607 - Acute Bilateral Quadriceps Tendon Rupture with Subsequent Post-Intervention Tendon Re-Rupture: A Case Report

Quadriceps tendon ruptures (QTRs) are uncommon musculoskeletal injuries, and furthermore the prevalence of bilateral QTRs is a rare occurrence. This case describes a 55-year-old male with chronic comorbidities who experiences a simultaneous bilateral QTR after falling when attempting to step down the stairs. Physical exam findings and radiological imaging confirm a bilateral complete suprapatellar tendon soft tissue tear, which is followed by an open surgical repair and inpatient rehabilitation. The patient subsequently re-ruptures his right quadriceps tendon, which is managed conservatively with home physical therapy.


Discussions:

Quadricep tendon ruptures most often occur from a sudden, hyper-eccentric contraction of the quadriceps complex, usually in an attempt to prevent a fall. Within this cohort are bilateral QTRs, which are a rarer occurrence and have a much lower prevalence compared to unilateral ruptures. Rupture of both tendons has more therapeutic barriers since the patient has severely limited ambulation and is significantly dependent when it comes to mobility and activities of daily living. When managing any patient with this pathology, one must consider the 1) the mechanism of injury, 2) risk factors involved and 3) appropriate multidisciplinary intervention that leads to restoration of knee function and long-term recovery. 


Conclusions: Bilateral quadriceps tendon ruptures are an uncommon phenomenon, and management faces significant challenges when planning/optimizing appropriate healthcare and therapy. Early diagnosis, surgery and therapy intervention is crucial for excellent outcomes in mobility restoration. Physiatrists and rehabilitation healthcare workers have the crucial and unique role of help a bilateral QTR patient restore as much functional capacity of the lower extremity as possible. The report aims to increase educational awareness of bilateral QTR presentation, diagnosis and follow-up management in hopes of promoting insight and discussion towards optimizing management.