Both unilateral and simultaneous bilateral rupture of the quadriceps tendon are frequently misdiagnosed. Patients typically present to the emergency department after a fall associated with sudden sharp pain and inability to extend the knee. Most frequently, the patient is elderly. Those under age 40 with bilateral quadriceps rupture usually have an associated metabolic disorder. The 22-year-old uremic patient we report is the youngest case with simultaneous bilateral rupture of the quadriceps tendon described in the English literature. Emphasis is placed on the initial clinical presentation and management. In addition, the pathophysiology and differential diagnosis are reviewed.