Elsevier

Injury

Volume 45, Issue 12, December 2014, Pages 1970-1973
Injury

Quadriceps tendon rupture in maintenance haemodialysis patients: Results of surgical treatment and analysis of risk factors

https://doi.org/10.1016/j.injury.2014.09.008Get rights and content

Abstract

Background

Reports of spontaneous quadriceps ruptures in end-stage renal disease (ESRD) patients are scarce, and the assessment of risk factors for tendon rupture is poorly addressed in the majority of the studies. The purpose of the present study is to report a series of patients on haemodialysis with spontaneous quadriceps tendon ruptures operated at our institution. The results of the surgical treatment are described and the potential risk factors associated with the rupture are analyzed.

Methods

Our study consisted of retrospective analysis of patient's charts. Clinical and laboratory findings of the operated group were compared to the ones of a control group of haemodialysis patients matched by age, gender, and time on haemodialysis, but without tendon rupture.

Results

Between 1998 and 2010, six ESRD patients with 11 spontaneous ruptures of the quadriceps tendon were treated at our institution. On postoperative evaluation all patients were able to walk without crutches after six months of follow-up, and there were no new ruptures. Positive serology for Hepatitis C was present in two cases (33%) but in none of the controls (p = 0.034). Mean serum levels of intact parathormone (iPTH) and alkaline phosphatase were both higher in cases (p = 0.013 and p = 0.034, respectively). In contrast, mean serum levels of albumin, ferritin and haemoglobin were all lower in cases (p = 0.008, p = 0.043 and p = 0.016, respectively).

Conclusion

Reconstructive surgery is a good way to restore knee function in ESRD patients with quadriceps tendon ruptures. Our cases exhibited higher levels of iPTH and alkaline phosphatase than control patients, reinforcing the role of secondary hyperparathyroidism in tendon weakening. They also had a higher frequency of hepatitis C and lower levels of albumin and haemoglobin compared to controls, possibly implicating chronic inflammation as a potential risk factor for tendon rupture.

Introduction

Rupture of a quadriceps tendon has a great impact on knee function and, as a consequence, on independent walking ability. It can result from trauma or occur spontaneously in subjects with systemic disorders like gout [1], [2], rheumatoid arthritis [2], systemic lupus [3], hyperparathyroidism [4], [5], [6], and end-stage renal disease (ESRD) [7], [8], [9], [10], [11], [12], [13]. Spontaneous ruptures in ESRD patients are uncommon and reports of this condition in the literature are scarce, most of them consisting of case reports [11], [14]. Of note, the assessment of risk factors for tendon rupture is poorly addressed in the majority of the studies, although a long time on haemodialysis and the presence of secondary hyperparathyroidism seem to be factors commonly present in patients with spontaneous tears [4], [10], [15]. Regardless of the cause, surgery is the treatment of choice as it is associated with the best results [14], [16], [17].

The purpose of the present study is to report a series of patients on haemodialysis with spontaneous quadriceps tendon ruptures operated at our institution, emphasizing the results of the surgical treatment. Also, in a search for factors that may play a role in the genesis of rupture, clinical and laboratory findings of the cases were compared to the ones of a control group of haemodialysis patients matched by age, gender, and time on haemodialysis, but without tendon rupture.

Section snippets

Materials and methods

Enrolled cases were operated in the Orthopaedic Division of the University Hospital. The control group consisted of haemodialysis patients in a proportion of two controls for each case, recruited among three haemodialysis centres from the county and surroundings. They were matched by age, gender, and time on haemodialysis but did not have tendon rupture.

The study consisted of a retrospective analysis of patients’ charts. It was approved by the Ethical Committee of the Medical School/University

Results

Between 1998 and 2010, six patients with 11 spontaneous quadriceps tendon ruptures were surgically treated at our hospital. They were two males and four females, with a mean age of 44 ± 12 years (Table 2). All patients had end-stage renal disease (ESRD) and were on maintenance haemodialysis for 7.7 ± 2.9 years by the time of rupture. None of them was diabetic. The cause of the end-stage renal disease was hypertension (n = 4), chronic glomerulonephritis (n = 1), and unknown (n = 1).

Four patients had

Discussion

Quadriceps tendon ruptures are uncommon in otherwise healthy people. Bilateral tears are even less frequent, and when occurring in a spontaneous fashion are usually associated with systemic disorders that lead to tendon weakening and rupture [1], [13].

We are reporting a series of 11 cases of quadriceps tendon tears in ESRD patients addressing their surgical treatment, the obtained results and the potential risk factors related to the rupture.

Our patients were predominantly women in the fifth

Conflict of interest

All authors declare that there are no conflict of interest that could inappropriately influence (bias) this work.

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