PARTIAL RUPTURE OF THE DISTAL INSERTION OF THE PATELLAR TENDON IN A PROFESSIONAL BASKETBALL CENTER

Abstract

846 HISTORY: A 27 year old professional basketball center reported an injury to his left knee, inferior to his patella, when he banged it against a car door 2 weeks prior to presentation. He reported an increase in pain and tenderness over the tibial tubercle over the 2 weeks. He had no complaints of any knee instability, swelling, locking, or popping. Of note, a prior MRI performed 6 months earlier for an unrelated complaint revealed proximal patellar tendinosis but no changes in the distal tendon. PHYSICAL EXAMINATION: There was no swelling or ecchymosis about the knee. There was no joint effusion or joint line tenderness. Ligamentous exam did not reveal any instability. Knee extension and flexion was full and strength was good, but with pain over the tibial tubercle with resisted extension. No tenderness over the patella or proximal patellar tendon was noted. There was no patellar instability. Localized tenderness over the patellar tendon insertion onto the tibial tubercle was elicited by palpation. DIFFERENTIAL DIAGNOSIS: 1. Bone contusion of the tibial tubercle 2. Distal patellar tendinitis 3. Partial rupture of the distal patellar tendon 4. Symptomatic old Osgood-Schlatter ossicle TESTS AND RESULTS: RADIOGRAPHS: AP, lateral, sunrise views of left knee- Normal, without evidence of fracture, dislocation, patella baja, or patella alta. No old Osgood-schlatter ossicle. MRI: Axial, sagittal and coronal views of left knee, Turbo spin echo sequence- Acute partial tearing of the distal patellar tendon, 8mm wide by 15mm in length, with associated bone edema at the tibial tubercle insertion. Mild chronic proximal patellar tendinosis. MRI 6 months ago showed no abnormalities at the distal tendon insertion. FINAL/WORKING DIAGNOSIS: Partial rupture of the distal patellar tendon TREATMENT: Non-operative treatment consisting of immobilization followed by rehabilitation was considered. However, the considerable risk of complete patellar tendon rupture in this high level, jumping athlete warranted surgical repair. At surgery, the partial tendon tear was identified, debrided, and repaired with two suture anchors. A cylinder cast was removed at two weeks post-op and aggressive therapy was instituted. He was able to return to play after 3 months.