Tibial tubercle fracture associated with distal rupture of the patellar tendon: case report

Abstract

Avulsion of the tibial tubercle is an uncommon injury that occurs in the young athlete, resulting from an eccentric contraction of the extensor mechanism with the leg fixed to the ground. Concomitant injuries to the patellar tendon are very rare, with few cases reported in the literature. The authors present a case of a 15-year-old basketball player who suffered an avulsion of the tibial tubercle associated with complete distal rupture of the patellar tendon while training. It was treated with open reduction of the tibial fragment and reconstruction of the patellar tendon with mini-anchors and cannulated screws, as well as hamstring autograft tendon reinforcement. The patient showed excellent results and returned to sports after 12 months of follow-up.

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

“…Most reported injuries were associated with sports activities during basketball [6,8,12,14], football or soccer [10,13], skateboarding [11], running [5,14], and jumping [7,9,12]. The two traction apophysitis diseases of the knee, Osgood-Schlatter disease and Sinding-Larsen-Johansson syndrome, are postulated to be associated with avulsion fractures of the tibial tubercle [10,12].…”

“…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].…”

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

“…Multiple treatment and fixation methods have been proposed, such as the use of immobilization with plaster or percutaneous fixation in the Ogden 1 type fractures and the use of Kirschner wires[ 8 ], tension bands[ 25 ], staples[ 26 ], conventional AO screws[ 23 ] or cannulated screws (unicortical or bicortical with and without the use of washers, it has been previously shown that there are no differences regarding the number of cortices)[ 27 ] measuring 3.5 mm[ 3 ], 4.0 mm[ 28 ], 4.5 mm[ 22 ], 5.0 mm[ 17 ] and 6.5 mm[ 14 ] with full or partial thread; usually, two screws are used, but the use of three screws has been described[ 18 ]. The reinsertion/fixation of the patellar tendon has been described using direct suture repair of the tendon to the periosteum[ 14 ], staples[ 29 ], tension bands, transosseous sutures through the tibia in an oblique[ 3 ] or horizontal direction[ 17 ], pole screws[ 22 ], fixing anchors placed in the native footprint of the PT insertion or on each side of the fracture line[ 30 ] and combinations of these methods[ 28 ]. The preferred suture technique for patellar tendon repair is the Krackow technique for most cases and the Bunell technique for some cases[ 12 ], and various suture materials are used: 2/0 Ethindond[ 31 ], #2 Fiberwire ® [ 3 ],[ 17 ], #2 polydioxanone[ 18 ] or Vycril[ 14 ].…”

“…Similarly, the use of semitendinosus autografts for acute lesions[ 22 ] and the use of Achilles tendon allografts for chronic lesions[ 32 ] to augment or protect the PT have been previously described (where wire cerclages have also been used[ 18 , 19 ]or high strength sutures[ 3 ]). In some cases, surgery is associated with additional procedures, such as releasing the anterolateral compartment of the leg to prevent the appearance of a compartment syndrome or partial meniscectomies.…”

Distal Patellar Tendon SpeedBridge Repair

“…Numerous repair techniques have been described, including end-to-end suture repair with or without cerclage reinforcement. 2 , 5 Additionally, suture anchors have been used for primary repair, with good functional outcomes reported. 6 The goal of surgical treatment is to re-establish the extensor mechanism using a repair technique that is strong enough to permit early mobilization to prevent quadriceps atrophy and knee stiffness.…”