Introduction: Concurrent ruptures of several major tendons of the lower limbs are exceptional. They can be post-traumatic or related to metabolic or drug-induced factors. Their management is complex and requires optimal functional rehabilitation. Clinical Case: We report the case of a 40-year-old hypertensive patient treated with amlodipine, who, following indirect trauma in a road accident, presented with complete functional impairment of the lower limbs. Examination revealed a triple tendon rupture: a complete bilateral rupture of the quadriceps tendon at the level of the patella (Caton-Deschamps index of 0.40 on the right and 0.45 on the left) and a rupture of the right Achilles tendon 1 cm from its insertion. On postoperative day 16, the patient underwent a single-stage surgery. The Achilles tendon was sutured with axial transosseous sutures in the prone position. The two quadriceps tendons were reinserted in the supine position using vertical patellar transosseous tunnels. Strict plaster cast immobilization was maintained for 45 days. At 34-month follow-up, the patient is walking independently with a slight right-sided limp. Extension is complete and symmetrical. Flexion is 130? on the left and limited to 100? on the right. The right ankle is mobile. Ultrasound reveals microcalcifications of scar tissue on the three operated tendons and the contralateral healthy Achilles tendon. Conclusion: Reinsertion using transosseous tunnels combined with 6 weeks of immobilization is a reliable strategy for securing these injuries.
References
[1]
Yee Leong, W., Gheorghiu, D. and Rao, J. (2013) A Rare Case of Simultaneous Acute Bilateral Quadriceps Tendon Rupture and Unilateral Achilles Tendon Rupture. JournalofOrthopaedicCaseReports, 3, 22-25. https://doi.org/10.13107/jocr.2250-0685.110
[2]
Mokoko-Louckou, A.E., Chaibou, B., Abdouli, I., Bienvenu Bouhelo-Pam, K.P., Idrissi, M.E., Shimi, M., et al. (2018) Rupture bilatérale spontanée et simultanée du tendon quadricipital dans l’adénome parathyro?dien: à propos d’un cas et revue de la littérature. Pan African Medical Journal, 29, Article 14. https://doi.org/10.11604/pamj.2018.29.14.13540
[3]
Novoa, D., Romero, R. and Forteza, J. (1987) Spontaneous Bilateral Rupture of the Quadriceps Tendon in Uremia and Kidney Transplantation. Clinical Nephrology, 27, Article 48.
[4]
Oliva, F., Marsilio, E., Cuozzo, F. and Maffulli, N. (2023) Quadriceps Tendon Tears Rehabilitation: A Narrative Review of the Literature. Muscles, Ligaments and TendonsJournal, 13, 667-676. https://doi.org/10.32098/mltj.04.2023.20
[5]
De Baere, T., Geulette, B., Manche, E. and Barras, L. (2002) Résultats fonctionnels après réparation chirurgicale de la rupture du tendon quadricipital. Acta Orthopaedica Belgica, 68, 146-149.
[6]
Yanke, A.B., Dandu, N., Trasolini, N.A., Darbandi, A.D., Walsh, J.M., Rice, R., et al. (2023) Suture Anchor‐Based Quadriceps Tendon Repair May Result in Improved Patient‐Reported Outcomes but Similar Failure Rates Compared to the Transosseous Tunnel Technique. Arthroscopy, 39, 1483-1489. https://doi.org/10.1016/j.arthro.2022.11.031
[7]
Benyass, Y., Chafry, B., Koufagued, K., Bouabid, S. and Chagar, B. (2015) Les ruptures traumatiques du tendon quadricipital: à propos de 3 cas. Pan African Medical Journal, 22, Article 343. https://doi.org/10.11604/pamj.2015.22.343.8272
[8]
Zambanini, A., Padley, S., Cox, A. and Feher, M. (1999) Achilles Tendonitis: An Unusual Complication of Amlodipine Therapy. Journal of Human Hypertension, 13, 565-566. https://doi.org/10.1038/sj.jhh.1000872
[9]
Levy, M., Seelenfreund, M., Maor, P., Fried, A. and Lurie, M. (1971) Bilateral Spontaneous and Simultaneous Rupture of the Quadriceps Tendons in Gout. TheJournalofBoneandJointSurgery.BritishVolume, 53, 510-513. https://doi.org/10.1302/0301-620x.53b3.510
[10]
Benameur, H., Chaves, C., Sautet, A., Feron, J. and Cambon-Binder, A. (2018) Spontaneous Bilateral Quadriceps Tendon Rupture Revealing a Parathyroid Carcinoma. JointBoneSpine, 85, 131-132. https://doi.org/10.1016/j.jbspin.2017.01.003
[11]
Karapinar, S.E., Duvarci, U.C., Tunc, S., Sar??s?k, U.U., Topcu, O.F., Dincer, R., et al. (2025) The Effect of Amlodipin, a Calcium Channel Blocker, on Tendon Healing: An Experimental Study in Rat Model of Achilles Tendon Injury. European Journal of Trauma and Emergency Surgery, 51, Article 330. https://doi.org/10.1007/s00068-025-03006-2
[12]
Muluem, O.K., Fonkoue, L., Marie-Ange, N.Y., Vofo, S.N., Guemse, M.E., Dongmo, G., et al. (2022) Impact of Surgical Treatment of Patella Tendon Rupture Regarding Return to Sports in Yaounde. OpenJournalofOrthopedics, 12, 225-235. https://doi.org/10.4236/ojo.2022.125021
[13]
Belmoubarik, A., Abouchane, M. and Mahraoui, M.A. (2015) Cas rare de rupture bilatérale des tendons d’Achille sans notion de tendinopathie ou de chirurgie de la cheville chez un jeune sportif: à propos d’un cas et revue de la littérature. Pan AfricanMedicalJournal, 20, Article 223. https://doi.org/10.11604/pamj.2015.20.223.5985
[14]
Diallo, M., Traoré, M.B., Moussa, A.K., Coulibaly, D., Coulibaly, K., Sanogo, C.O., et al. (2025) Evaluation of Surgical Treatment of Recent Traumatic Achilles Tendon Ruptures Using the Bosworth Technique: A Report of 12 Cases. SurgicalScience, 16, 397-402. https://doi.org/10.4236/ss.2025.169040
[15]
Azagui, Y., Haddoun, A.R., Belmoubarek, A., Andaloussi, Y. and El, Ouarab, M. (2014) Reconstruction d’une rupture ancienne du tendon quadricipital par greffe tendineuse au DI-DT (à propos d’un cas). Revue Marocaine de Chirurgie Orthopédique et Traumatologique, 55, 39-43.
[16]
Alkhatatba, M., Anaqreh, Y., Essa, S.B., Alma’aiteh, A., Ziad Audat, H., Obeidat, N., et al. (2023) Bilateral Spontaneous Quadriceps Tendon Rupture: A Case Report and Literature Review. SICOT-J, 9, Article 31. https://doi.org/10.1051/sicotj/2023031