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General Rehabilitation

Falling on My Knees: A Rare Case of Bilateral Quadriceps Tendon Repeat Rupture

Thursday, November 16, 2023

    Primary Author(s)

  • Monika Schmitt, DO (she/her/hers)

    Resident Physician
    New York University Grossman School of Medicine PM&R Program
    New York, New York

    • Co-Author(s)

  • Siulam C. Koo, DO

    Resident Physician
    New York University Grossman School of Medicine PM&R Program
    New York, New York

  • AB

    Amit K. Bansal, DO

    Attending Physician
    NYU Med CntrNYU Hospital for Joint Disease
    Plainsboro, New Jersey

Case Diagnosis: A 60-year-old male with bilateral quadriceps tendon repeat rupture.

Case Description or Program Description: A 60-year-old male with medical history of obesity, hypertension, and hyperlipidemia was admitted to an IRF following surgical repair of bilateral quadriceps tendon (BQT) rupture caused by a ground-level fall onto his knees, requiring bilateral knee braces locked in full extension. On IRF day 3, the patient experienced another ground-level fall during occupational therapy when he slid forward out of his wheelchair onto his coccyx attempting to reach forward. He reported no increased pain after this event and was able to bear weight. X-ray of the sacrum/coccyx was unrevealing.

Setting: Acute inpatient rehabilitation facility (IRF)

Assessment/Results: Serial physical exams were significant for a palpable gap in the BQT, and work-up with MRI showed complete re-rupture. He subsequently underwent repeat BQT repair, and resumed full program therapy the next day with bilateral bivalve casts spanning the thighs to the ankles to prevent further injury. The patient made great progress and was discharged home at supervision level. Casts were removed 5 weeks postoperatively by orthopedics with transition to hinged knee braces.

Discussion (relevance): BQT rupture is an uncommon phenomenon that can be spontaneous or traumatic, typically seen in a middle-aged male with obesity, diabetes, or renal failure. Management is surgical, and complications are rare. This report describes an atypical complication in which a seemingly unrelated fall with intact function after surgical intervention caused a re-rupture of the BQT, requiring repeat surgery and reinforced immobilization with bivalve casting.

Conclusions: Failure of quadricep tendon rupture repair is a potential complication seen in the IRF setting. Even in cases of minor trauma without functional compromise, the physiatrist should be vigilant and consider work-up to rule out re-injury. Bivalve casts are appropriate for high-risk patients following BQT repair considering minor trauma could overpower locked braces causing a degree of flexion.