Case report of a double spontaneous rupture: quadriceps tendon and contralateral Achilles tendon

Dr Soisic LECROCa, Dr Yan EGGELa, Dr Maria IAKOVAa

a Clinique Romande de Réadaptation SuvaCare

Uni or bilateral quadriceps tendon ruptures are rare (1.37 / 100,000 person-years), those of the Achilles tendon are more common (21.5 / 100,000 person-years). To our knowledge, concomitant combination of these two ruptures has not been reported in the literature. This case reports a spontaneous rupture of quadriceps tendon and of Achilles contralateral tendon.

54 years, athletic patient without comorbidity, known for a ruptured left quadriceps tendon two years ago. During a ski descent, he presents a complete spontaneous rupture of the right quadriceps tendon and partial rupture of the left Achilles tendon, both repaired surgically. A stationary environment rehabilitation allowed a full recovery.

Risk factors known in the literature for these tendon ruptures (1,2) (age, certain medications, anabolic steroids, certains systemic diseases, obesity, corticosteroid injections, static disorders in the knee or ankle, previous surgery) have not been found for this patient. The usually described triggers mechanisms could be found in this case (eccentric quadriceps contraction, sudden contraction of the sural triceps), occurring on tendons potentially weakened by repetitive microtrauma caused by intensive sport.

However, this double spontaneous rupture and the previous rupture of the contralateral quadriceps tendon 2 years ago are suggestive of tendon abnormalities. In case of repetition, an histological analysis of the ruptured tendon could be achieved to assess the organization and structure of collagen fibers, tenocytes and microvascularization (3). The search for a COL5A1 polymorphism also seems interesting because it has been associated with spontaneous tendon ruptures (3,4).

1. Saragaglia Orthopaedics & traumatology : surgery and research (2013). 2. Boudissa Orthopaedics & traumatology : surgery and research (2014). 3. Maffulli International Orthopaedics (2012). 4. Galasso Orthopedics (2012)

Keywords : rupture, tendon, quadriceps, Achilles