A Case Report of Rare Bilateral Quadriceps Tendon Rupture Diagnosed by Point of Care Ultrasound (POCUS)

A 49-year-old male presented to the emergency department (ED) with bilateral knee pain that began after a mechanical fall down several steps. He states that he fell in such a way that both knees were flexed while he was in the air, which he described as a “flying prayer” position, and he landed with all his weight onto his flexed knees. He did not immediately seek medical care but instead wore knee braces and used crutches to ambulate. This resulted in multiple other falls due to persistent pain and lack of mobility. He was seen at an outside facility prior to presenting to our ED and was reportedly diagnosed with severe arthritis based on x-ray imaging and told he may have a minor quadriceps tendon injury. No other imaging was performed at that time. Due to continued pain, he presented to our ED where we utilized point-of-care ultrasound (POCUS) which revealed the presence of bilateral full-thickness quadricep muscle and tendon tears. He was treated with surgical repair of his quadriceps tendons and had an uncomplicated postoperative course. This case report highlights the importance of ultrasound in diagnosing musculoskeletal injuries and improving patient outcomes. We also summarize POCUS findings that emergency physicians can use to diagnose quadriceps muscle and tendon tears.