A Unique Patellar Tendon Rupture and Small Tibial Avulsion fracture in a Post-Menopausal Patient

Abstract

Introduction: This study highlights the case of a 75-year-old female patient with a history of bilateral knee replacements who presented with a subacute patellar tendon rupture that occurred after falling on her left knee.

Case report: The patient had a left total knee replacement one year previously and came in for her one-year follow-up. She presented 3 weeks after her injury with a high-riding patella and a small tibial tubercle avulsion fracture on X-ray, yet she did not experience much pain nor any loss of active extension of her left knee. Despite the severity and subacute presentation of the patient's patellar tendon injury, conservative measures that included physical and occupational therapy was recommended instead of surgery due to her paradoxical retention in gross function of her left knee.

Conclusion: Showcasing this patient's case may provide further understanding of patellar tendon ruptures and tibial avulsion fractures, specifically factors that allow the patient to retain strength and extensor function in her knee to curb the need for surgery.

Keywords: Osteoporosis; Patellar Tendon; Tibial Avulsion Fracture.

Figure 1 & 2

Patient’s left leg is shown with the patient seated on the left and standing on the right. Swelling, erythema, and a well healing skin abrasion is appreciated near the upper third of the scar from her total knee replacement. Slight ecchymosis is present overlying the tibial tubercle. A superiorly displaced patella is evident with proximal compression of skin.

Figure 3-5

The first lateral x-ray of the patient’s left knee was done after her knee replacement and before her avulsion fracture, which appreciates a proper alignment of the prosthesis as well as chondromalacia of the patella in a normal position. Figures 4 and 5 are lateral and AP x-rays, respectively, of the left knee after the injury, which are significant for a high riding patella as well as small tibial tubercle avulsion that are most notable on the lateral x-ray.