Spontaneous major tendon ruptures in patients receiving long-term hemodialysis

Seven spontaneous ruptures of major tendons in five patients receiving long-term hemodialysis were reviewed between June 1990 and May 2000. The average age of the two men and the three women was 51.4 years. The average period of hemodialysis was 11 years. The etiology, pathologic focus, frequency, symptoms, problems, and operative indications were examined. Reconstruction using Leeds-Keio artificial tendons provided excellent results in all patients but one. 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.