When both knees give way: simultaneous bilateral quadriceps tendon rupture after a low-energy trauma, a case report from Tanzania

Introduction: Simultaneous bilateral quadriceps tendon ruptures are rare and potentially disabling injuries that may be overlooked, particularly following low-energy trauma. Prompt recognition and surgical repair are important for restoring the knee extensor mechanism and functional mobility. Case presentation: A 52-year-old woman with obesity, visiting Tanzania as a tourist, sustained a twisting injury to both knees while descending airport stairs. She presented with bilateral knee pain and inability to stand or actively extend either knee. Examination revealed bilateral suprapatellar tenderness, palpable defects, and knee effusions. Radiographs showed degenerative changes without acute bony injury, while magnetic resonance imaging confirmed simultaneous bilateral quadriceps tendon ruptures. Following shared decision-making, a staged approach was selected to facilitate postoperative mobility and rehabilitation. The left tendon was repaired the following day, and the right 4 weeks later, using the same repair technique. Postoperative rehabilitation included progressive weight-bearing, range-of-motion exercises, and physiotherapy. Four weeks after the second repair, she was mobilizing with crutches; range of motion was 0–120° on the left and 0–80° on the right, assessed at 8 and 4 postoperative weeks, respectively. At a 6-month teleconsultation, she reported returning to her usual daily activities. Conclusion: Bilateral quadriceps tendon rupture should be considered when patients present with loss of active knee extension after seemingly minor trauma. Early diagnosis and individualized surgical and rehabilitation planning are essential. Staged repair may be considered in selected circumstances, although evidence comparing it with simultaneous repair remains limited.