Tibial tubercle fracture with avulsion of patellar ligament

Wu, Kun-Chi; Ding, Dah-Ching

doi:10.1016/j.fjmd.2013.01.005

Cited by 7 publications

(11 citation statements)

References 9 publications

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“…Tubercle avulsion is considerably more common in adolescents than that in adults due to the weakness of an open physis although tubercle fracture may also occur in adults, typically as a result of direct impact [1,4]. Regarding combined lesions, in adolescents it has been proposed that tubercle avulsion is followed by rotation, which tensions soft tissues around the tubercle, arresting fragment translation; continued quadriceps contraction then causes tendon avulsion [5,6]. This mechanism is plausible in our patient as radiographs demonstrated rotation and translation of the bony fragment.…”

Section: Discussionmentioning

confidence: 99%

“…Alternatively, the patellar tendon may avulse from an intact tubercle; this injury is similarly infrequent in healthy adults [2,3]. A combined lesiontubercle fracture with patellar tendon avulsion from the tubercle fragment -has only ever been reported in adolescents, typically those involved in sport, and can present challenges in both diagnosis and management [4][5][6][7][8][9]. This is the first reported case of tibial tubercle fracture with simultaneous avulsion of the distal patellar tendon in an adult.…”

Section: Introductionmentioning

confidence: 99%

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Combined Tibial Tubercle Fracture With Patellar Tendon Avulsion in an Adult: A Rare Case and Novel Fixation Technique

Woolnough

Lovsted

MacDonald

et al. 2020

Cureus

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Tibial tubercle avulsion fracture with simultaneous patellar tendon avulsion is a rare injury that has only ever been reported in adolescents; the diagnosis and management of this combined lesion has not been described in the adult population. A healthy 62-year-old male presented with acute knee pain and an inability to walk after a fall on ice. Radiographs demonstrated a displaced fracture of the tibial tubercle; patellar tendon integrity could not be verified by ultrasonography. Intraoperatively, the patient was found to have a distal avulsion of the patellar tendon in addition to tubercle fracture. First, the tendon was secured to the tubercle fragment with transosseous sutures. A novel slotted-plate construct was used to fix the tubercle fragment prior to tightening the sutures. Postoperatively, the patient was permitted to bear weight as tolerated with the operative knee immobilized in extension. After six weeks, knee range of motion was gradually increased using a hinged brace. At one year, the patient had achieved excellent range of motion (full extension to 135 degrees of flexion) and strength (5/5 knee flexion and extension) without residual pain or complications. This case represents the first description of diagnosis, management, and rehabilitation of a combined tibial tubercle fracture with distal patellar tendon avulsion in an adult. The unique construct, a slotted-plate over transosseous sutures, provided excellent results and likely has further applications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Combined Tibial Tubercle Fracture With Patellar Tendon Avulsion in an Adult: A Rare Case and Novel Fixation Technique

Woolnough

Lovsted

MacDonald

et al. 2020

Cureus

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“…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 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, in our case, we preferred not to use a tourniquet due to the possibility of retraction of the PT with its use. Similarly, only a few studies have used postoperative drainage[ 14 , 23 , 30 ]. In all cases, a vertical midline incision of variable length was preferred for the management of the patients (generally 6 to 10 cm in most studies).…”

Section: Discussionmentioning

confidence: 99%

“…A 180 degree rotation of the bone fragment has been reported in many studies[ 2 , 3 , 11 , 21 , 28 ]. Wu et al [ 30 ] mentioned that after 180° of rotation, soft-tissue attachments around the tibial tubercle prevent further displacement, but continued application of a force beyond this angle may then cause a patellar ligament avulsion.…”

Section: Discussionmentioning

confidence: 99%

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

Morales-Ávalos

Martínez-Manautou

Garza-Castro

et al. 2020

WJO

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BACKGROUND Few cases of avulsion fractures of the tibial tuberosity with simultaneous rupture of the patellar tendon have been reported in the literature. Therefore, its mechanism and incidence have not been determined conclusively. This type of fracture is considered a serious injury that requires prompt diagnosis and early surgical repair. There is no therapeutic algorithm or standard method of treatment due to the infrequency of the injury. In this case report, we conducted an exhaustive review and synthesis of the existing literature including all previously reported cases. CASE SUMMARY We present a 16-year-old male soccer player with a case of a tibial tuberosity fracture with distal avulsion of the patellar tendon 5 d prior to surgical treatment. The patient presented with a loss of the extensor mechanism of the knee, edema, the inability to walk, and pain. X-rays showed a high patella and a 180-degree avulsion of the tibial tuberosity. The diagnosis was confirmed by magnetic resonance imaging and computed tomography. The patient underwent open reduction and internal fixation of the fracture with a cannulated screw and washer as well as patellar tendon repair with two metallic anchors. The rehabilitation protocol consisted of initial immobilization in extension followed by passive mobility and muscle strengthening exercises. The patient demonstrated excellent postoperative outcomes and returned to regular activity without complications. CONCLUSION This case presentation and literature review comprise the most relevant clinical, radiographic, and treatment details described in the international literature to date, providing the reader with an overview of this rare condition.

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Krackow technique in patellar tendon rupture with tibial tuberosity avulsion with anterolateral rim of tibial plateau fracture: A case report

Shah,

Gupta,

Kubavat

2024

IJOS

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: Simultaneous occurrence of patellar tendon rupture and tibial tuberosity avulsion with anterolateral rim of tibial plateau fracture is an extremely rare condition that mainly occurs in adolescent population involved in sports activities. It is believed to be due to eccentric contraction of the extensors with the leg fixed to the ground. : The author present a case of 42 years old male patient who suffered an avulsion fracture of the tibial tuberosity with anterolateral rim of tibial plateau with rupture of patellar tendon in road-traffic accident which is rarely seen. : It was treated with open reduction with cannulated cancellous screw insertion and tension band wiring and patellar tendon repair by krackow technique which showed excellent results post-operatively. The pathophysiology, mechanism of injury, diagnosis and management of this case is reviewed in this article.

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Tibial tubercle fracture with avulsion of patellar ligament

Cited by 7 publications

References 9 publications

Combined Tibial Tubercle Fracture With Patellar Tendon Avulsion in an Adult: A Rare Case and Novel Fixation Technique

Combined Tibial Tubercle Fracture With Patellar Tendon Avulsion in an Adult: A Rare Case and Novel Fixation Technique

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

Krackow technique in patellar tendon rupture with tibial tuberosity avulsion with anterolateral rim of tibial plateau fracture: A case report

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