Bilateral fracture of anterior tibial tuberosity with complete patellar tendon rupture in an adolescent patient

Abstract

Anterior tibial tuberosity fracture avulsion is an uncommon injury. A concomitant patellar rupture is even more scarcely encountered. We report the case of a 14-year-old male patient who suffered bilateral anterior tuberosity fractures with concomitant bilateral complete patellar tendon rupture. Adolescence, athletic activity, and high BMI may have contributed to this concomitant bilateral injury. Both lesions were treated in a one-stage repair surgery, performing an open reduction and internal fixation of the tibial tuberosity with a cannulated cortical screw and a primary tendon suture following the Krakow technique. To the authors' knowledge, no other cases of bilateral presentation of both lesions have been reported so far in the literature.

Figure 1.

(A-D) Lateral x-ray images (A) showing a bilateral anterior tuberosity fractures. Multiple infrapatellar calcifications on the right knee can be observed, suggesting a possible concomitant tendon tear. Intraoperative photographs (B) with the open surgical approach. The bony fracture avulsion (white arrows) and the complete patellar tendon rupture can be observed. Intraoperative fluoroscopic images (C) showing the internal fixation through a bicortical screw. Intraoperative photographs (D) demonstrating the fixed fracture and the reinserted patellar tendon with a Krakow suture technique.

Figure 2.

(A-D)Lateral x-rays (A,B) 6 months after surgery; a complete fracture consolidation is demonstrated (A: right, B: left). Clinical photographs showing complete bilateral flexion (C) and extension (D).