Simultaneous Patellar, Quadriceps, and Triceps Tendon Ruptures in a Professional Male Bodybuilder After Low-Impact Trauma.

BACKGROUND

Simultaneous rupture of multiple major tendons is exceedingly rare and is typically associated with high-energy trauma or underlying systemic disease. This report describes the management and outcome of an unusual low-energy, three-tendon rupture involving the quadriceps, patellar, and triceps tendons in a professional bodybuilder.

CASE: A 36-year-old male professional bodybuilder presented after slipping on ice with acute loss of bilateral knee extension and right elbow extension. Physical examination and imaging confirmed complete rupture of the left quadriceps tendon, right patellar tendon, and right triceps tendon. The patient underwent single-stage surgical repair of all three tendons, utilizing transosseous fixation for both knee tendons and a suture anchor construct for the triceps tendon, followed by a tailored rehabilitation protocol. Functional and radiographic outcomes were assessed over one year. At one year, the left quadriceps and right triceps demonstrated a full range of motion and strength, allowing the patient to return to work without limitation. Imaging of the right patellar tendon demonstrated proximal tendon discontinuity and patella alta, consistent with repair failure. Despite this, the patient maintained 5/5 quadriceps strength, intact straight leg raise, and reported no limitations in daily activities, likely due to compensatory stabilization from an intact retinaculum. Revision surgery was recommended but deferred.

CONCLUSION

This case demonstrates that simultaneous multi-tendon rupture can occur after low-energy trauma in the absence of identifiable systemic disease. Early clinical suspicion supported by imaging and coordinated surgical and rehabilitative management can yield meaningful functional recovery, even in the presence of radiographic failure.

LEVEL OF EVIDENCE: IV.