Bilateral quadriceps tendon rupture secondary to hyperparathyroidism

Ben Tarigan, MD


Teenager with bilateral knee pain and swelling. No history of trauma.


hyperparathyroidism SPR unknown case 11 tendon

Publication Date: 2009-08-04


Teenager with bilateral knee pain and swelling. No history of trauma.


Bilateral Patella Baja. Soft tissue swelling. Calcifications in the soft tissues superior to both patellas on the lateral views.

Coursened trabeculae and subperiosteal resorption in the medial, proximal tibial cortex bilaterally.


Spontaneous rupture of both quadriceps tendons associated with secondary hyperparathyroidism due to renal failure.


Secondary hyperparathyroidism secondary to renal failure has many radiologic manifestations. Damage to the renal parenchyma can interfere with the formation of 1,25-(OH)2D and, together with phosphate retention, can result in rickets and osteomalacia with secondary hyperparathyroidism.

Spontaneous tendon ruptures have been reported in association with renal failure and secondary hyperparathyroidism. The rupture site is typically at the junction of the tendon with the bone, likely secondary to a weakened bone-tendon junction due to bone resorption. Spontaneous tendon ruptures tend to occur in weight bearing regions, most commonly the knee (quadriceps and patellar tendons) or the ankle (achilles tendon), and less commonly the elbow (triceps brachii tendon). The ruptures may be bilateral (as in this case) and spontaneous. Ectopic calcifications in the ruptured tendon ends have also been reported.

Subperiosteal resporption due to secondary hyperparathyroidism is the most common radiographic abnormality seen; however, periosteal new bone formation is noted in some patients. In children, subperiosteal bone resorption frequently involves the femoral necks, proximal humeri, and medial aspects of the proximal tibia, producing a bite defect. In older children and adults, subperiosteal resporption is most commonly detected along the radial aspects of the middle and proximal palanges of the second and third digits. Bone resorption is also observed in the lateral and medial ends of the clavicle. The weakened bones lead to increased likelihood of physeal fractures of weight bearing bones (i.e. bilateral SCFE may be seen with this entity.)


  1. Tsourvakas, Stefanos et al. "Spontaneous major tendon ruptures in patients on chronic hemodialysis" Eur J Orthop Surg Traumatol (2005) 15: 109-112.
  2. Kirks, D.R. & Griscom, N.T. PRACTICAL PEDIATRIC IMAGING: Diagnostic Radiology of Infants and Children, Lippincott-Raven Publishers, 1998m 451-453.
  3. Kuhn, J.P., Slovis, T.L. & Haller, J.O. CAFFEY'S PEDIATRIC DIAGNOSTIC IMAGING. Elsevier, Inc., 2004, 1819, 2245-2246.

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