9:626-635 (29.) Tedd RJ, Norton MR, Thomas WG: Bilateral simultaneous atraumatic atraumatic /atrau·mat·ic/ (a?traw-mat´ik) not producing injury or damage. atraumatic not producing injury or damage. atraumatic adjective Without injury quadriceps tendon ruptures associated with 'pseudogout.' Injury 2000; 31:467-469 (30.) Goldenberg R, Paterson N: Bilateral rupture of the quadriceps tendon. J Med Soc NJ 1949; 46:349 (31.) Wetzler S, Merkow W: Bilateral, simultaneous and spontaneous rupture of the quadriceps tendon. JAMA 1950; 144:615-616 (32.) Wilson J: Bilateral rupture of rectus femoris rectus femoris n. A muscle with origin from the ilium and the acetabulum, with insertion into a tendon of the quadriceps muscle of the thigh. tendons in chronic nephritis chronic nephritis Chronic glomerulonephritis, see there . BMJ BMJ n abbr (= British Medical Journal) → vom BMA herausgegebene Zeitschrift 1957; 1:1402-1403 (33.) Dalal V, Whittam D: Bilateral simultaneous rupture of the quadriceps tendon. BMJ 1966; 2:1370 (34.) MacDonald J: Bilateral subcutaneous rupture of the quadriceps tendon: report of a case with delayed repair. Can J Surg 1966; 9:74-77 (35.) Brotherton B, Ball J: Bilateral simultaneous rupture of the quadriceps tendons. Br J Surg 1975; 62:918-920 (36.) Morein G, Goldschmidt Z, Pauker M, et al: Spontaneous tendon ruptures in patients treated by chronic hemodialysis. Clin Orthop 1977; 124:209-213 (37.) Newberg A, Wales Wales, Welsh Cymru, western peninsula and political division (principality) of Great Britain (1991 pop. 2,798,200), 8,016 sq mi (20,761 sq km), west of England; politically united with England since 1536. The capital is Cardiff. L: Radiographic radiographic (rā´dēōgraf´ik), adj relating to the process of radiography, the finished product, or its use. diagnosis of quadriceps tendon rupture. Radiology 1977; 125:367-371 (38.) Pejic R, Principato E, Liepa B: Simultaneous bilateral and complete rupture of the quadriceps extensor mechanism. J Med Soc NJ 1977; 74:1069-1072 (39.) Siwek K, Rao J: Bilateral simultaneous rupture of the quadriceps tendons. Clin Orthop 1978; 131:252-254 (40.) Grenier R, Guimont A: Simultaneous bilateral rupture of the quadriceps tendon and leg fractures in a weightlifter, a case report. Am J Sports Med 1983; 11:451-453 (41.) MacEachern AG, Plewes JL: Bilateral simultaneous spontaneous rupture of the quadriceps tendons, five case reports and a review of the literature. J Bone Joint Surg Br 1984; 66:81-83 (42.) Lavalle C, Aparicio LA, Moreno J, et al: Bilateral avulsion of quadriceps tendons in primary hyperparathyrodism. J Rheumatol 1985; 12:596-598 (43.) Suman RK: Bilateral simultaneous traumatic avulsion of the quadriceps tendon. Aust N Z J Surg 1985; 55:513-515 (44.) Young T: Simultaneous traumatic rupture of the quadriceps tendons. Arch Emerg Med 1985; 2:37-39 (45.) Keogh P, Shanker S Shank´er n. 1. (Med.) See Chancre. , Burke T, et al: Bilateral simultaneous rupture of the quadriceps tendons: a report of four cases and review of the literature. Clin Orthop 1988; 234:139-141 (46.) Ryuzaki M, Konishi K, Kasuga A, et al: Spontaneous rupture of the quadriceps tendon in patients on maintenance hemodialysis, report of three cases with clinicopathological observations. Clin Nephrol 1989; 32:144-148 (47.) Provelegios S, Markakis P, Cambouroglou G, et al: Bilateral, spontaneous and simultaneous rupture of the quadriceps tendon in chronic renal failure and secondary hyperparathyroidism, report of five cases. Arch Anat Cytol Pathol 1991; 39:228-232 (48.) Mont M, Torres J, Tsao A: Hypocalcemic-induced tetany tetany (tĕt`ənē), condition of mineral imbalance in the body that results in severe muscle spasms. Tetany occurs when the concentration of calcium ions (Ca++) in extracellular fluids such as plasma falls below normal. that causes triceps triceps, any muscle having three heads, or points of attachment, but especially the triceps brachii at the back of the upper arm. One head originates on the shoulder blade and two on the upper-arm bone, or humerus. and bilateral quadriceps tendon ruptures. Orthop Rev 1994; 23:57-60 (49.) Nabors ED, Kremchek TE: Bilateral rupture of the extensor mechanism of the knee in healthy adults. Orthopedics 1995; 18:477-479 (50.) David HG, Green JT, Grant AJ, et al: Simultaneous bilateral quadriceps rupture: a complication of anabolic steroid anabolic steroid (ăn'əbŏl`ĭk stĕr`oid, stĭr`–) or androgenic steroid (ăn'drōjĕn`ĭk) abuse. J Bone Joint Surg Br 1995; 77:159-160 (51.) Calvo E, Ferrer A, Robledo AG, et al: Bilateral simultaneous spontaneous quadriceps tendons rupture, a case report studied by magnetic resonance imaging. Clin Imaging 1997; 21:73-76 (52.) Dunnick N: Image interpretation session: 1999. bilateral quadriceps tendon rupture and multiple brown tumors brown tumor Osteitis fibrosa cystica Nephrology A hyperparathyroidism-induced tumor-like mass of bony tissue characterized by fibrosis, cyst formation, marked osteoclastic resorption, multinucleated giant cells, and hemosiderin–which imparts the brown color in a patient with a secondary hyperparathyroidism. Radiographics 2000; 20:262-263 (53.) Kaar TK, O'Brien M, Murray P, et al: Bilateral quadriceps tendon rupture. a case report. Ir J Med Sci 1993; 162:502 RELATED ARTICLE: KEY POINTS * The triad of a history of a fall, the inability to actively extend the knees, and palpable suprapatellar gaps is highly suggestive of a simultaneous bilateral quadriceps tendon rupture. * Surgical intervention is the preferred method of treatment, with a postoperative course of immobilization for 4 to 6 weeks in a cast, followed by physical therapy. * Younger patients with this injury should be evaluated for an underlying medical condition, especially a renal or endocrine disease. From the Department of Physical Medicine and Rehabilitation physical medicine and rehabilitation or physiatry or physical therapy or rehabilitation medicine Medical specialty treating chronic disabilities through physical means to help patients return to a comfortable, productive life despite a medical , Spaulding Rehabilitation rehabilitation: see physical therapy. Hospital/Harvard Medical School, Boston, Mass. Reprint reprint An individually bound copy of an article in a journal or science communication requests to Mrugeshkumar K. Shah, MD, MPH, MS, 10 Summer St, Apt 303S, Malden, MA 02148. |
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