A delayed transverse avulsion fracture of the superior pole of the patella after anterior cruciate ligament reconstruction

Fracture of the patella after the anterior cruciate ligament reconstruction

“…McCarroll [1] presented the theory that the transverse patella fractures are similar to stress fractures due to reduced vascularization of the central parts of the patella. Benson and Barnett [25] described the patella vascularization and collateral blood flow after taking the graft. Extraossal blood supply surface of patella comes from geniculates artery that are stored while taking graft.…”

Displaced Nonunion Patellar Fracture Following Use of a Patellar Tendon Autograft for ACL Reconstruction

“…The time period when these fractures occur is variable. 1,11 Direct blows generally result in stellate fractures while indirect trauma, such as a forceful quadriceps contraction, usually results in a transverse fracture. In more than 2000 patellar tendon autograft procedures performed by the senior author (B.R.B.)…”

Extensor Mechanism Macrotraumatic Complications

“…8,35 Other studies have also confirmed that early fracture recognition and internal fixation allows adequate rehabilitation without compromising final clinical outcome. 3,32 Benson et al 2 reported a late avulsion fracture of the superior pole of the patella 1 year after the index reconstruction and 6 months after return to full athletic activities. McCaroll 19 reported a transverse fracture that occurred during a golf swing 6 months postoperatively.…”

“…It has been proposed that these delayed patella fractures may represent failure of a relatively devascularized and weakened portion of the patella. 2 During graft harvest the midpatellar and inferior polar components of the intraosseous blood supply are disrupted. Whether this blood supply reconstitutes and its relevance to early or late postoperative patella fractures remains unclear.…”