Simultaneous Bilateral Extensor Mechanism Disruptions: More Than Double the Trouble?

Abstract

Simultaneous bilateral extensor mechanism disruption (BEMD) is a rare condition, for which the relationship between comorbid conditions, complications, and clinical outcomes has not been well defined. We hypothesized that patients with BEMD would have more comorbidities, more repair failures, and worse clinical outcomes compared with patients with unilateral extensor mechanism disruption (UEMD). We performed a retrospective review of all adult patients seen at our institution for either a quadriceps or patellar tendon rupture between 2012 and 2017. Statistical analysis was conducted using Student's t-tests and Fisher's exact tests. Significance was defined as p < 0.05. Fourteen patients with BEMD and 221 patients with UEMD were included for comparison. The average length of follow-up was 268 days. Patients with BEMD had higher body mass indexes and higher American Society of Anesthesiologists scores than patients with UEMD. They also had worse Patient-Reported Outcomes Measurement Information System physical function scores, nearly four times the length of stay, and three times the rate of repair failures as patients with UEMD. At final follow-up, all 14 patients in the BEMD group were ambulatory and 9 of the 10 patients who were working prior to injury had returned to work. Simultaneous BEMD are rare injuries, occurring in only 6% of the current series. When treating these patients, orthopaedic surgeons should have a heightened awareness that they have more comorbidities, more failures, and worse functional outcomes than their unilateral counterparts.

A simultaneous bilateral quadriceps and patellar tendons rupture in patients with chronic kidney disease undergoing long-term hemodialysis: a case report

“…Therefore, ruptures of these tendons are uncommon injuries that occur mainly in middle-aged and older aged men. Simultaneous rupture of bilateral quadriceps tendons is rare, accounting for less than 5% of all cases and it's much more difficult to repair than a unilateral tendon rupture [10]. In addition, some research indicated there was an association between patella spurs and quadriceps tendon ruptures, we should pay more attention when the knee radiographs found a patella spur [11].…”

A Simultaneous Rupture of the Patellar Tendon and the Con-tralateral Quadriceps Tendon in a Patient with Chronic Renal Failure Undergoing Long Term Hemodialysis

“…So, Transection of these tendons is a rare injury and commonly affecting middle age and elderly men. Moreover, bilateral Simultaneous rupture of quadriceps tendons is rare, contributing to less than 5% of all ruptures of the quadriceps tendon and it’s more difficult to manage than a unilateral tendon rupture ( 13 ).…”

Rutura Crónica Bilateral do Tendão Quadricipital: Diagnóstico Tardio e Reparação Direta

“…A rutura bilateral crónica do tendão quadricipital é descrita como sendo de difícil tratamento e de longo período de recuperação. 12 O seu tratamento deve ser seguido de reabilitação funcional intensiva. 2 O diagnóstico e tratamento precoces são habitualmente descritos em associação a melhor resultado funcional.…”