Bilateral Post Traumatic Avulsion of Patellar Apexes: A Case Report

Patellar tendon rupture and patellar apex rupture are established complications in patients with end stage kidney disease, however, little to no literature describes bilateral patellar avulsion. This is a case presentation of bilateral knee avulsion due to bilateral patellar tendon rupture at the level of the apexes in a patient with end stage kidney disease on dialysis. A 52 year old female presented to the emergency department for low energy traumatic event. On physical exam patient had bilateral patella alta with limited range of motion. On imaging, bilateral knee MRI was diagnostic of bilateral avulsion of patellar apexes. In light of the clinical and radiological findings, patient was admitted for surgical repair, in which a free tendon graft was placed. Post operation radiography showed good patellar placement and fixation. Upon discharge, patient was allowed partial weight bearing for the first 6 weeks, followed by full weight bearing. 1 year post surgery, patient was pain free and able to ambulate comfortably. We conclude that, patellar apex avulsion should be suspected in patients with renal dysfunction presenting for unilateral or bilateral chronic knee pain even if no severe mechanism of injury was present