From the Guidelines
Several medical conditions significantly increase the risk for quadriceps tendon rupture, including chronic kidney disease, diabetes mellitus, gout, rheumatoid arthritis, systemic lupus erythematosus, hyperparathyroidism, and obesity, as well as long-term use of corticosteroids and fluoroquinolone antibiotics like ciprofloxacin and levofloxacin. These conditions contribute to tendon weakening through various mechanisms, such as uremic tendinopathy in chronic kidney disease, collagen cross-linking abnormalities in diabetes, chronic tendon inflammation in inflammatory conditions like gout and rheumatoid arthritis, and abnormal calcium metabolism in hyperparathyroidism 1. Additionally, advanced age, typically over 40, represents a significant risk factor due to natural tendon degeneration with aging. The use of fluoroquinolone antibiotics, such as ciprofloxacin and levofloxacin, has been associated with an increased risk of tendon rupture, particularly in adults, with a rate estimated at 15 to 20 per 100,000 treated patients 1. Patients with these conditions should be cautious with activities involving sudden quadriceps loading and consider strengthening exercises under medical supervision to maintain tendon health. Key risk factors for quadriceps tendon rupture include:
- Chronic kidney disease
- Diabetes mellitus
- Gout
- Rheumatoid arthritis
- Systemic lupus erythematosus
- Hyperparathyroidism
- Obesity
- Long-term use of corticosteroids
- Long-term use of fluoroquinolone antibiotics, such as ciprofloxacin and levofloxacin
- Advanced age, typically over 40. It is essential to note that while the provided evidence discusses various medical conditions and medications, the primary concern for quadriceps tendon rupture risk is associated with the conditions and medications listed above, as supported by the highest quality and most recent study available 1.
From the Research
Medical Conditions that Increase the Risk of Quadriceps Tendon Rupture
- Renal disease: Studies have shown that patients with end-stage renal disease (ESRD) are at a higher risk of quadriceps tendon rupture 2, 3.
- Rheumatologic disorders: Certain rheumatologic disorders have been associated with an increased risk of quadriceps tendon rupture 2, 4.
- Endocrine disorders: Endocrine disorders, such as diabetes, have been linked to an increased risk of tendon rupture, including quadriceps tendon rupture 4.
- Chronic kidney disease: Chronic kidney disease has been identified as a risk factor for tendon rupture, including quadriceps tendon rupture 4.
- Gout: Gout has been associated with an increased risk of tendon rupture, including quadriceps tendon rupture 4.
- Rheumatoid arthritis: Rheumatoid arthritis has been linked to an increased risk of tendon rupture, including quadriceps tendon rupture 4.
Other Factors that Increase the Risk of Quadriceps Tendon Rupture
- Use of statins: The use of statins has been associated with an increased risk of tendinopathy and tendon rupture, including quadriceps tendon rupture 4.
- Use of corticosteroids: The use of corticosteroids has been linked to an increased risk of tendon rupture, including quadriceps tendon rupture 4.
- Use of fluoroquinolones: The use of fluoroquinolones has been associated with an increased risk of tendon rupture, including quadriceps tendon rupture 4, 5.
- Testosterone therapy: Testosterone therapy has been linked to an increased risk of quadriceps tendon injury 6.
- Hepatitis C: Hepatitis C has been associated with an increased risk of quadriceps tendon rupture 3.
- Secondary hyperparathyroidism: Secondary hyperparathyroidism has been linked to an increased risk of quadriceps tendon rupture 3.