Traumatic bilateral concurrent patellar tendon rupture: an alterative fixation method

  • Hok-Ming Ho
  • Wai-Keung Edison Lee


A 37-year-old healthy Chinese man with traumatic bilateral concurrent patellar tendon rupture is presented. This is the 19th case reported in the literature. Sports-related activities are the most common cause of injury. The mechanism of rupture is forceful contraction of quadriceps muscle on a partially flexed knee. Previous surgical treatments have potential problems. Soft tissue anchors were used for restoration of the patellar continuity. Improved surgical techniques and excellent functional results are expected.


Traumatic bilateral concurrent patellar tendon rupture Soft tissue anchors Knee extensor mechanism Literature review Case report 



The authors received no grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.


  1. 1.
    Babini SM, Arturi A, Marcos JC, Babini JC, Iniguez AM, Morteo OG (1988) Laxity and rupture of the patellar tendon in systemic lupus erythematosus. Association with secondary hyperparathyroidism. J Rheumatol 15:1162–1165PubMedGoogle Scholar
  2. 2.
    Babini SM, Jones MW, Choudhury RR, Smith E (1995) Bilateral patellar tendon rupture secondary to repeated local steroid injections. J Accid Emerg Med 12:300–301PubMedGoogle Scholar
  3. 3.
    Barber FA, Herbert MA, Click JN (1995) The ultimate strength of suture anchores. Arthroscopy 11:21–28PubMedGoogle Scholar
  4. 4.
    Barber FA, Herbert MA, Click JN (1996) Suture anchor strength revisited. Arthroscopy 12:32–38PubMedGoogle Scholar
  5. 5.
    Burkhart SS, Johnson TC, Wirth MA, Athanasiou KA (1997) Cyclic loading of transosseous rotator cuff repairs: tension overload as a possible cause of failure. Arthroscopy 13:172–176PubMedGoogle Scholar
  6. 6.
    Carson WG, James SL, Larson RL, Singer KM, Winternitz WW (1984) Patellofemoral disorders: physical and radiographic evaluation. I. Radiographic examination. Clin Orthop 185:178–186PubMedGoogle Scholar
  7. 7.
    Chan CH, Niu CC, Yang WE, Chan WJ, Shih CH (1999) Spontaneous bilateral patellar tendon rupture in primary hyperthyroidism. Orthopedics 22:1177–1179PubMedGoogle Scholar
  8. 8.
    Chandler FA (1953) Repair of ruptured patellar tendon with airplane control cable. JAMA 153:1093Google Scholar
  9. 9.
    Clark SC, Jones MW, Choudhury RR, Smith E (1995) Bilateral patellar tendon rupture secondary to repeated steroid injections. J Accid Emerg Med 12:300–301PubMedGoogle Scholar
  10. 10.
    Cooney LM, Aversa JM, Newman JH (1890) Insidious bilateral infrapatellar tendon rupture in a patient with systemic lupus erythematosus. Ann Rheum Dis 39:592–595Google Scholar
  11. 11.
    Davidsson L, Salo M (1969) Pathogenesis of subcutaneous tendon ruptures. Acta Chir Scand 135:209–212Google Scholar
  12. 12.
    Dejong CH, van de Luytgaarden WG, Vroemen JP (1991) Bilateral simultaneous rupture of the patellar tendon. Case report and review of the literature. Arch Orthop Trauma Surg 110:222–226PubMedGoogle Scholar
  13. 13.
    Donati RB, Cox S, Echo BS, Powell CE (1986) Bilateral simultaneous patellar tendon rupture in a female collegiate gymnast. A case report. Am J Sports Med 14:237–239Google Scholar
  14. 14.
    Fowler A, Mitchell GP (1950) Bilateral rupture of the extensor tendons of the knee. Lancet I:205–206Google Scholar
  15. 15.
    Giblin P, Small A, Nichol R (1982) Bilateral rupture of the ligamentum patellae: two case reports and a review of the literature. Aust N Z J Surg 52:145–148PubMedGoogle Scholar
  16. 16.
    Glabbeek FV, Groof ED, Boghemans J (1992) Bilateral patellar tendon rupture: case report and literature review. J Trauma 33:790–792PubMedGoogle Scholar
  17. 17.
    Goodrich A, Diffore RJ, Tippens JK (1983) Bilateral simultaneous rupture of the infrapatellar tendon. Orthopedics 6:1472–1474Google Scholar
  18. 18.
    Greenbaum B, Perry J, Lee J (1994) Bilateral spontaneous patellar tendon rupture in the absence of concomitant systemic disease or steroid use. Orthop Rev 23:890–893PubMedGoogle Scholar
  19. 19.
    Groβ G, Reck T, Kessler C, Herzog T, Hoffmann-Preiss K (1992) Bilateral rupture of the patellar tendon without predisposing systemic disease. Arch Orthop Trauma Surg 112:42–44PubMedGoogle Scholar
  20. 20.
    Hannon RJ (1990) Bilateral patellar tendon rupture. Ulster Med J 59:82–83PubMedGoogle Scholar
  21. 21.
    Huberti HH, Hayes WC, Stone JL, et al (1984) Force ratios in the quadriceps tendon and ligamentum patella. J Orthop Res 2:49–54PubMedGoogle Scholar
  22. 22.
    Hughes GN, Harder JA (1979) Bilateral patellar tendon rupture associated with chronic glomerulonephritis. Can J Surg 22:389PubMedGoogle Scholar
  23. 23.
    Hungerford DS, Barry M (1979) Biomechanism of the patellofemoral joint. Clin Orthop 147:9–15Google Scholar
  24. 24.
    Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101:101PubMedGoogle Scholar
  25. 25.
    Kalantar-Zadeh K, Singh K, Kleiner M, Jarrett MP, Luft FC (1997) Nontraumatic bilateral rupture of patellar tendons in a diabetic dialysis patient with secondary hyperparathyroidism. Nephrol Dial Transplant 12:1988–1990CrossRefPubMedGoogle Scholar
  26. 26.
    Kamali M (1979) Bilateral traumatic rupture of the infrapatellar tendon. Clin Orthop 142:131–134PubMedGoogle Scholar
  27. 27.
    Kannus P, Jozsa L (1991) Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. J Bone Joint Surg Am 73:1507–1525PubMedGoogle Scholar
  28. 28.
    Kircun R, Kricun ME, Arangio GA, Salzman GS, Berman AT (1980) Patellar tendon rupture with underlying systemic diseases. AJR Am J Roentgenol 135:803–807PubMedGoogle Scholar
  29. 29.
    Kohn P, Wirth CJ (1988) Doppelseitige intraligamentäre traumatische Ruptur beider Kniescheibensehnen—ein Fallbericht. Akt Traumatol 18:271–274Google Scholar
  30. 30.
    Krackow KA, Thomas SC, Jones LC (1986) A new stitch for ligament-tendon fixation. Brief note. J Bone Joint Surg Am 68:764–766PubMedGoogle Scholar
  31. 31.
    Kuo RS, Sonnabend DH (1993) Simultaneous rupture of the patellar tendons bilaterally: case report and review of the literature. J Trauma 34:458–460PubMedGoogle Scholar
  32. 32.
    Labelle H, Laurine CA (1976) Radiological investigation of normal and abnormal patellae. J Bone Joint Surg Br 57:530Google Scholar
  33. 33.
    Lugger L (1974) Traumatische subkutane simultane Ruptur beider Kniescheibenbänder. Zentralbl Chir 99:850–852PubMedGoogle Scholar
  34. 34.
    Margles SW, Lewis MM (1978) Bilateral spontaneous concurrent rupture of the patellar tendon without apparent associated systemic disease: a case report. Clin Orthop 136:186–187PubMedGoogle Scholar
  35. 35.
    Martin JR, Wilson CL, Mathews WH (1958) Bilateral rupture of the ligamenta patellae in a case of disseminated lupus erythematosus. Arthritis Rheum 6:548–552Google Scholar
  36. 36.
    McLaughlin HL, Francis KC (1956) Operative repair of injuries to the quadriceps extensor mechanism. Am J Surg 91:651–653Google Scholar
  37. 37.
    McMaster PE (1933) Tendon and muscle rupture. Clinical and experimental studies on the causes and location of subcutaneous ruptures. J Bone Joint Surg Am 15:705Google Scholar
  38. 38.
    Morgan J, McCarty DJ (1974) Tendon ruptures in patients with systemic lupus erythematosus treated with corticosteroids. Arthritis Rheum 17:1033–1036PubMedGoogle Scholar
  39. 39.
    Norlin R (1994) Use of Mitek anchoring for Bankart repair: a comparative, randomized prospective study with traditional bone sutures. J Shoulder Elbow Surg 3:381–385Google Scholar
  40. 40.
    Olen RN, Chmell S (1986) Bilateral patellar ligament rupture. A case report. Orthopedics 9:1665–1667PubMedGoogle Scholar
  41. 41.
    Ong BC, Sherman O (2000) Acute patellar tendon rupture: a new surgical technique. Arthroscopy 16:869–870PubMedGoogle Scholar
  42. 42.
    Peiro A, Ferrandis R, Garcia l, Alcazar E (1975) Simultaneous and spontaneous bilateral rupture of the patellar tendon in rheumatoid arthritis. A case report. Acta Orthop Scand 46:700–703PubMedGoogle Scholar
  43. 43.
    Podesta L, Sherman MF, Bonamo JR (1991) Bilateral simultaneous rupture of the infrapatellar tendon in a recreational athlete. A case report. Am J Sports Med 19:325–327Google Scholar
  44. 44.
    Rose PS, Frassica FJ (2001) Atraumatic bilateral patellar tendon rupture. A case report and review of the literature. J Bone Joint Surg Am 83:1382–1386Google Scholar
  45. 45.
    Rosenberg JM, Whitaker JH (1991) Bilateral infrapatellar tendon rupture in a patient with jumper's knee. Am J Sports Med 19:94–95PubMedGoogle Scholar
  46. 46.
    Sherlock DA, Hughes A (1988) Bilateral spontaneous concurrent rupture of the patellar tendon in the absence of associated local or systemic disease. Clin Orthop 237:179–183PubMedGoogle Scholar
  47. 47.
    Sochart DH, Shravat BP (1994) Bilateral patellar tendon disruption—a professional predisposition? J Accid Emerg Med 11:255–256PubMedGoogle Scholar
  48. 48.
    Sullivan RL (1986) Traumatic bilateral patellar tendon rupture with chronic renal disease. Wis Med J 85:12–13Google Scholar
  49. 49.
    Swift RI, Hershman MJ, Wood CB (1990) Bilateral spontaneous, concurrent patellar tendon rupture. Br J Clin Pract 44:730–731PubMedGoogle Scholar
  50. 50.
    Webb LX, Toby EB (1986) Bilateral rupture of the patella tendon in an otherwise healthy male patient following minor trauma. J Trauma 26:1045–1048PubMedGoogle Scholar
  51. 51.
    Zernicke RF, Garhammer J, Jobe FW (1977) Human patellar-tendon rupture. J Bone Joint Surg Am 59:179–183PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  1. 1.Department of Orthopaedics and TraumatologyTseung Kwan O HospitalHong KongP.R.C.

Personalised recommendations