Patellar sleeve avulsion fracture in a patient with Sinding-Larsen-Johansson syndrome: a case report

Abstract

Background: Patellar sleeve avulsion (PSA) fractures are rare injuries that occur in in skeletally immature patients. Initial diagnosis is key to a successful outcome, as these injuries are easily overlooked on plain radiographs with poor results well documented from delayed management. High index of suspicion from the mechanism of injury, thorough clinical examination and Magnetic Resonance Imaging (MRI) help to avoid misdiagnosis. Case presentation: The case of a 12-year-old male athlete with an acute PSA after a conservative treatment of a SLJ syndrome is described. The patient was referred to our clinic due to severe pain and loss of function after performing a high jump. Plain radiographs (X-ray) and MRI confirmed an inferior pole PSA which was fixed with double trans osseous ultra-high strength tapes. At the 3-month follow-up visit the patient was able to ambulate brace free. At 2-years follow up the patient was able to play soccer and ice hockey. To our knowledge, there are no case reports of inferior pole PSA with prior SLJ syndrome described in literature. Conclusions: Early clinical suspicion and distinguishing this PSA from other enchondral ossification disorders around the knee is critical to avoid misdiagnosis. Whether SLJ syndrome increases the risk of sustaining a PSA is still not clear. Trans osseous fixation with suture tapes leads to good functional results in a young athlete with inferior pole PSA.

Management and subsequent outcomes of patellar sleeve injuries: A retrospective case series of 90 pediatric and adolescent patients

“…While it is interesting to note two cases described in the literature of a patellar sleeve injury occurring in a patient with SLJ syndrome, patients with SLJ were intentionally excluded from this study to remove ambiguity. 18,19 Despite reports that non-operative intervention, even in minimally displaced cases, may lead to chronic patella alta or ossification of the patellar tendon, 6,10 64 patients (71%) underwent non-operative management. None of these patients had patella tendon ossification on final radiographs and only one patient had patella alta, which was not statistically significantly different from the operative cohort in the subgroup analysis.…”

“…While it is interesting to note two cases described in the literature of a patellar sleeve injury occurring in a patient with SLJ syndrome, patients with SLJ were intentionally excluded from this study to remove ambiguity. 18 , 19 …”

Neglected Isolated Sleeve Fracture of the Superior Pole of the Patella in a Healthy Adult – A Case Report and Review of Literature

“…Sleeve fracture (SF) of the patella is described as the traumatic avulsion fracture of the inferior/superior pole, in which a small osseous fragment is pulled, along with a periosteal sleeve and patellar cartilage [ 1 ]. SF represents an unusual type of patellar fracture and has been reported mainly in children or adolescents.…”

Patellar Sleeve Fracture: An Important Consideration for Pediatric Knee Pain

“…3 Common activities that can result in this mechanism of injury include sports such as soccer, basketball, football, track and field, and baseball. 4,5 This injury may initially present to the emergency department, an urgent care facility, or to the patient's primary care provider, whether that be a pediatrician or family medicine physician.…”

“…Recommendations include having a high index of suspicion after learning the mechanism of injury, performing a thorough clinical examination, understanding that plain film radiographs may not be sufficient in diagnosing PSFs, and using diagnostic tools such as US and MRI in addition to plain radiographs to avoid a misdiagnosis. 4,5 However, further studies to determine the efficacy of point-of-care US for the diagnosis of patellar sleeve fractures are needed to determine if it is a superior modality compared with MRI. Clinical Pediatrics 62 (12) Ethical Approval/Patient Consent Our study did not require an ethical board approval because all the data and information used in the study were gathered from reviewing previously published literature.…”