Department of Rheumatology, University Hospital of Ibn Rochd, Casablanca (Morocco), 72 rue Abou Dabi, Oasis, 20410, Casablanca, Morocco.
Department of Central Radiology, University Hospital of Ibn Rochd, Casablanca, Morocco.
BMC Musculoskelet Disord. 2020 Jul 21;21(1):477. doi: 10.1186/s12891-020-03513-w.
Patellar tendon rupture is a rare condition, especially when it is bilateral. The most frequent associated pathologies are systemic lupus erythematosus, chronic renal failure, or treatments like corticosteroids. The aim of this case report is to draw attention to the non-specific clinical aspect of this condition, to recall its radiological signs, and highlight the diagnostic contribution of musculoskeletal ultrasound.
A 39-year-old man was diagnosed with a systemic lupus erythematosus with cutaneous, pulmonary, cardiac, hematological, renal, and immunological manifestations. He was treated with high-dose corticosteroids. Within 3 months he presented with a total functional impotence of the knees. On physical examination, there was a gap in the right infrapatellar region, his patellae were abnormally ascended, and his left knee was swollen. Insall-Salvati ratio on knees conventional radiographies was 2.5 in the right and 2.25 in the left knee, assessing bilateral patella alta. Ultrasound revealed a complete and bilateral patellar tendon rupture. The treatment consisted in a surgical repair and physiotherapy. The patient was able to mobilize independently after 6 months.
Bilateral patellar tendon rupture is exceptional. Systemic lupus erythematosus and corticosteroids are among trigger factors. Careful examination of the patellae should be done in front of knee extension deficit. Ultrasound plays a determining role in the diagnosis.
髌腱断裂是一种罕见的情况，特别是双侧髌腱断裂更为罕见。最常见的相关疾病是系统性红斑狼疮、慢性肾衰竭或皮质类固醇等治疗方法。本病例报告的目的是提请注意这种情况的非特异性临床特征，回顾其放射学表现，并强调肌肉骨骼超声在诊断中的作用。
一名 39 岁男性被诊断为系统性红斑狼疮，伴有皮肤、肺部、心脏、血液、肾脏和免疫表现。他接受了大剂量皮质类固醇治疗。在 3 个月内，他出现了双侧膝关节完全功能丧失。体格检查时，右髌下区域有间隙，髌骨异常上移，左膝肿胀。双膝常规 X 线检查的 Insall-Salvati 比值在右侧为 2.5，在左侧为 2.25，提示双侧髌骨高位。超声显示双侧髌腱完全断裂。治疗包括手术修复和物理治疗。6 个月后，患者能够独立行走。
双侧髌腱断裂较为罕见。系统性红斑狼疮和皮质类固醇是其触发因素之一。在膝关节伸展受限的情况下，应仔细检查髌骨。超声在诊断中起着决定性的作用。
