Combined avulsion fracture of the tibial tubercle and patellar tendon rupture in young athlete: An uncommon injury

Abstract

Introduction: Patellar tendon rupture is a rare entity, accounting for 3% of all knee extension system injuries. In some cases, the tear is accompanied with avulsed tibial tubercle. Such concurrent fracture is extremely rare, and only a few previously cases have been described in the literature. We reported a 13-year-old male with combined avulsion fracture of the tibial tubercule and patellar tendon rupture. Case Report: A 13-year-old male junior basketball athlete presenting with left knee pain since 2 days before admission. The patient had previously fell to the ground with his left knee hitting the ground while playing basketball. Physical examination demonstrated swollen left knee. Radiographic examination suggested tibial tubercle avulsion, and magnetic resonance imaging demonstrated partial rupture of distal patellar tendon. The patient then underwent open reduction and internal fixation using single cannulated screw for the avulsed tibial tubercle, and patellar tendon reconstruction using suture anchor with ultra high molecular weight polyethylene fibers. Postoperatively, the patient was placed in a locked straight leg brace. One week after surgery, the patient began range of motion exercises and progression of weight bearing with physical therapy. At 4 months of follow-up, the patient can already weightbear, and he had regained active knee range of motion. Discussion: Combined avulsion fracture of the tibial tubercle and patellar tendon rupture in young athlete is an extremely rare case. As such, there is no guideline regarding the best treatment. In this report, we chose open surgery for anatomical reduction of the tuberosity fragment because we consider the growth plate and direct visualization of the patellar tendon. Rigorous physical therapy is of utmost importance in this patient for return to sport, as he is a young athlete. Conclusions: Open reduction and internal fixation using single cannulated screw, and patellar tendon reconstruction suture anchor might be a treatment of choice for those with combined avulsion fracture of the tibial tubercle and patellar tendon rupture in young patients.