Tibial tubercle avulsion fractures in adolescents: impact on function and quality of life

Abstract

The objective of the study was to assess functional outcomes and quality of life of patients treated for tibial tubercle avulsion fractures (TTAFs). Retrospective study of patients under 18 years of age treated from June 2011 to May 2018. Demographic data included age, gender, mechanism of injury, side, fracture classification, associated injuries, predisposing factors, and type of treatment. Clinical results included knee range of motion, pain, return to sports, overall satisfaction, functional outcomes, and complications. At final follow-up, Tegner Lysholm Knee Scoring Scale, and Kidscreen-10 were applied. Ten patients were included, all males, with a median age of 15 years. Mechanism of injury: football (three patients), basketball (two patients), running (two patients), handball (one patient), gymnastics (one patient), and fall (one patient). Nine were treated surgically with reduction and fixation with cannulated screws or Kirschner wires, plus treatment of associated injuries (three patellar tendon avulsions, one contralateral proximal tibia epiphyseal fracture, and two prophylactic fasciotomies). One patient developed mild recurvatum and two presented minor decreased knee flexion. Eight patients returned to their previous level of sports activity. Median Tegner Lysholm Knee Score was 100/100 and Kidscreen-10 was 50/50. With appropriate treatment, nearly 100% of TTAFs have good functional outcomes and low impact on quality of life.

Tibial Tuberosity Fracture: A Highly Selective Injury

“…The association was weaker when comparing TTF to forearm fractures (Table 2), likely because male sex is a risk factor for forearm fractures as well. Our findings are consistent with previous series showing that TTFs occur almost exclusively in males 19–24. In a series of 30 adolescents with TTF by Shin et al, 28 (93.3%) were male and 2 (6.7%) were female 19.…”

“…1). This is consistent with previous studies estimating the average age of TTF to be 14 to 15 years 19–22. The frequency of TTFs in this age range could be related to regional stress concentration in the tibial tubercle secondary to apophyseal closure 25.…”

“…This is consistent with previous studies estimating the average age of TTF to be 14 to 15 years. [19][20][21][22] The frequency of TTFs in this age range could be related to regional stress concentration in the tibial tubercle secondary to apophyseal closure. 25 This process occurs between the ages of 11 and 17 years in boys and between 10 and 15 years in girls.…”

“…Our findings are consistent with previous series showing that TTFs occur almost exclusively in males. [19][20][21][22][23][24] In a series of 30 adolescents with TTF by Shin et al, 28 (93.3%) were male and 2 (6.7%) were female. 19 One proposed explanation is that increased quadriceps strength in males could play an important role in the pathophysiology of TTF.…”

Tibial tubercle fractures are sports injuries in male adolescents with a considerable risk of complications and reoperations: a systematic review

“…The average CMS value was 51 (range 34–67), demonstrating poor methodological quality. No studies were graded as “excellent” or “good” as nine were found “fair” [2, 5, 12, 18–20, 25, 28, 36].…”