Published: 2022-02-25

Bilateral patellar tendon rupture: a case report

Henrique Costa Sousa, Barbara Choupina, Moisés Ventura, Ricardo Santos Pereira, André Costa, Paulo Jorge Carvalho


Bilateral patellar tendon rupture is a rare injury, usually associated with systemic disease or chronic medication side effect. Early diagnosis and prompt surgical repair are essential to achieve good functional outcomes. The authors report a case of a 44-year-old male with history of multiple urinary tract infection treated with fluoroquinolones who sustained spontaneous simultaneous bilateral patellar tendon rupture. Patient underwent bilateral transosseus tendon repair with autologous semitendinosus augmentation. Nine months after surgery, the patient was able to walk without pain and unassisted, had a normal range of motion in both knees and performed his daily activities without limitation. Surgical treatment of patellar tendon rupture is recommended to allow prevention of extensor mechanism disfunction sequelae. Transosseus tendon repair with autologous semitendinosus augment plasty is a valid surgical technique for treatment of this pathology with biomechanical and literature support.


Patellar tendon rupture, Autologous semitendinous augmentation, Fluoroquinolones

Full Text:



Pengas IP, Assiotis A, Khan W. Adult native knee extensor mechanism ruptures. Injury. 2016;47:2065-70.

Savarese E, Bisicchia S, Amendola A. Bilateral spontaneous concurrent rupture of the patellar tendon in a healthy man: case report and review of the literature. Musculoskelet Surg. 2010;94(02):81-8.

Rose PS, Frassica FJ. Atraumatic bilateral patellar tendon rupture, A case report and review of the literature. J Bone Joint Surg Am. 2001;83-A(09):1382-6.

Rosso F, Bonasia DE, Cottino U, Dettoni F, Bruzzone M, Rossi R. Patellar tendon: from tendinopathy to rupture. Asia-Pacific J Sports Med Arthrosc. Rehabil Technol. 2015;2(04):99-107.

Sibley T, Algren DA, Ellison S. Bilateral patellar tendon ruptures without predisposing systemic disease or steroid use: a case report and review of the literature. Am J Emerg Med. 2012;30:263-5.

Alves C, Mendes D, Marques FB. Fluoroquinolones and the risk of tendon injury: a systematic review and meta-analysis. Eur J Clin Pharmacol. 2019;75(10):1431-43.

Tsai WC, Yang YM. Fluoroquinolone associated tendinopathy. Chang Gung Med J. 2011;34:461-7.

Rosa B, Campos P, Barros A, Karmali S, Gonçalves R. Spontaneous bilateral patellar tendon rupture: case report and review of fluoroquinolone induced tendinopathy. Clin Case Rep. 2016;4(7):678-81.

Camarda L, D’arienzo A, Morello S. Bilateral ruptures of the extensor mechanism of the knee: a systematic review. J Orthop. 2017;14:445-53.

Von Glinski A, Yilmaz E, Rausch V, Königshausen M, Schildhauer TA, Seybold D et al. Semitendinosus autograft augmentation after bilateral patellar tendon re-rupture: a case report and technique note. Eur J Orthop Surg Traumatol. 2019;29(6):1347-53.

Juliato RH, Boschi LH, Juliato RF, Freitas AP, França AF, Bottura LB. Bilateral Atraumatic Patellar Ligament Rupture-Case Report. Rev Bras Ortop (Sao Paulo). 2019;54(2):223-7.

Maffulli N, Del Buono A, Loppini M, Denaro V. Ipsilateral hamstring tendon graft reconstruction for chronic patellar tendon ruptures: average 5.8-year follow-up. J Bone Joint Surg Am. 2013;95(17):e1231-6.

Gilmore JH, Clayton-Smith ZJ, Aguilar M. Reconstruction techniques and clinical results of patellar tendon ruptures: evidence today. Knee. 2015;22:148-55.

Mihalko WM, Vance M, Fineberg MJ. Patellar tendon repair with hamstring autograft: a cadaveric analysis. Clin Biomech (Bristol, Avon.) 2010;25(04):348-51.

Insall J, Salvati E. Patella position in the normal knee joint. Radiology. 1971;101:101-4.