Spontaneous major tendon ruptures in patients on chronic hemodialysis

Abstract

Eight spontaneous ruptures of major tendons (five patellar and three triceps brachii) in five patients receiving long-term hemodialysis were reviewed between 1995 and 2003. The average age of the two men and the three women was 37.2 years. The average length of hemodialysis was 10.8 years. Etiology, pathologic focus, frequency, symptoms, problems, and operative indications were examined. Reconstruction using Persson’s technique for patellar tendon ruptures and Levy’s technique for triceps tendon ruptures (the suture line was then protected with a figure-of-eight tension band wire) provided excellent results in all patients. Hyperparathyroidism existed in all patients. Local amyloid depositions were not found in any of the patients. In all patients, the ruptured site was not in the tendon but at the tendon attachment to the bone, which was smooth and completely free from tendon tissue. Thus, the most likely etiology of tendon ruptures in patients receiving hemodialysis was thought to be the fragility of the bone at the tendon attachment attributable to secondary hyperparathyroidism. To prevent this complication, control of hyperparathyroidism may be important, especially in active young patients.