Hybrid Fixation Technique for Spontaneous Quadriceps Tendon Rupture in Chronic Kidney Disease

Spontaneous quadriceps tendon rupture is an uncommon but serious injury, particularly in patients with chronic kidney disease (CKD), who are predisposed to musculoskeletal complications. Our patient is a 58-year-old male with a history of CKD, on hemodialysis for the past 5 years. The patient presented with a history of sudden pain and an inability to extend his right knee without any history of injury. On clinical examination, it was found that there was a palpable gap above the patella and a magnetic resonance imaging scan confirmed a complete tear of the quadriceps tendon at the level of the attachment to the patella. Laboratory tests showed elevated levels of serum creatinine and parathyroid hormone which were indicative of CKD. The patient was managed with an open repair of the tendon using combined transosseous and suture anchor fixation, followed by a structured rehabilitation plan. At 1 year of follow-up, the patient had regained full range of motion without any signs of re-tear and also reported recovery in terms of functionality with resumption of his normal daily activities. This case highlights the effectiveness of this hybrid fixation technique for managing quadriceps tendon ruptures in CKD patients. It emphasizes the value of combining transosseous sutures and suture anchor fixation to optimize tendon reattachment and ensure stable, functional recovery in this high-risk population. In addition, it underscores the importance of surgical intervention in such cases and stresses the need for orthopedicians to maintain a high index of suspicion for tendon injuries in CKD patients.