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

Abstract

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.

Tibia Tuberosity Fracture and Patellar Tendon Rupture Combination in a Pediatric Patient: Case Report and Narrative Review

“…The occurrence of such injuries has increased due to the growing participation in sports at younger ages. Very few cases have been reported in the literature [ 3 ]; hence suspicion of such complex injuries should be high. Therefore, we present a case of combined simultaneous TTF along with PTR and discuss the related literature.…”

“…TTF occurs due to failure through the secondary growth plate of the proximal tibia and is more commonly seen in boys aged 12-17 [ 1 - 3 ]. It is usually attributed to jumping actions that most commonly occur during sports participation, with basketball being the most common [ 3 ], like in our case.…”

“…TTF occurs due to failure through the secondary growth plate of the proximal tibia and is more commonly seen in boys aged 12-17 [ 1 - 3 ]. It is usually attributed to jumping actions that most commonly occur during sports participation, with basketball being the most common [ 3 ], like in our case. Forceful quadriceps contraction, particularly during jumping activities, imposes tremendous forces on the more distal part of the extensor mechanism.…”

“…Tibial tuberosity fracture, in particular, has been described in the literature as secondary to an injury of the physeal growth plate [ 1 - 3 ]. It is seen more frequently in boys and associated with sports such as basketball and football that include excessive jumping activity [ 3 ].…”

“…Tibial tuberosity fracture, in particular, has been described in the literature as secondary to an injury of the physeal growth plate [ 1 - 3 ]. It is seen more frequently in boys and associated with sports such as basketball and football that include excessive jumping activity [ 3 ]. It has been described either after forceful contraction of the quadriceps during jumping or eccentric quadriceps contraction during forceful knee flexion [ 2 ].…”