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The New England Journal of MedicineImages in Clinical Medicine: Quadriceps Tendon Ruptures

Quadriceps Tendon Rupture in Chronic Kidney Disease: A Rare but Significant Complication

A 38-year-old man with end-stage renal disease presented with progressive difficulty in walking, leading to a diagnosis of quadriceps tendon rupture in both knees. This rare condition, often associated with chronic kidney disease and secondary hyperparathyroidism, underscores the complex interplay between systemic diseases and musculoskeletal health.

Key Points

  • The patient had been dealing with progressive walking difficulty for several years.
  • Initial symptoms began with acute pain and swelling in both knees after a minor accident.
  • Physical examination revealed a soft-tissue depression proximal to the patella and a palpable suprapatellar gap at the expected quadriceps tendon insertion site.
  • The patient was unable to extend his knees and walked with flexed knees.
  • Laboratory studies indicated secondary hyperparathyroidism.
  • Radiographs showed inferior displacement of the patellae, leading to a diagnosis of quadriceps tendon rupture.
  • Quadriceps tendon rupture may occur spontaneously or with minimal trauma in patients with chronic kidney disease and secondary hyperparathyroidism.
  • The patient declined surgical repair and was lost to follow-up.

HCN Medical Memo
Because the kidneys are unable to effectively remove β2-m from the blood in renal disease patients, this leads to an accumulation of β2-m in the blood and tissues, including the muscles, which can ultimately lead to muscle ruptures.

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