Background: The Achilles Tendon is the largest Tendon in the body. Local infiltration is recognized to be cost-saving and effective in treating musculoskeletal pain. However, using corticosteroids in the long term can lead to adverse consequences such as osteoporosis, immunosuppressive effect, or Tendon Rupture. Case presentation: In this paper, we reported a case with Bilateral Achilles Tendon Rupture following corticosteroid treatment. When Achilles Tendon Rupture occurs, surgical treatment is necessary to rehabilitate Achilles Tendon function and avoid severe complications. Conclusion: This report reviewed a case of Bilateral Achilles Tendon Rupture following corticosteroid treatment precautions which should be considered.

Objective: Quadriceps Tendon Ruptures are rare injuries affecting the knee extensor mechanism, typically occurring in middle-aged patients with underlying pathologies. Bilateral simultaneous quadriceps Tendon Ruptures are even more uncommon, and almost all reported cases in the literature are associated with an underlying disease. Case Presentation: A 62-year-old Caucasian male presented complaining of pain in the anterior-superior aspect of both knees following a fall while walking that same day, during which his knees were in a semi-flexed position. Physical examination revealed a loss of active knee extension in both limbs and a palpable gap between the superior pole of the patella and the quadriceps Tendon. MRI of both knees was performed two days after the injury, confirming Bilateral quadriceps Tendon Ruptures. Twelve days after the initial injury, the patient underwent surgical intervention, and both injuries were addressed simultaneously using a transosseous tunnel technique. The transosseous technique consisted of three longitudinal and parallel tunnels drilled into the patella, and a modified Kessler suture was used to secure and reattach the quadriceps Tendon back to the superior pole of the patella. At the patient’s eight-month follow-up, the patient was asymptomatic, ambulating normally, and had full knee extension with 120° flexion Bilaterally. However, hypotrophy of the quadriceps muscle was noted Bilaterally. Conclusion: Proper evaluation and treatment of these injuries are crucial to achieving good outcomes, as they can lead to significant knee pain and disabilities.

Traumatic Bilateral patellar Tendon Rupture (BPTR) is a rare injury with low levels of clinical suspicion, especially in young adults. Since early diagnosis of the BPTR is the cornerstone of a successful management, BPTR reports are valuable as they raise awareness of the careful clinical and radiologic workout in similar cases. Here, we present a case of BPTR in a 34-year-old male following a motorcycle accident. At the emergency department, the necessary examinations including clinical, physical, and radiologic tests were performed and BPTR was diagnosed accordingly. The patient underwent reconstruction surgery the day after the injury. At the last follow-up, the patient was able to perform active straight leg raise with 130° flexion and no extension lag. The superior results of BPTR reconstruction in this report further emphasize the importance of early diagnosis and repair of BPTR. Active straight leg raise test is necessary to perform for all patients with a history of an eccentric load of the knee extensor mechanism, and if positive, extensor mechanism Rupture should be strongly suspected.

Background: Bilateral Rupture of the patellar Tendon is a very rare injury, which takes place in relation to chronic systemic diseases. These injuries are known causes. Some of these causes are particular in patellar Tendon Rupture and another are in quadriceps Tendon Rupture. Case presentation: 70-year-old diabetic man with simultaneous Bilateral patellar Tendon disruption of proximal insertion without trauma, receiving long-term hemodialysis. Conclusions: In the present study, we report a case of patellar Tendon Rupture that has two differences with literature: first, renal failure is a known risk factor for quadriceps Tendon Rupture, and secondly, the prevalent age of patellar Tendon Rupture is less than 40 years. Clinical picture, diagnosis, pathogenesis and treatment are discussed. Finally, the literature is reviewed based on previous studies.

Background: Large defects in chronic Achilles Tendon Ruptures are difficult to rapair. The purpose of this study was to evaluate the clinical and functional outcomes following reconstruction of the chronic large gaps in Achilles Tendon ruture using free semitendinosus interposition Tendon grafting.Methods: In a case series study, eleven male patients with mean age of 30±4 years and average defect size of 8.31±1.96 cm in their old Achilles Tendon underwent reconstruction during 6 years in a teaching hospital in Tehran-Iran. Ipsilateral semitendinosus free Tendon graft was used for reconstruction. The cases were evaluated by Ankle-Hindfoot Scale of American Orthopaedic Foot and Ankle Society (AOFAS), and the Achilles Tendon Rupture Score (ATRS) to with a mean follow-up of 25.36±3.3 months.Results: The pre-operative AOFAS and ATRS of 70.4±5.3 and 31.7±5.7 preoperatively improved to 91.8±4.8 and 88.7±4.2 values. The ankle dorsiflexion showed a significant decline-postoperative value of 13.5±4.2 degrees compared to preoperative of 17.2±3.9 degrees (p=0.04). All the cases except a professional athlete, returned to their previous activities.Conclusion: This technique offers good clinical and functional results in patients with large defects and is associated with no donnersite morbidity. We recommend this technique for the reconstruction of the chronic at Ruptures in patients with over 6 cm defects.

Ipsilateral fractures of the femur and tibia result in a flail knee joint condition referred to as “ floating knee” . Associated knee ligament injuries are common and have been reported to be frequently missed in initial evaluations. We report the diagnosis and treatment of the concomitant patellar Tendon Rupture during fixation of the distal femur and proximal tibia fractures in a patient who presented with floating knee and a history of osteomyelitis. This case further highlights the paramount importance of careful assessment of the knee in patients who present with floating knee injuries. We also recommend that MRI and ultrasonography be used to prevent ignored patellar Tendon Ruptures in such patients; particularly when physical exam is challenging or an intra-articular injury is present.

Introduction: Consumption of anabolic-androgenic steroids (AAS) is described as a major factor in Tendon weakening process. The reports of Bilateral quadriceps Tendon Rupture (QTR) following the AAS consumption are very rare. The current study describeda case of simultaneous Bilateral QTR following a low-energy trauma in a body builder with the history of ASS consumption. Case Presentation: A 32-year-old male body builder was referred to under study center with a history of falling down from thestairs nearly 2 weeks earlier. Magnetic resonance imaging (MRI) showed QTR in both knees from superior pole of patella. He deniedany major trauma to explain the recent problem. Thus, the QTR was attributed to a low-energy trauma. While ruling out the Tendonweakening conditions promptly, the history of oral and intramuscular consumption of AAS was noted. The patient was operatedto repair QTR. At the last follow-up session, he was able to actively straighten his legs. The consumption of AAS was discontinuedafterward. Conclusions: Consumption of AAS by athletes has considerably increased during the last few decades. An appropriate warningof orthopedic surgeons regarding AAS side effects is necessary in order to recognize the predisposing factor of Tendon Rupture insimilar circumstances and address the case properly.

Background: Spontaneous Rupture of Tendon is a rare disease that often occurs following an underlying disease or drug usage. However, the association of this condition with primary hyperparathyroidism has rarely been reported.Case: In a case-study, two cases of spontaneous Tendon Rupture associated with primary hyperparathyroidism are reviewed. The first one is a middle-aged woman that due to Bilateral patellar Tendon Rupture is operated for secondary repair and augmentation of Tendons. The second one is a middle-aged man with unilateral triceps brachii Tendon Rupture who has been operated for primary Tendon repair. Conclusion: Since paramount force is needed for Tendon Rupture, in spontaneous Tendon Rupture cases, patient evaluation for detecting underlying diseases and drug usage is necessary. In cases that the history of an underlying disease is not indicated, evaluation of serum level concentrations of Ca, P, ALP, and PTH is recommended for contraindication of primary hyperparathyroidism.

Background and Objective: There has been considerable debate regarding the best treatment of the Achilles Tendon Rupture. One of the nonoperative treatment method for Achilles Tendon Rupture is using the functional brace. The aim of this study was to evaluate the effect of the functional brace with/without patellar Tendon bearing on treatment of patients with Achilles Tendon Rupture.Materials and Methods: In this semi experimental study, 17 patients with Achilles Tendon Rupture were recruited and randomly allocated into 2 groups: functional brace with patellar Tendon bearing and functional brace without patellar Tendon bearing. Pain, plantar and dorsi flexion strength and the required time for progressively increased dorsi flexion position in orthoses to reach the neutral position were measured. Data analyzed with SPSS-13, independent t-test and Smironov-Kolomogrov.Results: Three patients were excluded during follow up and finally this study was done on 14 patients. The difference of the pain intensity and the plantar and dorsi flexion, in each group, before and after the intervention was significant (P<0.05), but the difference between two groups after intervention in all variables was not significant.Conclusion: This study showed that both brace with/without patellar Tendon bearing are effective on improvement of pain and the plantar flexion and dorsi flexion strength and also are effective in required time to reach the neutral position.