Distal Patellar Tendon Avulsion Associated with an ACL Tear in a Teenager: A Case Report and Review of the Literature

Abstract

Distal patellar tendon avulsions are rare injuries in healthy individuals, and to date, no case affecting skeletally mature teenagers and adolescents has been reported. In the majority of cases, distal patellar tendon avulsions are associated with severe intra-articular knee lesions, signifying a high-energy trauma. We present the case of a 15.5-year-old female who was admitted to the emergency department after a knee injury. The mechanism of injury was a combination of landing after a jump off a scooter and sudden deceleration with a fixed foot. Lateral radiographs revealed a distal patellar tendon avulsion. An MRI was conducted to accurately diagnose concomitant lesions. The MRI revealed a complete tear of the ACL, and associated bone bruises on the lateral femoral condyle, and also on the posterolateral tibial plateau. A knee joint exam under general anesthesia demonstrated good stability during valgus stress testing and only a grade 1 positive Lachman test. Therefore, we decided to only reconstruct the extensor mechanism and to abstain from a primary ACL reconstruction. The presented case and review of the literature demonstrate the clinical relevance of this atypical lesion. In fact, a distal patellar tendon avulsion after physeal fusion of the proximal tibia should raise a strong suspicion of severe associated intra-articular knee lesions and requires prompt MRI investigation. However, controversy still exists regarding the management of these injuries, in particular concerning the question of whether to address both injuries in a single stage or in 2 stages.

Treatment of patellar tendon avulsion at the tibial tubercle at subacute stage: a case report

“…The limited number of cases of distal patellar tendon rupture described in the literature have been reported in adults, and most of them are associated with additional intra-articular lesions (ACL and MCL tears, meniscal damage) [2]. To our knowledge, there are few publications in the literature that share the treatment and results after distal patellar tendon avulsion in the pediatric population [3], [4]. Although distal patellar tendon avulsions are rare in the pediatric population, it can cause serious problems such as knee pain and loss of function of the extensor mechanism.…”

Combined Rupture of the Right Anterior Cruciate Ligament and Patellar Tendon on a 28-Year-Old Spanish Professional Handball Player Successfully Treated by Single-Stage Reconstructive Surgery

“…If the ACL is reconstructed in the first 3 weeks after the injury occurs (inflammatory phase), the main postoperative complications reported after a single-stage treatment include low patella, arthrofibrosis, and limited knee flexion [ 5 ]. These complications can be attributed to the recommendation to limit knee flexion to between 0° and 30° during the initial recovery period [ 2 , 3 , 6 ].…”

“…Owing to the rarity of this combined injury and the resultant impossibility of carrying out clinical trials to investigate it, the best surgical option remains unknown and there is no established protocol for the treatment of this injury [ 4 , 6 , 7 , 10 – 12 ].…”