Orthopedic Traumatology B – University Hospital Mohammed VI Oujda

Simultaneous bilateral ruptures of the knee extensor mechanism, involving both quadriceps and patellar tendons, are exceedingly rare and severe injuries. They are strongly associated with systemic metabolic disorders such as chronic renal failure (CRF), diabetes, and secondary hyperparathyroidism. This report details a unique case and discusses the diagnostic and therapeutic challenges. A 38-year-old male with a history of insulin-dependent diabetes and CRF on hemodialysis sustained a low-energy fall. He presented with an inability to extend either knee. Clinical examination and radiographs suggested patellar tendon rupture on the right (patella alta) and quadriceps tendon rupture on the left (patella baja). Magnetic resonance imaging (MRI) confirmed a complete right patellar tendon rupture and a complete left quadriceps tendon rupture. The patient underwent urgent bilateral surgical repair using trans-osseous suture techniques, followed by a structured, gradual rehabilitation protocol. 73 This case underscores the profound vulnerability of tendons in patients with CRF, where metabolic alterations predispose to spontaneous or low-energy ruptures. A high index of suspicion is necessary for early diagnosis, which relies on clinical examination and MRI confirmation. Urgent surgical intervention and a carefully managed rehabilitation program are crucial for restoring functional knee extension and achieving a successful outcome.