Bilateral Patellar Tendon Rupture in a 64-Year-Old Man: Possible Interaction of Inhaled Corticosteroids, Age and Mechanical Stress.

Bilateral rupture of the patellar tendon is a rare occurrence, most often associated with systemic disease or exposure to systemic corticosteroids or fluoroquinolones. We report the case of a 64-year-old man with bronchiectasis managed with long-term inhaled corticosteroids who sustained bilateral patellar tendon rupture following a low-energy deceleration while crossing the road. He underwent bilateral patellar tendon repair with medial and lateral retinacular reinforcement and was managed postoperatively with a structured rehabilitation programme. At 28-week follow-up, he remained independently ambulant with no evidence of tendon re-rupture. The patient had several recognised contributors to tendon vulnerability, including advanced age and prolonged inhaled corticosteroid exposure. Although inhaled corticosteroids confer lower systemic bioavailability than oral preparations, long-term use may contribute to tendon vulnerability, particularly when combined with additional mechanical or degenerative factors; however, causality cannot be confirmed. No histological analysis, preinjury imaging, or biochemical tendon assessment were available to characterise baseline tendon integrity. This case highlights the importance of enquiring about chronic inhaled corticosteroid use and considering the additive interaction of multiple risk factors when evaluating spontaneous tendon rupture.