Bilateral spontaneous rupture of the quadriceps tendon as an initial presentation of alkaptonuria--a case report.
ABSTRACT Unilateral rupture of the quadriceps tendon is not uncommon, but bilateral spontaneous quadriceps tendon rupture is a rare occurrence and is usually associated with some underlying predisposing condition. We describe a case of a previously healthy patient who presents with bilateral spontaneous rupture of both quadriceps tendon. Investigations revealed that he had underlying alkaptonuria which was previously undiagnosed. Alkaptonuria is a rare inborn metabolic disease, which results in the derangement of homogentisic acid metabolism. Excessive accumulation of homogentisic acid is known to affect multiple organ systems, resulting in tendinopathy and arthropathy in the muscoskeletal system.
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ABSTRACT: 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.Hydrometallurgy 02/2011; 2(1):35-39. DOI:10.1016/j.fjmd.2010.12.005 · 2.22 Impact Factor
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ABSTRACT: This article reviews the pathogenetic role of metabolic disorders, which are of paramount relevance to the progression of tendon damage. In diabetes, the prevalence of rheumatological diseases is high, mainly because of the deleterious effects of advanced glycation end products that deteriorate the biological and mechanical functions of tendons and ligaments. In heterozygous familial hypercholesterolaemia, most patients develop Achilles xanthomatosis, a marker of high risk for cardiovascular disease caused by cholesterol deposition in the tendons. Tendon degeneration has also been observed in non-familial hypercholesterolaemia. Monosodium urate crystal depositions in soft tissues are hallmarks of chronic gouty arthritis. In this group of diseases, the mobilization of cholesterol and uric acid crystals is presumably followed by low-grade inflammation, which is responsible for tendon degeneration. Adiposity may contribute to tendon disorders via two different mechanisms: increased weight on the load-bearing tendons and systemic dysmetabolic factors that trigger subclinical persistent inflammation. Finally, tendon abnormalities have been observed in some rare congenital metabolism disorders such as alkaptonuria.Rheumatology (Oxford, England) 01/2013; 52(4). DOI:10.1093/rheumatology/kes395 · 4.44 Impact Factor