Epidemiology, Diagnosis, and Management of Tibial Tubercle Avulsion Fractures in Adolescents

Abstract

» Although rare, tibial tubercle avulsion fracture must be considered in the differential diagnosis for the pediatric patient presenting with acute knee pain.» In the adolescent population, tibial tubercle avulsion fracture is a rare injury that is typically seen in boys who engage in sporting activities that involve jumping or sprinting.» The proximal tibial physis closes distally in the posteromedial to anterolateral direction, creating an environment that predisposes the tubercle to a potential avulsion injury.» Historically, the Ogden classification has guided nonoperative and operative management of this condition.» Multiple fracture fixation methods have been described with the overall goal of restoring the extensor mechanism and the joint surface.

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

“…Cancellous partially threaded screws are recommended for internal fixation as they allow greater compression at fracture site, although K-wires may be useful in younger children [1]. Soft tissue repair with suture fixation of the periosteum is also an option, especially for patients with a very immature skeleton [1,2,10,11,13,15]. Arthroscopy may be advantageous to assess joint surface congruency and treat any associated meniscal injuries.…”

“…Genu recurvatum is a rare complication that can possibly be explained by tibial tuberosity physis early growth arrest [1,3,4,7,13,15]. It is generally not a concern since TTAFs occur mainly in adolescents nearing skeletal maturity, when the aforementioned physis is approaching physiological closure [2][3][4][9][10][11][12][13][14][15]. Such growth disturbance has been described in pre-adolescent patients [3,7,9].…”

“…This typically applies to type II-V fractures [3,6,10,15]. There are several surgical options, including ORIF with cannulated screws or K-wires, closed reduction and percutaneous pinning, arthroscopy or soft tissue repair [1][2][3]5,7,[10][11][12][13]15]. Cancellous partially threaded screws are recommended for internal fixation as they allow greater compression at fracture site, although K-wires may be useful in younger children [1].…”

“…The proximal tibia has two secondary ossification centers: the epiphyseal ossification center (which appears in the first weeks of life and contributes to growth) and the tibial tubercle ossification center (that usually begins to develop between 7 and 12 years old and is located where the patellar tendon inserts) [1][2][3]10,13,15]. Around 14 years of age in girls and 16 years in boys these two centers of ossification start to fuse with each other and with the metaphysis, in the central zone first.…”

“…TTAFs can be managed either conservatively or surgically. However, in both cases it is mandatory to preserve a functional knee extensor apparatus, obtain anatomic reduction of the articular surface and manage associated injuries [1][2][3]7,[10][11][12]15]. There is a low incidence of complications and functional outcomes are generally great, regardless of the type of treatment [1][2][3][4][5][6][7][10][11][12][13][14].…”