Simultaneous bilateral tibial tubercle avulsion fracture in a basketball player

Abstract

A 16-year-old male basketball player had sustained an injury upon landing after a forceful jump. Plain radiography demonstrated bilateral tibial tubercle avulsion fracture involving partially proximal physis. Open reduction and internal fixation were performed at once. Continuous passive motion was started immediately after operation, and the patient was ambulated with hinged knee extension braces. After 27 months follow-up his knees completely regained normal range of motion except a 3 degrees extension loss in the left knee. He resumed all daily functional activities (Lysholm functional score of 99), but he slightly lost his level of activity (Tegner activity level from 7 to 6). No angular deformity at all on the frontal plane was determined upon radiological examination. Tibial slope angles were symmetrical and within the normal range. There were visible small bone fragments inside the left patellar tendon.

Fracture of tibial tuberosity in an adult

“…There is controversy between keeping the knee immobilised or not and the postoperative immobilisation period 18. We must remember that this type of injury usually affects children and adolescents.…”

Lessons learnt from managing an avulsion fracture of the tibial tubercle extending into the tibial physis

“…The physis of the tibial tuberosity is composed primarily of fibrocartilage and fibrous tissue, with bone being added to the anterior portion of the tibial metaphysis by membranous bone formation 8 9. The development of the tibial tubercle shows progression from this fibrocartilage to columnar cartilage and begins proximally 10 11. These structural features would be an adaptation to the strong tensile forces exerted in this region 8.…”

“…Originally these injuries were classified by Watson-Jones into three types; in type I a small fragment is avulsed from the tubercle, type II occurs when the whole tubercle is avulsed and in a type III injury, the fracture extends across the proximal physis into the knee joint 15. This classification was modified by Ogden with subdivision into groups A and B according to the level of comminution and displacement 11. A type IV was described by Ryu and Debenham when the fracture extended posteriorly through the physis16 and type V was added by McKoy and Stanitski with a combination of IIIB and IV giving rise to a Y-shaped pattern 17.…”

Fratura avulsão bilateral e simultânea da tuberosidade tibial em uma adolescente: relato de caso e terapêutica adotada

“…Computed tomography is well indicated when there is a fracture of the tibial tubercle that affects the joint surface (7,8) . There is some controversy regarding whether to keep the patient immobilized after the operation, for how long to do this (9) . It needs to be borne in mind that this type of injury generally affects individuals with an immature skeleton.…”