Combined avulsion fracture of the tibial tubercle and patellar tendon rupture in pediatric population: case series and review of literature

Yousef, Mohamed

doi:10.1007/s00590-017-2048-z

Cited by 27 publications

(39 citation statements)

References 9 publications

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“… 16 However, the role of high-strength suture tape augmentation of the Krackow technique in the setting of inferior pole avulsion remains unclear. 18 …”

Section: Introductionmentioning

confidence: 99%

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High-Strength Suture Tape Augmentation Improves Cyclic Gap Formation in Transosseous Patellar Tendon Repair: A Biomechanical Study

Gould

Weiner

Tomaszewski

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To compare gap displacement at various intervals of cyclic testing and biomechanical load to failure of a Krackow patellar tendon repair augmented with high-strength suture tape versus the standard Krackow transosseous technique for inferior pole patellar tendon rupture. Methods Twelve matched pairs of cadaveric knees were used (8 males and 4 females; mean age 79.6 years, range 57 to 96). An inferior pole patellar tendon rupture was simulated after random assignment of specimens in each pair to the standard or augmented Krackow technique. Each specimen was then repetitively cycled from 90° to 5° for 1,000 cycles. A differential variable reluctance transducer was used to measure gap displacement. After cyclic loading, load to failure was determined by pulling the tendon at a rate of 15 mm/s until a sudden decrease in load occurred. Results Compared with the control repair, specimens with augmented repair demonstrated significantly less displacement at all testing intervals up to 1,000 cycles ( P < .05). Two patellar tendons failed before the end of cyclic loading, and 4 specimens had inadequate tendon length for loading. Among the 18 remaining specimens, no significant difference in load to failure was observed between the experimental group (n = 11) and the control group (n = 7) (1,006.5 ± 332.1 versus 932.8 ± 229.1 N, respectively; P = .567). Conclusions Significantly greater gap displacement was observed in the standard Krackow repair group compared with the augmented Krackow group at all cyclic loading intervals. This suggests that the Krackow transosseous procedure augmented with high-strength suture tape is biomechanically viable for inferior pole patellar tendon repair. Clinical Relevance This biomechanical study supports the use of high-strength suture tape augmentation of Krackow transosseous repair for inferior pole patellar tendon rupture.

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“… 16 However, the role of high-strength suture tape augmentation of the Krackow technique in the setting of inferior pole avulsion remains unclear. 18 …”

Section: Introductionmentioning

confidence: 99%

“…Midsubstance rupture is much less common than inferior pole rupture 18 and also requires a different repair procedure and final construct. To repair a midsubstance rupture, a Krackow locking stitch is performed at both the proximal and distal limbs of the transected tendon and then hand-tied over the rupture site.…”

Section: Introductionmentioning

confidence: 99%

High-Strength Suture Tape Augmentation Improves Cyclic Gap Formation in Transosseous Patellar Tendon Repair: A Biomechanical Study

Gould

Weiner

Tomaszewski

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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“…A longitudinal midline incision directly over the normal anatomic location of the patella was made. Consistent with imaging, the patellar tendon was separated from the patella at the inferior pole bilaterally which is the most common site of rupture [5]. Additionally, extensive fraying of BPT was seen.…”

Section: Case Presentationmentioning

confidence: 79%

Simultaneous Bilateral Rupture of Patellar Tendons in a Young Man Without Predisposing Factors or Systemic Disease

Barner¹,

Gluck²,

Witte³

2019

Cureus

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Bilateral patellar tendon (BPT) rupture is an exceedingly rare cause of extensor mechanism failure with many patients having predisposing factors such as systemic disease, steroid, or antibiotic use that increase the risk. Patients may present with an inability to extend the knee, diffuse pain and swelling, and a high riding patella on lateral radiographs. We present a case of a young man without predisposing factors or systemic disease who experienced a BPT rupture while playing sports.

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“…Extensor mechanism deficit can occur concomitantly in patients with a tibial tubercle avulsion fracture due to patellar tendon rupture [ 9 ]. The reported incidence of patellar tendon rupture ranges from 2%–15.7% [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…The presence of a palpable defect between the inferior pole of the patella and tibial tuberosity should heighten clinical suspicion for associated patellar tendon rupture [ 7 ]. If physical examination cannot be performed due to cast immobilization or pain, the presence of patella alta on radiographic imaging as well as calcified fragments below the patella may indicate the presence of patellar tendon rupture [ 7 , 9 ]. The tibial tubercle represents the most inferior aspect of the extensor mechanism, and adolescents are at increased risk of injury due to the relative weakness of the physis compared to the tendon insertion [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Tibial Tubercle Avulsion Fracture with Multiple Concomitant Injuries in an Adolescent Male Athlete

Agarwalla

Puzzitiello

Stone

et al. 2018

Case Reports in Orthopedics

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Tibial tubercle avulsion fractures are an uncommon injury occurring due to strong contraction of the quadriceps femoris muscle during leg extension, ultimately causing failure of the physis at the patellar tendon insertion. This injury has been previously reported with various concomitant injuries, such as compartment syndrome from bleeding into the anterior compartment, vascular injury, patellar tendon avulsion, and meniscal injury—exhibited only with fracture types that extend intra-articularly. We report the case of a 14-year-old healthy adolescent male basketball player who sustained this injury as a result of a collision with another player. He initially reported to the emergency department and then presented to our practice, where he was diagnosed with a tibial tubercle avulsion fracture with patellar tendon rupture. During the operative management of these injuries, it was noted that fascial tissue avulsed through the injury site causing subacute extensive bleeding within the anterolateral compartments. Due to concerns of compartment syndrome, a fascial release was performed along the anterolateral compartments. By five months postoperatively, the patient demonstrated near-normal function, no evidence of extensor lag, and nearly full range of motion. Unlike previously reported cases, this is the first report of a patient who suffered such an injury with multiple concomitant injuries to the neighboring structures. Due to the severity of compartment syndrome and the variability in its temporal presentation from the initial injury, it is paramount that careful evaluation of vascular integrity and a low threshold for fasciotomy be in place to prevent vascular compromise.

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Combined avulsion fracture of the tibial tubercle and patellar tendon rupture in pediatric population: case series and review of literature

Cited by 27 publications

References 9 publications

High-Strength Suture Tape Augmentation Improves Cyclic Gap Formation in Transosseous Patellar Tendon Repair: A Biomechanical Study

High-Strength Suture Tape Augmentation Improves Cyclic Gap Formation in Transosseous Patellar Tendon Repair: A Biomechanical Study

Simultaneous Bilateral Rupture of Patellar Tendons in a Young Man Without Predisposing Factors or Systemic Disease

Tibial Tubercle Avulsion Fracture with Multiple Concomitant Injuries in an Adolescent Male Athlete

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