A Case Report: Bilateral Patella Stress Fractures in a Collegiate Gymnast

Abstract

Introduction: The overuse and repetitive loading of a bone cause a stress fracture, commonly occurring in the weight-bearing structures of the lower extremities of athletes, but rarely the patella. Patella stress fractures are an extremely rare occurrence. Müller first described a patella stress fracture in 1943; however, we could find <15 reported cases in literature since that time. Thus, some uncertainty exists as to the proper treatment of this very rare condition.

Case report: A female collegiate gymnast presented with 2-months of anterior knee pain, and initial radiographs revealed a non-displaced patella stress fracture. An magnetic resonance imaging (MRI)was obtained which confirmed the diagnosis and ruled out any patellar tendon or intra-articular pathology. The patient was treated with immobilization, vitamin supplementation, and low-intensity pulsed ultrasound therapy. At 3 months, the patient had complete healing of her fracture and returned to full competition in her sport. After approximately 1year of returning to sport, she unfortunately developed a patella stress fracture in her contralateral knee confirmed by radiographs and MRI. She received the same conservative management plan as before, and at 3 months, she was pain free and returned to full competition in her sport. She is now 3 years from injury on the right knee and 2 years from injury on the left knee and continues to compete at the Division I collegiate level without pain.

Conclusion: This case report illustrates how patella stress fractures may be successfully treated conservatively, even when presenting with a radiographic fracture line. This varies from other forms of stress fractures where surgical fixation is recommended once radiographic fracture line is noted. This is likely due to the abundant blood supply in the region, which allows for healing.

Keywords: Patella stress fracture; patella; stress fracture.

Figure 1

(a)Radiograph of right patella stress fracture on presentation. (b)Magnetic resonance imaging of right patella stress fracture.

Figure 2

(a) Radiograph of left patella stress fracture on presentation. (b) Magnetic resonance imaging of left patella stress fracture.

Graph 1

Knee Injury and OsteoarthritisOutcomeScore.

Figure 3

(a) Radiograph of right patella 2 years from time of injury. (b) Radiograph of left patella 1 year from time of injury.

Figure 4

(a) Radiograph of right patella 3 years from time of injury. (b) Radiograph of left patella 2 years from time of injury.