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Case Reports
. 2023 Jun 1;59(6):1061.
doi: 10.3390/medicina59061061.

Type V Tibial Tubercle Avulsion Fracture with Suspected Complication of Anterior Cruciate Ligament Injury: A Case Report

Hiroki Okamura  1 , Hiroki Ishikawa  1 , Takuya Ohno  1 , Shogo Fujita  1 , Kei Nagasaki  1 , Katsunori Inagaki  2 , Yoshifumi Kudo  2
Affiliations
Case Reports

Type V Tibial Tubercle Avulsion Fracture with Suspected Complication of Anterior Cruciate Ligament Injury: A Case Report

Hiroki Okamura et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Type V tibial tubercle avulsion fractures are extremely rare; therefore, information on them remains limited. Furthermore, although these fractures are intra-articular, to the best of our knowledge, there are no reports on their assessment via magnetic resonance imaging (MRI) or arthroscopy. Accordingly, this is the first report to describe the case of a patient undergoing detailed evaluation via MRI and arthroscopy. Case Presentation: A 13-year-old male adolescent athlete jumped while playing basketball, experienced discomfort and pain at the front of his knee, and fell down. He was transported to the emergency room by ambulance after he was unable to walk. The radiographic examination revealed a Type Ⅴ tibial tubercle avulsion fracture that was displaced. In addition, an MRI scan revealed a fracture line extending to the attachment of the anterior cruciate ligament (ACL); moreover, high MRI intensity and swelling due to ACL were observed, suggesting an ACL injury. On day 4 of the injury, open reduction and internal fixation were performed. Furthermore, 4 months after surgery, bone fusion was confirmed, and metal removal was performed. Simultaneously, an MRI scan obtained at the time of injury revealed findings suggestive of ACL injury; therefore, an arthroscopy was performed. Notably, no parenchymal ACL injury was observed, and the meniscus was intact. The patient returned to sports 6 months postoperatively. Conclusion: Type V tibial tubercle avulsion fractures are known to be extremely rare. Based on our report, we suggest that MRI should be performed without hesitation if intra-articular injury is suspected.

Keywords: anterior cruciate ligament; knee; sports injury; tibial tubercle avulsion fractures.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a) Frontal view and (b) lateral view of plain radiographs obtained at the time of injury indicated Type Ⅴ tibial tubercle avulsion fracture.
Figure 2
Figure 2
(a) CT and (b) MRI scans of the right knee, sagittal view. (a) CT scan revealed tibial tubercle fracture of Ogden Type IIIB and Salter–Harris Type IV, indicating tibial tubercle fracture of Ogden Type V. (b) MRI scan revealed that the fracture line reached the attachment of ACL, and high MRI intensity and swelling due to ACL were observed, suggesting an ACL injury. CT, computed tomography; MRI, magnetic resonance image; and ACL, anterior cruciate ligament.
Figure 3
Figure 3
Intraoperative image of the right knee fracture area. (a) Disruption of the periosteum (yellow arrow) embedded in the fracture site (blue arrow). (b) Partial rupture of the patellar tendon (white arrow) was noted.
Figure 4
Figure 4
(a) Frontal view and (b) lateral view of postoperative plain radiographs revealed good fixation by repositioning.
Figure 5
Figure 5
(a) Frontal view and (b) lateral view of plain radiographs obtained after metal removal revealed good bone union.
Figure 6
Figure 6
Arthroscopic image of the ACL in the right knee. ACL was segmented with no synovial coverage, but there was no obvious tearing. ACL, anterior cruciate ligament.
See this image and copyright information in PMC

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