Bipartite patella separation with quadriceps tendon avulsion: A rare surgical case

Abstract

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. The occurrence of bipartite patellar disruption simultaneously with quadriceps tendon avulsion is an extremely rare injury. A literature review found three documented cases in which only two repaired both the patella and tendon. We present a case report outlining this unusual injury and propose a method of surgical treatment. Case Report: A 45-year-old male presented following a fall directly onto his knee, with no significant medical history or previous injury. He was diagnosed with both separation of a type III bipartite patella and a clinical suspicion of a quadriceps tendon rupture. Intra-operatively, we found a complete tear of the quadriceps tendon at its insertion to the patella with disruption of the synchondrosis and significant separation of the bipartite patella. The displaced fragment was reduced and held using two cannulated screws, the quadriceps tendon was reattached to the superior pole of the patella using two anchor sutures and the retinaculum repaired. Conclusion:We could find no documented cases of using both cannulated screws and anchor sutures as a fixation method for this injury. We recommend this technique as we found that it gave a stronger fixation and was associated with a good functional outcome for our patient.

Bipartite patella separation and partial quadriceps tendon rupture in the setting of trauma

“…These variants are the result of the failure of secondary ossification centers to fuse into a single patellar ossification center. Injury to the incomplete ossification center fusion seen in bipartite and tripartite patella is rare, and has been reported to be associated with traumatic quadriceps tendon rupture, with only 7 previously reported cases [3] , [4] , [5] , [6] , [7] , [8] .…”