Multiple spontaneous tendon ruptures from enthesis failure in primary hyperparathyroidism: a case report and review of imaging findings

Salah, Maaz Mohammad; Yong, Yan Rong; Poh, Wee Teng; Chong, Le Roy

doi:10.1007/s00256-018-3092-4

Cited by 4 publications

(1 citation statement)

References 21 publications

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“…This case report presents a bifocal injury to the knee extensor apparatus where both the patella and quadriceps tendons were fully torn along with a superior pole avulsion fracture of the patella. Although multiple ruptures to the ipsilateral quadriceps and patellar tendons are rare, similar injuries have been documented previously 3,5-9 . Kang et al proposed a classification system for bifocal knee extensor apparatus injuries with 5 types: (1) rupture of the patellar tendon at the tibial tubercle with avulsion of the tibial tubercle, (2) rupture of the patellar tendon at the tibial tubercle with avulsion of the inferior pole of the patella, (3) rupture of the quadriceps tendon at the superior pole of the patella with avulsion of the tibial tubercle, (4) avulsion of the inferior pole of the patella with avulsion of the tibial tubercle, and (5) avulsion of the patella and quadriceps tendons directly from their patellar attachments.…”

Section: Discussionsupporting

confidence: 72%

Tear of Quadriceps and Patellar Tendon with Superior Pole Avulsion of Patella

Kelmer

Johnson

Turcotte

et al. 2023

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Case: A 58-year-old man presented with right knee pain and inability to extend the knee after falling. magnetic resonance imaging (MRI) demonstrated complete rupture of the quadriceps tendon, avulsion of the superior pole patella, and a highgrade partial tear of the proximal patellar tendon. Surgical dissection revealed that both tendon tears were full-thickness disruptions. Repair was performed without complications. The patient achieved independent ambulation and passive range of motion from 0°to 118°at 3.8 years postoperatively.Conclusions: We present a case of a simultaneous ipsilateral tear of the quadriceps and patellar tendons with superior pole patella avulsion that resulted in a clinically successful repair. Extensor mechanism disruption of the knee due to complete tendon rupture of the quadriceps tendon occurs in 1.3% of the US population annually and rupture of the patellar tendon occurs in less than 0.5% 1,2 . Both injuries are more common in men; however, rupture of the patellar tendon is more common before 40 years while quadriceps tendon rupture is positively correlated with age 1,2 . Risk factors of tendon ruptures include chronic inflammation, chronic renal disease, hyperparathyroidism, diabetes mellitus, rheumatoid arthritis, and systemic lupus erythematosus 1,2 . Early diagnosis and surgical repair of these injuries is essential to optimize recovery and functionality. 1,2 Bifocal disruption of the knee extensor mechanism, or floating patella, is an uncommon injury and is more sparsely documented in the literature 3 . We present a case of simultaneous ipsilateral rupture of the quadriceps and patellar tendons with superior pole avulsion of the patella that resulted in a clinically successful repair.Written consent for publication was obtained from the patient. Case ReportA 58-year-old man presented to the emergency department with right knee pain and inability to straighten his right leg after a fall directly onto the anterior aspect of his knee.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C44).

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Section: Discussionsupporting

confidence: 72%

Tear of Quadriceps and Patellar Tendon with Superior Pole Avulsion of Patella

Kelmer

Johnson

Turcotte

et al. 2023

JBJS Case Connector

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Ultra-high field magnetic resonance imaging of the quadriceps tendon enthesis in healthy subjects

et al. 2023

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Primary Hyperparathyroidism in the Common Orthopaedic Practice

Sferopoulos¹

2021

TOORTHJ

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An extensive review of the publications on primary hyperparathyroidism (pHPT) is presented in this report. It has strongly been emphasized in the literature that patients with pHPT may present either with the classical symptomatology or with asymptomatic disease, emerged due to biochemical screening. The clinical and epidemiological presentation of pHPT in western countries has changed profoundly during the past few decades, and bone disease is nowadays a distinct rarity. The introduction of serum calcium screening for osteoporosis and the technological advances in the laboratory assessment of parathyroid hormone have played important roles in early diagnosis. Subsequently, the disease is increasingly being detected as asymptomatic hypercalcaemia without guiding signs or symptoms. A third type of disease, the normocalcaemic variant, has been recently described in the literature. However, the potential diagnosis of pHPT should always be on the orthopaedics’ list of differential diagnoses in female or elderly patients with vertebral fractures and nephrolithiasis, either symptomatic or asymptomatic, as well as when solitary or multiple osteolytic lesions are encountered on the radiographs. Additionally, a middle aged woman with parathyroid adenoma and subsequent brown tumors detected on the pelvic radiographs is reported. Her initial laboratory findings indicated a minimal increase of the serum calcium, a mild increase of the erythrocyte sedimentation rate, and a significant increase in total serum alkaline phosphatase. Finally, the detection of elevated parathyroid hormone levels indicated the diagnosis of pHPT and necessitated imaging studies of the parathyroid glands, which indicated a parathyroid adenoma. Following successful excision of the parathyroid adenoma, the patient suffered from the hungry bone syndrome. After a follow-up of 20 years, the patient had normal calcium, vitamin D, and parathyroid hormone serum levels, while a pelvic radiograph indicated no significant changes in the appearance of the brown tumors.

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Multiple spontaneous tendon ruptures from enthesis failure in primary hyperparathyroidism: a case report and review of imaging findings

Cited by 4 publications

References 21 publications

Tear of Quadriceps and Patellar Tendon with Superior Pole Avulsion of Patella

Tear of Quadriceps and Patellar Tendon with Superior Pole Avulsion of Patella

Ultra-high field magnetic resonance imaging of the quadriceps tendon enthesis in healthy subjects

Primary Hyperparathyroidism in the Common Orthopaedic Practice

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