Two cases of combined patellar tendon avulsion from the tibia and patella

Abstract

Avulsion fractures of the inferior pole of the patella and proximal tibial apophysis are independently rare injuries. They occur in children due to the relative weakness of the apophyseal cartilage compared to the ligaments and tendons. The combination of these two fractures, is exceedingly rare, with only a few previously described cases in the literature. Due to the infrequent presentation of this injury, careful examination and consideration of advanced imaging is important for diagnosis and preoperative planning. Here we present two cases of combined sleeve fractures of the inferior pole of the patella and tibial apophysis, with discussion of the pathophysiology, classification, identification and management of the injury.

Bifocal Patellar Tendon Avulsion Fractures in Children and Adolescents: Diagnosis and Treatment Considerations for a Unique Injury Pattern

“…Only a handful of reported cases of this injury pattern are found in the orthopedic literature. 2 , 8 , 9 , 10 A high index of suspicion and sufficient diagnostic imaging are keys to successful treatment.…”

“…However, bifocal patellar tendon avulsion fractures are rare injuries, and this series will supplement the limited literature on this topic. 2 , 8 , 9 , 10 Third, postoperative follow-up ranged from 7.7 to 26.4 months, and most patients had not reached skeletal maturity. Potential complications such as leg length discrepancy and recurvatum may not yet be evident in these patients.…”

“…Avulsion fractures of the tibial tubercle represent <1% of apophyseal injuries in the pediatric population. 1 , 2 These fracture patterns are most common in male adolescents, typically between the ages of 13 and 16 years. 1 The mechanism of injury involves high tensile force at the attachment of the patellar tendon to the tibial apophysis due to a violent quadriceps contraction.…”

“…To our knowledge, there are only 5 case reports of this injury in the literature. 2 , 8 , 9 , 10 The purpose of this study was to highlight important diagnostic and treatment considerations in patients who present with bifocal patellar tendon avulsion fractures from the tibial tubercle and inferior patellar pole. We hypothesized that these bifocal injuries are best characterized with advanced imaging preoperatively and demonstrate satisfactory patient-reported outcomes after operative repair.…”

Neglected Rupture of the Patellar Tendon After Fixation of Tibial Tubercle Avulsion in an Adolescent Male Managed With Ipsilateral Semitendinosus Autograft Reconstruction

“…As the physis is the weakest link of the muscletendon-bone interface during childhood, a tibial tubercle avulsion is much more likely to occur than a patellar tendon rupture. The combination of a tibial tubercle fracture with patellar tendon avulsion is even rarer, with only a few cases reported in the literature [5][6][7][8][9][10][11][12][13][14]. The tibial tuberosity fracture was first classified by Watson-Jones [15] before being modified into A and B subtypes by Ogden et al in 1980 [16].…”