Yasen Sam K, Foster Aaron J, Thakrar Raj R
Department of Trauma and Orthopaedics, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, Hampshire.
J Orthop Case Rep. 2019;9(4):88-91. doi: 10.13107/jocr.2250-0685.1494.
Rupture of the extensor mechanism is a relatively common injury, most frequently occurring as a result of patella fracture, while ruptures of the quadriceps tendon and patellar ligament are less common. Extensor mechanisms of healthy knees are able to tolerate large forces before rupturing; therefore, complete ruptures without significant trauma are due to minor injury to an already degenerate or attenuated tendon. Hyperlipidemia has been linked as a cause of tendon degeneration due to the systemic biological effect that it has on tenocytes. Non-identical bilateral ruptures are rare. To the best of our knowledge, this is the only case report of bilateral ruptures involving the quadriceps tendon of one knee and patellar ligament of the contralateral knee simultaneously.
A 42-year-old man presented to our department with bilateral traumatic rupture of the extensor mechanism of the knee. He had no medical history, was not taking any regular medications, and had no significant family history but a 15-year history of anterior knee pain. Both of his legs gave way on landing from a jump. Radiographs demonstrated a knee effusion with normal patella height on the left and a knee effusion with an elevated patella on the right. A diagnosis of quadriceps tendon rupture on the left and patellar ligament rupture on the right was made.
Hyperlipidemia has been associated with ruptures of the Achilles tendon but has not been reported in association with failure of the extensor mechanism of the knee. We suggest that all patients presenting with bilateral tendon ruptures, especially in the absence of systemic disease or corticosteroid therapy, are investigated for hyperlipidemia and treated accordingly.
伸膝装置断裂是一种相对常见的损伤，最常因髌骨骨折导致，而股四头肌腱和髌韧带断裂则较少见。健康膝关节的伸膝装置在断裂前能够承受较大力量；因此，无明显创伤的完全断裂是由于已经退变或减弱的肌腱受到轻微损伤所致。高脂血症因对肌腱细胞的全身生物学效应而被认为是肌腱退变的一个原因。非对称性双侧断裂很少见。据我们所知，这是唯一一例同时涉及一侧膝关节股四头肌腱和对侧膝关节髌韧带双侧断裂的病例报告。
一名42岁男性因双侧膝关节伸膝装置创伤性断裂前来我科就诊。他无病史，未服用任何常规药物，也无明显家族史，但有15年的膝前疼痛病史。他从高处跳下落地时双腿均无力支撑。X线片显示左侧膝关节有积液，髌骨高度正常，右侧膝关节有积液，髌骨抬高。诊断为左侧股四头肌腱断裂和右侧髌韧带断裂。
高脂血症与跟腱断裂有关，但尚未见与膝关节伸膝装置失效相关的报道。我们建议，所有出现双侧肌腱断裂的患者，尤其是在没有全身性疾病或皮质类固醇治疗的情况下，都应进行高脂血症检查并相应治疗。
