Avulsion fracture of the tibial tuberosity with associated proximal patellar ligament avulsion. A case report and literature review

Boyle, Matthew J.; Dawe, Christopher J.

doi:10.1016/j.injury.2010.11.039

Cited by 7 publications

(8 citation statements)

References 12 publications

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“…In most cases, the age of presentation was between 11-years-old[ 13 ] and 18-years-old[ 14 ]. This injury is more common in males than in females and occurs predominantly on the left side[ 15 ]. Patients with this pathology tend to have well-developed quadriceps muscles capable of exerting tremendous forces across the extensor mechanism of the knee[ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Tibial tuberosity avulsion-fracture associated with complete distal rupture of the patellar tendon: A case report and review of literature

Morales-Ávalos

Martínez-Manautou

Garza-Castro

et al. 2020

WJO

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BACKGROUND Few cases of avulsion fractures of the tibial tuberosity with simultaneous rupture of the patellar tendon have been reported in the literature. Therefore, its mechanism and incidence have not been determined conclusively. This type of fracture is considered a serious injury that requires prompt diagnosis and early surgical repair. There is no therapeutic algorithm or standard method of treatment due to the infrequency of the injury. In this case report, we conducted an exhaustive review and synthesis of the existing literature including all previously reported cases. CASE SUMMARY We present a 16-year-old male soccer player with a case of a tibial tuberosity fracture with distal avulsion of the patellar tendon 5 d prior to surgical treatment. The patient presented with a loss of the extensor mechanism of the knee, edema, the inability to walk, and pain. X-rays showed a high patella and a 180-degree avulsion of the tibial tuberosity. The diagnosis was confirmed by magnetic resonance imaging and computed tomography. The patient underwent open reduction and internal fixation of the fracture with a cannulated screw and washer as well as patellar tendon repair with two metallic anchors. The rehabilitation protocol consisted of initial immobilization in extension followed by passive mobility and muscle strengthening exercises. The patient demonstrated excellent postoperative outcomes and returned to regular activity without complications. CONCLUSION This case presentation and literature review comprise the most relevant clinical, radiographic, and treatment details described in the international literature to date, providing the reader with an overview of this rare condition.

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Section: Discussionmentioning

confidence: 99%

Tibial tuberosity avulsion-fracture associated with complete distal rupture of the patellar tendon: A case report and review of literature

Morales-Ávalos

Martínez-Manautou

Garza-Castro

et al. 2020

WJO

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“…This combination of lesions favors the choice of open surgery for anatomical reduction of the tuberosity fragment with direct visualization of the patellar tendon. 7 The bone fragment can be secured with screws or Kirschner wires. For the patellar tendon, transosseous suture, stapling, suture with anchors, and reinforcement with semitendinous graft can be performed.…”

Section: Discussionmentioning

confidence: 99%

Tibial tubercle fracture associated with distal rupture of the patellar tendon: case report

Pereira

Faria

Campos

et al. 2018

Revista Brasileira de Ortopedia (English Edition)

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Avulsion of the tibial tubercle is an uncommon injury that occurs in the young athlete, resulting from an eccentric contraction of the extensor mechanism with the leg fixed to the ground. Concomitant injuries to the patellar tendon are very rare, with few cases reported in the literature. The authors present a case of a 15-year-old basketball player who suffered an avulsion of the tibial tubercle associated with complete distal rupture of the patellar tendon while training. It was treated with open reduction of the tibial fragment and reconstruction of the patellar tendon with mini-anchors and cannulated screws, as well as hamstring autograft tendon reinforcement. The patient showed excellent results and returned to sports after 12 months of follow-up.

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“…The importance of repairing both injuries to maintain knee extension is emphasized [4] . Combined tibial tuberosity avulsion and patellar ligament rupture is rare [6] and few operative techniques have been documented to reconstruct both of these structures simultaneously. The patellar tendon can be drawn over the anterior surface of the tibial tuberosity and both structures then fixed with a cancellous screw, reinforced by repair of surrounding fascia and periosteum [5] .…”

Section: Discussionmentioning

confidence: 99%

“…Bone anchors have been used to attach the tendon around the tubercle [7] , however we feel this would not provide the same security to the fixation without a box stitch passed through proximal extensor mechanism. An alternative is Kirschner wires to hold the tuberosity fragment, which are removed after several weeks of adequate bone healing [6] . Our technique involves standard fixation of the tibial tubercle with cannulated screws, repair of the patella tendon with sutures anchored into a bone tunnel, and a final neutralization suture centrally anchored around a distal midline tibial screw.…”

Section: Discussionmentioning

confidence: 99%

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An Alternative Technique for Repair of Patellar Ligament Ruptures with Associated Tibial Tuberosity Avulsion Fracture

Pendse

Bruce

Chennagiri

et al. 2016

International Journal of Orthopaedics

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We describe a case report of a patient who suffered dual injury to the patellar tendon insertion treated with an alternative technique for the repair of patellar ligament rupture with concomitant tibial tuberosity avulsion. These injuries are rare and there is no uniform technique, described to deal with this complex injury. In this report we describe an alternative technique which provides with secure fixation of the tendon allowing for early rehabilitation. It is simple and reproducible yet provides a robust fixation of the tendon injury allowing to restore the normal anatomical parameters. This technique avoids the need for neutralization box stitch to be passed through the quadriceps tendon, avoiding violation of intact tissue and large surgical wounds. To our knowledge, this method has not been previously described.

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Avulsion fracture of the tibial tuberosity with associated proximal patellar ligament avulsion. A case report and literature review

Cited by 7 publications

References 12 publications

Tibial tuberosity avulsion-fracture associated with complete distal rupture of the patellar tendon: A case report and review of literature

Tibial tuberosity avulsion-fracture associated with complete distal rupture of the patellar tendon: A case report and review of literature

Tibial tubercle fracture associated with distal rupture of the patellar tendon: case report

An Alternative Technique for Repair of Patellar Ligament Ruptures with Associated Tibial Tuberosity Avulsion Fracture

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