Tibial Tubercle Avulsion Research Articles

Displaced closed avulsion of tibial tuberosity in a parkour enthusiast

Tibial tuberosity avulsion injury in isolation is a rare form of knee trauma. The associated damage to the knee extensor mechanism calls for adequate management for good functional regain. Most of the reported cases in literature consist of children and adolescent patients and the injury in adults is an uncommon pattern. Very few of the tuberosity fractures have concomitant patellar tendon avulsion. We present a case of this rare injury in a parkour learner who sustained this injury while practicing one of his stunts. The operative management and compliant physiotherapy ensured a satisfactory outcome.

An Alternative Technique for Repair of Patellar Ligament Ruptures with Associated Tibial Tuberosity Avulsion Fracture

We describe a case report of a patient who suffered dual injury to the patellar tendon insertion treated with an alternative technique for the repair of patellar ligament rupture with concomitant tibial tuberosity avulsion. These injuries are rare and there is no uniform technique, described to deal with this complex injury. In this report we describe an alternative technique which provides with secure fixation of the tendon allowing for early rehabilitation. It is simple and reproducible yet provides a robust fixation of the tendon injury allowing to restore the normal anatomical parameters. This technique avoids the need for neutralization box stitch to be passed through the quadriceps tendon, avoiding violation of intact tissue and large surgical wounds. To our knowledge, this method has not been previously described.

Quadriceps Tendon Rupture and Contralateral Patella Tendon Avulsion Post Primary Bilateral Total Knee Arthroplasty: A Case Report

Background: Extensor mechanism failure secondary to knee replacement could be due to tibial tubercle avulsion, Patellar tendon rupture, patellar fracture or quadriceps tendon rupture. An incidence of Patella tendon rupture of 0.17% and Quadriceps tendon rupture of around 0.1% has been reported after Total knee arthroplasty. These are considered a devastating complication that substantially affects the clinical results and are challenging situations to treat with surgery being the mainstay of the treatment.Case Description: We report here an interesting case of a patellar tendon rupture of one knee and Quadriceps tendon rupture of the contralateral knee following simultaneous bilateral knee replacement in a case of inflammatory arthritis patient. End to end repair for Quadriceps tear and augmentation with Autologous Hamstring tendon graft was done for Patella tendon rupture.OUTCOME: Patient was followed up for a period of 1 year and there was no Extension lag with a flexion of 100 degrees in both the knees.DISCUSSION: The key learning points and important aspects of diagnosing these injuries early and the management techniques are described in this unique case of bilateral extensor mechanism disruption following knee replacements.

An Alternative Technique for Repair of Patellar Ligament Ruptures with Associated Tibial Tuberosity Avulsion Fracture

We describe a case report of a patient who suffered dual injury to the patellar tendon insertion treated with an alternative technique for the repair of patellar ligament rupture with concomitant tibial tuberosity avulsion. These injuries are rare and there is no uniform technique, described to deal with this complex injury. In this report we describe an alternative technique which provides with secure fixation of the tendon allowing for early rehabilitation. It is simple and reproducible yet provides a robust fixation of the tendon injury allowing to restore the normal anatomical parameters. This technique avoids the need for neutralization box stitch to be passed through the quadriceps tendon, avoiding violation of intact tissue and large surgical wounds. To our knowledge, this method has not been previously described.

Simultaneous Rupture of Patella Tendon with Tibial Tubercle Avulsion Fracture, Anterior Cruciate Ligament Avulsion Fracture of the Tibial Spine in a Skeletally Mature Patient: A Case Report

There have been only rare incidences of simultaneous rupture of the patella tendon and anterior cruciate ligament. We describe a patient that had the first reported case of a patella tendon rupture with a tibial tubercle avulsion fracture and an anterior cruciate ligament avul- sion fracture of the tibial eminence. The patient was a 19-year-old skeletally mature collegiate athlete who sustained the above injuries after falling from his bicycle. The next day he was treated with an open reduction and internal fixation of both his tibial tubercle avulsion frac - ture and his tibial eminence avulsion fracture as well as a repair of his patella tendon. Over the course of his rehabilitation, the patient showed no complications and was pleased with his outcome at his 2 year visit. To our knowledge, this is the first time this specific pattern of injury has ever been reported.

Ipsilateral Patellar Distal Pole and Tibial Tubercle Avulsion Fractures in an Adolescent: A Case Report and Review of the Literature.

We present a case of simultaneous ipsilateral patellar distal pole and tibial tubercle avulsion fractures in an adolescent patient. While each entity is well documented when occurring in isolation, to the best of our knowledge, this is the first case in the medical literature of both injuries occurring simultaneously. The patient and his mother were informed that data concerning the case would be submitted for publication, and they provided consent. A fourteen-year-old healthy adolescent (with a body mass index of 23 kg/m2) presented to the emergency department following a fall forward onto a hyperflexed left knee. Immediate symptoms were pain in the knee and inability to bear weight. There was no relevant past or family history, and he had no prior history of fractures. Prior to the injury, he had been healthy with no history of pain in the anterior aspect of the knee or Osgood-Schlatter disease. On examination, there was a large effusion in the left knee, with tenderness at both the proximal and distal ends of the patellar tendon. The overlying skin was intact. Despite adequate analgesia, the patient was unable to perform a straight leg raise or extend the knee. The knee was stable in the coronal and sagittal planes. Radiographs (Figs. 1-A and 1-B) demonstrated an opacity distal to the patella, keeping with a sleeve-type avulsion fracture of the distal pole. The Insall-Salvati ratio was 1.8. The knee was placed in a temporary splint and surgery was recommended. Preoperative anteroposterior ( Fig. 1-A ) and cross-table lateral ( Fig. 1-B ) radiographs of the left knee. Both radiographs show an opacity distal to the patella, but the tibial tubercle appears relatively normal. Fig. 1-A Fig. 1-B The patient was taken to the operating room the following morning, and an arthrotomy was performed via a midline incision. Both medial and lateral retinacular disruption were noted. The distal patellar avulsion was evaluated; there was no substantial soft-tissue dissection, but we noted a multifragmentary extra-articular fracture …

Major complications and risk factors associated with surgical correction of congenital medial patellar luxation in 124 dogs.

Dogs treated for congenital medial patellar luxation were reviewed for the purpose of determining the incidence of postoperative major complications requiring surgical revision and the risk factors for their occurrence. Major complications occurred in 18.5% of the patellar luxation stabilization procedures with implant associated complications being the most frequent, patellar reluxation the second, and tibial tuberosity avulsion the third most common major complication. Other complications included patellar ligament rupture and trochlear wedge displacement. When recession trochleoplasty was performed in addition to tibial tuberosity transposition, a 5.1-fold reduction in the rate of patellar reluxation was observed. Release of the cranial belly of the sartorius muscle further reduced the incidence of patellar reluxation, while patella alta (pre- or postoperative) and patellar luxation grade were not found to influence the rate of reluxation. Tibial tuberosity avulsion was 11.1-times more likely when using a single Kirschner wire to stabilize a transposition, compared with two Kirschner wires. Independent to the number of Kirschner wires used, the more caudodistally the Kirschner wires were directed, the higher the risk for tibial tuberosity avulsion. Tension bands were used in 24.4% of the transpositions with no tuberosity avulsion occurring in stifles stabilized with a tension band. Overall, grade 1 luxations had a significantly lower incidence of major complications than other grades, while body weight, age, sex, and bilateral patellar stabilization were not associated with risk of major complication development.

Application of Femoral Quadriceps Transposition for the Contracture of the Quadriceps Muscles Following Tibial Tuberosity Avulsion in a Dog

Application of Femoral Quadriceps Transposition for the Contracture of the Quadriceps Muscles Following Tibial Tuberosity Avulsion in a Dog

Tibial tuberosity avulsion fracture in an adult-A rare case report

Tibial tuberosity avulsion fracture in an adult a rare case report. Avulsion of the tibial tuberosity is not an uncommon entity seen in adolescents. This injury is a very rare event in adults, with only a few cases reported in literature. Here we present a very rare case of an adult having tibial tuberosity avulsion with fracture femur. We performed an open reduction and internal fixation of the tibial tubercle using a cortical screw and tension-band wire. Patient had a good functional recovery after Six weeks of follow up.

A Response to “Osgood-Schlatter Disease in an English Setter”

Correspondence to: Dr. Dirsko von Pfeil Veterinary Specialists of Alaska 3330 Fairbanks Street Anchorage 99503, Alaska United States Phone: +1 907 274 0645 E-mail: drvonpfeil.vsoa@ak.net Dear Doctors Stigen and Mikalsen, We appreciate your contribution to the intriguing subject of tibial tuberosity injuries (1). Indeed, the case you saw recently in the Norwegian School of Veterinary Science appears to be very similar to Osgood-Schlatter disease in people. As stated in our publication, at the time of its writing, no case similar to the one you describe was reported in the available veterinary literature (2). We sincerely appreciate you sharing this case with the veterinary community. Based on the provided history of your patient, it is most likely that this dog suffered from a type – III tibial tuberosity avulsion fracture when it was five-months old. Over time, fusion with malunion of the proximally displaced and avulsed tibial tuberosity to the proximal tibia occurred. It is interesting that you state that “The most obvious pain response was provoked by maximally extending the right stifle joint” as with Osgood-Schlatter disease or tibial tuberosity avulsion, pain can usually be localized at the insertion of the patellar ligament, and elicited upon flexion of the knee. It would be interesting to follow this case and, if indicated see if shockwave treatment or resection of the ununited ossicles may help to decrease discomfort. In case of treatment, histopathology of the ossified particles may also provide additional information. Again, thank you for your contribution and helping to increase the knowledge base on tibial tuberosity injuries. Sincerely, Dirsko J. F. von Pfeil1,2; Charles E. DeCamp2; Curtis W. Probst2; Loic M. Dejardin2 1Veterinary Specialists of Alaska, Anchorage, Alaska, USA; 2Department of Small Animal Clinical Sciences, Michigan State University, College of Veterinary Medicine, East Lansing, Michigan, USA

Imaging Review of Adolescent Tibial Tuberosity Fractures

Adolescent tibial tuberosity injuries are infrequent fractures usually seen in physically active adolescent males. Powerful contraction of the knee extensors by sudden acceleration or deceleration of the quadriceps muscle can result in avulsion fractures of the tibial tuberosity apophysis. In late puberty, as the growth plate closes, it is transiently replaced by fibrocartilaginous elements. This transition causes a period of weakened tensile strength, which predisposes the tibial tuberosity to traction injury. Classification of tibial tuberosity fractures includes types I-V with added A and B subsets to types I, II and III. Multidetector computed tomography (MDCT) is a useful tool to more accurately classify complex, higher grade adolescent tibial tuberosity avulsion fractures when compared to plain film. This aids in preoperative planning and, therefore, results in improved treatment and management.

Poster 171 Case Report Tibial Tuberosity Avulsion in an Adult with a History of Osgood-Schlatter Disease: A Case Report

Poster 171 Case Report Tibial Tuberosity Avulsion in an Adult with a History of Osgood-Schlatter Disease: A Case Report

Tibial Tuberosity Fractures in Adolescents

Tibial tuberosity fractures have been described as uncommon injuries, but their frequency appears to be increasing. Because of the relatively few cases reported in the literature, little is known regarding risk factors for complications. In a large group of adolescents with tibial tuberosity fractures, we noted more frequent complications in patients who had posterior metaphyseal fractures in addition to tibial tuberosity avulsion fractures. The purpose of this study was to examine the outcomes associated with this fracture pattern and compare them with tibial tuberosity fractures without the posterior component. All patients who had closed or open reduction and internal fixation of a tibial tuberosity fracture between January 2003 and December 2010 were identified. All radiographs and medical records were reviewed. Fifty-three tibial tuberosity fractures had radiographs available for review; 15 (28%) fractures had a posterior component identified by either radiograph or computed tomography scan. Four of these combined injuries had an adverse event: 1 patient had compartment syndrome affecting all 4 compartments and 3 patients had refractures after closed reduction and casting. None of the 38 tibial tuberosity fractures without a posterior metaphyseal component had these complications. All patients had complete fracture healing and had returned to full activity at last follow-up. In this study, a posterior metaphyseal fracture associated with a tibial tuberosity fracture was a marker for potential complications. If radiographs suggest that a fracture line extends through the posterior metaphysis, computed tomography imaging is recommended to confirm the fracture pattern. Open reduction and internal fixation that includes both the anterior and posterior fragments is recommended for all fractures with these combined components, including nondisplaced fractures, because of an increased risk of refracture. Level IV (case study).

Tibial Tubercle Avulsion Fractures in Adolescent Basketball Players

Tibial tubercle avulsion fractures most commonly occur in adolescent boys and usually result from pushing off or landing while jumping. These fractures are relatively uncommon but can have a significant functional effect. The purpose of this study was to determine the long-term outcome with return to play in 8 adolescent basketball players with at least 4 years of postoperative reconditioning. Results with return to play at the preinjury level are favorable after treatment of acute tibial avulsion fractures in adolescent basketball players. Long-term outcome was excellent in all patients regardless of fracture type. Open reduction and internal fixation using 1 or 2 cancellous bone screws achieved union in all cases.

Avulsion de la tubérosité tibiale antérieure chez un jeune sportif

Avulsion fracture of the anterior tibial tuberosity is rare. This lesion occurs in the sportive adolescent. The authors report a case of 16-year-old sports amateur, who presents an avulsion of the anterior tibial tuberosity, treated by surgery. Epidemiologic, etiopathogenic, therapeutic and pronostic aspects are analysed.

Minimally displaced tibial tuberosity avulsion fracture in nine skeletally immature large breed dogs

The objective of this study was to describe the clinical and radiographic features, as well as the treatment and outcome of minimally displaced tibial-tuberosity-avulsion-fractures (MDTTAF). Signalment, history, diagnostics, therapy, and outcome were recorded. Follow-up was documented as re-examination, radiographic assessment or telephone conversation. Nine large breed dogs that were presented with lameness originating from the proximal tibia were included. All showed signs of pain when pressure was applied to the tibial tuberosity. There was no stifle instability or intra-articular disease. The main feature on mediolateral radiographs was a widened tibial-tuberosity-physis with reactive new bone and loss of edge definition of the epiphyseal and metaphyseal margins. Non-surgical treatment was chosen in eight dogs, and surgery in one dog. Radiographic follow-up showed progressive closure of the tibial-tuberosity-physis and healing. Clinical signs resolved at a median of 28 days (range: 14-120). Minimally displaced tibial-tuberosity-avulsion-fractures should be a differential diagnosis in skeletally immature large breed dogs older than nine months of age with signs of subtle pelvic-limb lameness, and signs of proximal tibial pain, but no evidence of stifle joint disease. Thorough clinical examination and critical review of bilateral radiographs are important to diagnose MDTTAF. The outcome in these cases suggests that the prognosis for MDTTAF is excellent. Age and size of the affected dogs in this study differ from an earlier publication that illustrated more severely displaced tibial tuberosity avulsion fractures, occurring mainly in terriers around five months of age.

Tibial tubercle fractures in children with intra-articular involvement: surgical tips for technical ease.

Tibial tubercle fractures often occur in athletic adolescents close to skeletal maturity. These fractures can present with marked displacement of the apophysis, intra-articular extension, and associated soft tissue injuries, such as tibial meniscal ligament tears. Here, we present our surgical technique which focuses on recreating the meniscal-articular relationship (using suture anchors) in severely displaced fractures. We retrospectively reviewed all tibial tuberosity fractures treated with this technique over the last 2.5years. Fractures with a minimum of a 12-month follow-up post-fixation were identified. Clinical records and radiographs were reviewed. Data included patient age, gender, involved side, injury classification (modified Ogden), mechanism of injury, treatment, return to activity, and complications. Six patients met the inclusion criteria. Mean age at time of surgery was 14.9 (range 13.2-16.8) years. All patients were male and the mean follow-up period was 14 (12-26) months. Range of motion was started at 4weeks post-operatively in a hinged knee brace, and return to sports occurred at an average of 3.75months postoperatively (range 3-5months). No evidence of growth disturbance of the proximal tibia or recurvatum at final follow-up was evident. We speculate that patients who sustain a tibial tubercle avulsion fracture types III or V will likely have intra-articular pathology, specifically capsular avulsion or coronary ligament disruption. By utilizing suture anchors, our technique emphasizes renewing the anatomic articular environment to ensure better long-term results and maintaining these active individuals in sports.

Autologous Fat Grafting as a Mesenchymal Stem Cell Source and Living Bioscaffold in a Patellar Tendon Tear

CASE REPORT (INSERTIONAL PATELLAR TENDINOSIS WITH LARGE COMPLEX INTERSTITIAL TEARS) A 17-year-old basketball player with a tibial tubercle avulsion fracture through the physis was diagnosed with a partial patellar tendon avulsion at the time of surgery. Two large fragment screws were placed for osseous fixation, and #2 FiberWire (Arthrex, Inc, Naples, Florida) was used to attach the tendon to the periosteum. Six months after the operation, he continued to have pain and was unable to jump or play basketball without considerable pain. Magnetic resonance imaging revealed a thickened patellar tendon insertion. A second surgery was recommended. However, he decided to explore nonsurgical alternatives. Upon initial visit with one of the authors (J.J.A.), diagnostic ultrasound revealed an extremely thickened patellar tendon at the insertion on the tibial tubercle with extensive linear hypoechoic areas, hyperemia, and some calcification (Figure 1). Distension of these hypoechoic areas with local anesthetic confirmed large complex interstitial tears. Two ultrasound-guided injections of 8 to 10 mL of PRP, activated with recombinant thrombin, were administered 5 weeks apart. In each procedure, 1 to 2 mL of 1% lidocaine (plain) was introduced using a 22-gauge needle, which was also used to provide multiple fenestrations in the abnormal areas. At 12 weeks after the initial injection, the patient reported improvement in symptoms such that he could actively scrimmage but had a significant pain afterward. Ultrasound revealed persistent interstitial tears. Retreatment was performed using a combination of bone marrow aspirate, PRP, and autologous fat graft for adipose-derived stem/stromal cells. Lipoaspirated fat graft provided cellular and scaffold (biomatrix) elements and was placed via ultrasound-guided injection to fill the tears at the thickened insertion. Autologous fat harvesting was accomplished according to standard aesthetic surgical technique using a 20-mL Monoject syringe (Covidien Co, Mansfield, Massachusetts) and the Tulip Medical (San Diego, California) closed syringe system (with a 2.1-mm caraway 3-port harvester microcannula) and Superluer loc hub. Forty-five milliliters of bone marrow was obtained as per the standard protocol described in the literature and filtered according to the manufacturer’s instructions, mixed with 15 mL of whole blood, and centrifuged down to 6 mL. Three milliliters of this mixture was mixed with 3 mL of lipoaspirate and injected into the tears. The remaining 3 mL of the concentrated bone marrow aspirate/PRP was then injected into the surrounding tissue. The Arteriocyte Magellan system was used for all the treatments, both PRP and bone marrow. He started basketball practice 2.5 weeks after the PRP/fat grafting treatment, and, by 3.5 weeks, started full scrimmage. At 6 weeks, he displayed diminished pain with jumping and was able to play a complete game at a fully competitive level. By 15 weeks, he could play 1.5 hours with minimal discomfort afterward. At 6 months, he played twice per week without pain during and after the activity.

Atypical Tibial Tuberosity Fracture in an Adolescent

Avulsion fractures of the tibial tuberosity are typically sustained by adolescent males during sporting activities. Tibial tuberosity avulsions with simultaneous proximal tibial epiphyseal fractures are rare injuries. We present an unusual case of Ogden type IIIA avulsion fracture of tibial tuberosity with a Salter Harris type IV posterior fracture of proximal tibial epiphysis in a 13-year-old boy. We believe that the patient sustained the tibial tuberosity avulsion during the take-off phase of a jump while playing basketball due to sudden violent contraction of the quadriceps as the knee was extending. This was then followed by the posterior Salter Harris type IV fracture of proximal tibial physis as he landed on his leg with enormous forces passing through the knee. Although standard radiographs were helpful in diagnosing the complex fracture pattern, precise configuration was only established by computed tomography (CT) scan. The scan also excluded well-recognized concomitant injuries including ligament and meniscal injuries. Unlike other reported cases, our patient did not have compartment syndrome. Anatomic reduction and stabilization with a partially threaded transepiphyseal cannulated screw and a metaphyseal screw followed by early mobilization ensured an excellent recovery by the patient.Our case highlights the importance of vigilance and a high index of suspicion for coexisting fractures or soft tissue injuries when treating avulsion fractures of tibial tuberosity. A CT scan is justified in such patients to recognize complex fracture configurations, and surgical treatment should be directed appropriately to both the fractures followed by early rehabilitation. Patients with such injuries warrant close monitoring for compartment syndrome during the perioperative period.

Avulsion fracture of the tibial tuberosity with associated proximal patellar ligament avulsion. A case report and literature review

Avulsion fracture of the tibial tuberosity is an uncommon fracture, usually seen in the adolescent athlete as an isolated injury, that accounts for less than 1% of all physeal injuries. Associated avulsion of the distal insertion of the patellar ligament is a rare concurrent finding, with only 15 previous cases reported in the literature. Associated avulsion of the proximal insertion of the patellar ligament in patients with a tibial tuberosity avulsion fracture is even more rare, with no previous cases reported in the literature. Avulsion fracture of the tibial tubercle usually occurs when the knee is forcibly flexed against contracting quadriceps, or from forceful quadriceps contraction against a fixed tibia. The injury can be described using the Ogden et al. classification system, which has been modified by Frankl et al. to include associated patellar ligament avulsion. While management of this injury typically involves simple surgical repair, a high index of suspicion is required to preoperatively detect any associated patellar ligament injury.