Abstract
Objectives:
Chronic kidney Disease (CKD) describes the gradual loss of kidney function. Some studies have shown that patients with CKD also have a reduction in muscle quality, which translates into low muscle strength or physical performance per unit of muscle mass or volume. This concept of low muscle quality is closely associated with muscle fat infiltration (MFI). Quadriceps tendon rupture is a complication in patients with CKD. The aim of this paper is to report the pathophysiology of CKD leading to quadriceps tendon rupture.
Methods:
We report a case of quadriceps tendon rupture patient with CKD, that went seeking for orthopedic assistance 1 year after felt weakness at left lower limb with minimal trauma. A 31-year-old female patient was diagnosed CKD by an internist and undergoing routine hemodialysis since 2017.
From physical examination, there was a palpable defect 2 cm proximal to the superior pole of the patella with inability to perform a straight leg raise. Radiological result showed a patella baja, laboratory findings showed the level of parathyroid hormone increased, and MRI examination showed full-thickness tear at left quadriceps tendon.
Results:
There is no consensus on the cause of CKD that leads to tendon rupture. Muscle fat infiltration (MFI), also known as myo-steatosis refers to any deposit of lipids found in the skeletal muscle. In CKD, MFI has been associated with a decrease in muscle strength and impaired muscle quality. A vicious cycle can be initiated where higher MFI can change muscle fiber orientation, decrease muscle elasticity, contraction, and power, and thereby decrease muscle strength. MFI and low muscle quality have emerged as two important concepts in the operational definition of sarcopenia in CKD patient. These conditions diminished local circulation, impaired collagen metabolism, repeated microtrauma, loose joints due to repeated articular swelling, tendon calcification, chronic acidosis and nerve lesions, can contribute to tendon weakening, decreases in its elasticity, and lead to tendon rupture.
Tendon rupture occurred along the upper pole of each patella, at the osteo-ligamentous junction, where rupture is most common. This segment of the tendon is least perfused, and in patients with chronic renal insufficiency it is especially pronounced because of perivascular calcium phosphate deposits in soft tissues.
Conclusion:
Chronic Kidney Disease can cause quadriceps tendon rupture with some mechanisms. MFI is understood as a marker of muscle quality, where a muscle with higher fat deposition has lower contraction power and capacity to produce force per unit of muscle mass. In this patient, we plan to quadriceps reconstruction with suture anchors and a biopsy will be carried out to see whether there is muscle fat infiltration as the underlying pathology.