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