Spontaneous bilateral quadriceps tendon rupture: A case report with review of the literature

Introduction: Spontaneous bilateral quadriceps tendon rupture is an exceptionally rare injury and is most often associated with systemic conditions, particularly end-stage renal disease (ESRD). Tendon fragility in ESRD patients increases the risk of rupture even after minimal trauma.
Case report: We report the case of a 28-year-old man undergoing chronic hemodialysis who presented with acute bilateral quadriceps tendon rupture following a minor domestic accident. Clinical evaluation revealed suprapatellar swelling and complete loss of active knee extension. Diagnostic imaging included plain radiographs and magnetic resonance imaging (MRI). The patient underwent bilateral surgical repair using transosseous sutures after preoperative hemodialysis, followed by standardized postoperative immobilization and rehabilitation. At three months, the patient achieved satisfactory functional recovery, with restored ambulation and independence in daily activities.
Discussion: This case illustrates the multifactorial mechanisms of tendon weakening in ESRD, including metabolic, vascular, and structural alterations. Early diagnosis and prompt surgical intervention are essential to achieve favorable outcomes, as delayed management is associated with significant functional impairment. Clinicians should maintain a high index of suspicion for quadriceps tendon rupture in ESRD patients presenting with sudden loss of knee extension, even after minor trauma.