Quadriceps Tendon Ruptures in Uremia

Abstract

Chronic renal failure and its sequelae, particularly secondary hyperparathyroidism, may be associated with spontaneous quadriceps tendon ruptures. This is a report of two cases of bilateral spontaneous simultaneous quadriceps tendon ruptures in uremia and a review of the literature. The level at which the tendon ruptures is inconstant. Light microscopy reveals nonspecific changes of degeneration and calcification. Under electron microscopy, the structure and maturity of collagen fibers are normal. The ruptures occur in patients younger than 40 years of age who reject medical treatment (i.e. oral phosphate binder) and have long-standing renal disease (mean = 12.3 years). The predisposing causes of rupture are unknown. An abnormality of collagen metabolism, ischemia, direct effects of parathormone, and dystrophic calcification are some of the possible contributory factors.

Association Between Statin Therapy and Tendon Rupture: A Case-Control Study

“…We found an association between chronic renal disease and tendon rupture, as has been described in previous studies. [11][12][13][14] The findings of our study must be interpreted with consideration of certain limitations. Like other case-control studies in medical centers, this single-site study may be prone to selection bias.…”

“…A 1-year time interval was used based on the temporal relationship noted in a previous study. 8 In addition to information about dose, duration, and specific type of statins used, data were abstracted about the following documented risk factors for tendon rupture: use of fluoroquinolones and corticosteroids 10 ; presence of chronic renal disease, [11][12][13] primary hyperparathyroidism, rheumatologic disease, and diabetes mellitus. 14,15 Tendon rupture was described as spontaneous if it occurred in the setting of activities of daily living (eg, climbing stairs or washing dishes) or provoked if it occurred during strenuous activities (eg, playing sports or falling down).…”

Quadriceps tendinosis and patellar tendinosis in professional beach volleyball players: sonographic findings in correlation with clinical symptoms

“…Calcification is also not a common phenomenon of tendon degeneration or tendon tearing. Calcifications within the quadriceps tendons have been reported in renal failure and secondary hyperparathyroidism [18] and occasionally within a soft-tissue mass with calcification representing the retracted quadriceps tendon in cases with complete quadriceps tendon tears [19]. Calcifications may be the results of a chronic inflammatory process as reaction to chronic repetitive tendon injury.…”

Role of secondary hyperparathyroidism in spontaneous rupture of the quadriceps tendon complicating chronic renal failure

“…In addition to the previous mechanism, high calcium phosphate product in such patients leads to dystrophic calcifications of soft tissue, which further weaken the tendon and participate in the rupture [7,8].…”