Abstract
Introduction & Objectives:
In orthopaedic medicine, a quadriceps tendon rupture (QTR) is an uncommon finding that needs appropriate surgical care to prevent permanent deformity and loss of knee function. Diabetic patients may experience spontaneous quadriceps tendon rupture due to compromised microvascular supply, which puts the quadriceps tendon at risk for fiber degradation and a reduced resistance. Early surgical management is needed to reinsert the tendon at the superior aspect of the patella. Here, we aimed to describe a rare case and the surgical technique of bilateral simultaneous quadriceps tendon rupture in a diabetic patient.
Case Presentation:
A 78-year-old man with a history of diabetes presented at the hospital due to his inability to straighten his left leg, accompanied by pain. His left knee showed swelling, limited range of motion, and a visible gap in the quadriceps tendon above the patella. The patient had intact pulses in the leg. Radiographic images displayed displacement of the patella, and MRI revealed a disrupted tendon with bleeding and swelling. A preliminary diagnosis of quadriceps tendon rupture was made. The patient underwent surgery to repair the tendon, in this patient we use midline incision, refreshed the ruptured ends. We use tape sutured with Bunnel technique and two suture anchor were running locked krackow stitiches to get more rigid fixation. After operation patient received post-operative rehabilitation with brace is fixed in full extension for 1 weeks and exercise isometrically. Patient can mobilization but uses 2 crutches. After 1 week of immobilization, the range of motion is increased gradually by 10° of flexion per 1-week periods. His final knee range of motion was 0° to 125° in both legs after an entire course of physiotherapy. He was discharged from the clinic after six months and returned to work.
Conclusions:
Quadriceps tendon rupture is a rare injury that is typically accompanied by a chronic medical condition. Therefore, as the rupture may be the first indication of an underlying problem, patients with bilateral QTR should be assessed for underlying pathologies such as diabetes mellitus or other endocrine disorders, renal, autoimmune, or rheumatologic diseases and we must use rigid fixation because in this chronic medical condition, patient has the risk of reruptured.