Franco Helena, Fraser David
Department of Orthopaedic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia.
J Orthop Case Rep. 2024 Oct;14(10):124-129. doi: 10.13107/jocr.2024.v14.i10.4834.
Bilateral spontaneous patellar tendon ruptures are rare, though it is hypothesized to be more common in patients with risk factors such as connective tissue disorders such as Ehlers-Danlos syndrome (EDS), systemic disorders weakening collagen structures, chronic stress around the patellar tendon, medications, and obesity or sedentary lifestyles. Clinicians should maintain a high degree of clinical suspicion for concerning features on clinical examination and radiological investigations to facilitate prompt diagnosis and operative management. This case report describes the first documented case of an adult patient with EDS who sustained bilateral spontaneous patellar tendon ruptures. There is one previously reported acute bilateral patellar tendon rupture occurring in a pediatric patient with EDS. Within the adult literature, two case reports have reported patients with EDS: One acute unilateral patellar tendon rupture who underwent operative management and one chronic patellar tendon tear requiring reconstruction 2.5 years following initial end-to-end repair.
A 45-year-old male sustained bilateral patellar tendon ruptures after falling onto his knees while pushing a heavy cart. The patient reported a giving-way sensation and was unable to mobilize independently. On presentation to the emergency department, the patient was noted to have an absent straight-leg raise and a palpable gap between the distal pole of the patella and patellar tendon. Plain radiograph and ultrasound investigations confirmed bilateral complete patellar tendon ruptures. The patient underwent operative management 5 days following injury through bilateral direct patellar tendon repair utilizing the Krackow technique with transosseous fixation. Twelve months post-operatively, the patient had returned to pre-injuries activities of daily living, a full active range of motion without extensor lag, and recorded "fair knee function" on the Lysholm Knee Scoring Scale.
This case report described the first reported bilateral spontaneous patellar tendon rupture in an adult patient with EDS, who underwent operative management and achieved a return to pre-injury function. Furthermore, this case report summarizes the pre-existing literature on spontaneous bilateral patellar tendon ruptures and patellar tendon ruptures in patients with EDS.
双侧自发性髌腱断裂较为罕见，不过据推测，在患有诸如埃勒斯-丹洛斯综合征（EDS）等结缔组织疾病、削弱胶原蛋白结构的全身性疾病、髌腱周围慢性应激、药物以及肥胖或久坐不动生活方式等风险因素的患者中更为常见。临床医生在临床检查和影像学检查时应对相关特征保持高度临床怀疑，以便及时诊断和进行手术治疗。本病例报告描述了首例有文献记载的成年EDS患者双侧自发性髌腱断裂的病例。此前有一篇报道称一名患有EDS的儿科患者发生了急性双侧髌腱断裂。在成人文献中，有两篇病例报告涉及EDS患者：一例急性单侧髌腱断裂患者接受了手术治疗，另一例慢性髌腱撕裂患者在初次端端修复2.5年后需要进行重建。
一名45岁男性在推一辆重型手推车时膝盖着地后发生双侧髌腱断裂。患者自述有打软腿的感觉，无法独立活动。在急诊室就诊时，发现患者直腿抬高试验阴性，髌骨远端与髌腱之间可触及间隙。X线平片和超声检查证实双侧髌腱完全断裂。受伤5天后，患者通过采用Krackow技术经骨固定进行双侧直接髌腱修复接受了手术治疗。术后12个月，患者已恢复到受伤前的日常生活活动，主动活动范围完全正常，无伸肌滞后，并在Lysholm膝关节评分量表上记录为“膝关节功能尚可”。
本病例报告描述了首例有报道的成年EDS患者双侧自发性髌腱断裂，该患者接受了手术治疗并恢复到受伤前的功能。此外，本病例报告总结了关于自发性双侧髌腱断裂以及EDS患者髌腱断裂的现有文献。
