Early, Bilateral Re-Rupture of Quadriceps Tendon After Previous Bone-Anchor Repair for Simultaneous, Low-Energy, Bilateral Quadriceps Rupture: A Case Report and Literature Review.

BACKGROUND Bilateral simultaneous quadriceps tendon rupture is a relatively rare injury, more commonly seen in patients older than 50 years and is usually associated with underlying metabolic or inflammatory diseases. CASE REPORT We report the case of an otherwise healthy, 42-year-old man who sustained a bilateral, quadriceps tendon rupture while he was trying to pound a branch of an olive tree into the ground. On clinical examination, a defect in both proximal patella poles was found on palpation, with complete discontinuity of the extensor apparatus. A meticulous surgical repair was performed using 3 bone anchors with an uneventful postoperative rehabilitation. A biopsy specimen taken at surgery showed evidence of chronic inflammation. He had a second episode while walking fast on the beach 3.5 months postoperatively, and presented again with bilateral quadriceps rupture. He was successfully managed with bilateral allograft reconstructions, showing a very good outcome at 18 months of follow-up. Our systematic literature review covering a 20-year period (2000-2020) revealed 10 articles on bilateral quadriceps ruptures in 14 healthy patients without comorbidities. All these injuries occurred in males, with a mean age of 56.8 years, during walking, descending stairs, or participating in recreational sports; the functional outcome was good to excellent in most cases, without any reported re-ruptures. To the best of our knowledge, no similar case has been reported in the literature. CONCLUSIONS Bilateral quadriceps tendons rupture is a rare injury, especially in young patients without associated comorbidities. The risk of recurrence is low, but when it occurs, more complex techniques of reconstruction are needed.