Bifocal Patellar Tendon Avulsion Fracture in a Child

Elisa Mareddu; Jocelyn Corbaz; Romain Desmarchelier; Aurélien Traverso

doi:doi:10.11648/j.js.20210904.18

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Bifocal Patellar Tendon Avulsion Fracture in a Child

Elisa Mareddu, Jocelyn Corbaz, Romain Desmarchelier, Aurélien Traverso

Published in Journal of Surgery (Volume 9, Issue 4)

Received: 5 July 2021 Accepted: 19 July 2021 Published: 29 July 2021

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Abstract

The avulsion fracture of the patellar tendon from its proximal and distal attachment is extremely rare. Only a few cases have been described in the English literature and many aspects are still poorly understood. During our practice we came across the case of a 13 year old boy with the above mentioned lesion that we present hereby. Other than describing our experience we tried to tackle the different questions surrounding this lesion, with a careful analysis of the previous reports. A “weaker bone” was considered the main risk factor without any connection with a particular disease or condition. We found out that it is a mainly a pediatric problem, due to the particular bone structure of this population, with many of the subjects being affected by Osgood–Schlatter disease. Different authors have reported their experiences and hypothesis concerning the mechanism behind this injury that has yet to be clearly defined. However most of them mentioned an eccentric load over a knee in forced flexion, leading us to believe that this could be the main source of this unique type of disruption of the extensor apparatus of the knee. Moreover the diagnosis can be quite challenging with many authors advocating for the use of advanced imaging. Treatment options are multiples and the choice relies for the most part on the practitioner preference. From what emerged from the available data it is almost exclusively surgical. Independently from the selected technique, the outcomes are generally favorable.

Published in	Journal of Surgery (Volume 9, Issue 4)
DOI	10.11648/j.js.20210904.18
Page(s)	188-192
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Patellar Tendon Rupture, Bifocal Patellar Tendon Lesion, Tibial Tuberosity Avulsion, Tibial Tuberosity Fixation, Knee Extensor Lesion

References

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[2]	Bolesta MJ, Fitch RD. Tibial tubercle avulsions. J Pediatr Orthop. 1986 Mar-Apr; 6 (2): 186-92.
[3]	Galla M, Lobenhoffer P. Patella fractures. Chirurg. 2005 oct; 76 (10): 987–97.
[4]	Watson-Jones R (1955) Fractures and joint injuries, vol 2, 4th edn. Williams & Wilkins, Baltimore, MD.
[5]	Ogden JA, Tross RB, Murphy MJ (1980) Fractures of the tibial tuberosity in adolescents. J Bone Joint Surg Am 62: 205–215.
[6]	Örtqvist M, Roos EM, Broström EW, Janarv PM, Iversen MD. Development of the Knee Injury and Osteoarthritis Outcome Score for children (KOOS-Child): comprehensibility and content validity. Acta Orthop. 2012 Dec; 83 (6): 666-73. doi: 10.3109/17453674.2012.747921. Epub 2012 Nov 11. PMID: 23140110; PMCID: PMC3555443.
[7]	Mehta SP, Fulton A, Quach C, Thistle M, Toledo C, Evans NA. Measurement Properties of the Lower Extremity Functional Scale: A Systematic Review. J Orthop Sports Phys Ther. 2016 Mar; 46 (3): 200-16. doi: 10.2519/jospt.2016.6165. Epub 2016 Jan 26. PMID: 26813750.
[8]	Frankl U, Wasilewski SA, Healy WL. Avulsion fracture of the tibial tubercle with avulsion of the patellar ligament. Report of two cases. J Bone Joint Surg Am. 1990 Oct; 72 (9): 1411-3. PMID: 2229123.
[9]	Kang S, Chung PH, Kim YS, Lee HM, Kim JP. Bifocal disruption of the knee extensor mechanism: a case report and literature review. Arch Orthop Trauma Surg. 2013 Apr; 133 (4): 517-21. doi: 10.1007/s00402-013-1696-7. Epub 2013 Feb 15. PMID: 23411937.
[10]	Sidharthan S, Schlichte LM, Green DW, Scher DM, Fabricant PD. Bifocal Patellar Tendon Avulsion Fractures in Children and Adolescents: Diagnosis and Treatment Considerations for a Unique Injury Pattern. Arthrosc Sports Med Rehabil. 2020 Dec 27; 3 (1): e97-e103. doi: 10.1016/j.asmr.2020.08.013. PMID: 33615253; PMCID: PMC7879166.
[11]	Bradko V, Stoll WT, Haruno LS, Rosenfeld SB, McKay SD. Two cases of combined patellar tendon avulsion from the tibia and patella. SICOT J. 2018; 4: 17. doi: 10.1051/sicotj/2018014. Epub 2018 May 23. PMID: 29792785; PMCID: PMC5967859.
[12]	Chautems R, Michel J, Barraud GE, Burdet A. Avulsion osseuse bifocale du tendon rotulien chez un adulte: à propos d'un cas [Bifocal avulsion of the patellar tendon in an adult: a case report]. Rev Chir Orthop Reparatrice Appar Mot. 2001 Jun; 87 (4): 388-91. French. PMID: 11431635.
[13]	Yoon JR, Kim TS, Kim HJ, Noh HK, Oh JK, Yoo JC. Simultaneous patellar tendon avulsion fracture from both patella and tibial tuberosity: a case report. Knee Surg Sports Traumatol Arthrosc. 2007 Mar; 15 (3): 225-7. doi: 10.1007/s00167-006-0168-9. Epub 2006 Aug 5. PMID: 16897070.
[14]	Stepanovich MT, Slakey JB. Combined Tibial Tubercle Avulsion Fracture and Patellar Avulsion Fracture: An Unusual Variant in an Adolescent Patient. Am J Orthop (Belle Mead NJ). 2016 Jan; 45 (1): E31-4. PMID: 26761925.
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APA Style

Elisa Mareddu, Jocelyn Corbaz, Romain Desmarchelier, Aurélien Traverso. (2021). Bifocal Patellar Tendon Avulsion Fracture in a Child. Journal of Surgery, 9(4), 188-192. https://doi.org/10.11648/j.js.20210904.18

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ACS Style

Elisa Mareddu; Jocelyn Corbaz; Romain Desmarchelier; Aurélien Traverso. Bifocal Patellar Tendon Avulsion Fracture in a Child. J. Surg. 2021, 9(4), 188-192. doi: 10.11648/j.js.20210904.18

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AMA Style

Elisa Mareddu, Jocelyn Corbaz, Romain Desmarchelier, Aurélien Traverso. Bifocal Patellar Tendon Avulsion Fracture in a Child. J Surg. 2021;9(4):188-192. doi: 10.11648/j.js.20210904.18

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@article{10.11648/j.js.20210904.18,
  author = {Elisa Mareddu and Jocelyn Corbaz and Romain Desmarchelier and Aurélien Traverso},
  title = {Bifocal Patellar Tendon Avulsion Fracture in a Child},
  journal = {Journal of Surgery},
  volume = {9},
  number = {4},
  pages = {188-192},
  doi = {10.11648/j.js.20210904.18},
  url = {https://doi.org/10.11648/j.js.20210904.18},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20210904.18},
  abstract = {The avulsion fracture of the patellar tendon from its proximal and distal attachment is extremely rare. Only a few cases have been described in the English literature and many aspects are still poorly understood. During our practice we came across the case of a 13 year old boy with the above mentioned lesion that we present hereby. Other than describing our experience we tried to tackle the different questions surrounding this lesion, with a careful analysis of the previous reports. A “weaker bone” was considered the main risk factor without any connection with a particular disease or condition. We found out that it is a mainly a pediatric problem, due to the particular bone structure of this population, with many of the subjects being affected by Osgood–Schlatter disease. Different authors have reported their experiences and hypothesis concerning the mechanism behind this injury that has yet to be clearly defined. However most of them mentioned an eccentric load over a knee in forced flexion, leading us to believe that this could be the main source of this unique type of disruption of the extensor apparatus of the knee. Moreover the diagnosis can be quite challenging with many authors advocating for the use of advanced imaging. Treatment options are multiples and the choice relies for the most part on the practitioner preference. From what emerged from the available data it is almost exclusively surgical. Independently from the selected technique, the outcomes are generally favorable.},
 year = {2021}
}

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TY - JOUR
T1 - Bifocal Patellar Tendon Avulsion Fracture in a Child
AU - Elisa Mareddu
AU - Jocelyn Corbaz
AU - Romain Desmarchelier
AU - Aurélien Traverso
Y1 - 2021/07/29
PY - 2021
N1 - https://doi.org/10.11648/j.js.20210904.18
DO - 10.11648/j.js.20210904.18
T2 - Journal of Surgery
JF - Journal of Surgery
JO - Journal of Surgery
SP - 188
EP - 192
PB - Science Publishing Group
SN - 2330-0930
UR - https://doi.org/10.11648/j.js.20210904.18
AB - The avulsion fracture of the patellar tendon from its proximal and distal attachment is extremely rare. Only a few cases have been described in the English literature and many aspects are still poorly understood. During our practice we came across the case of a 13 year old boy with the above mentioned lesion that we present hereby. Other than describing our experience we tried to tackle the different questions surrounding this lesion, with a careful analysis of the previous reports. A “weaker bone” was considered the main risk factor without any connection with a particular disease or condition. We found out that it is a mainly a pediatric problem, due to the particular bone structure of this population, with many of the subjects being affected by Osgood–Schlatter disease. Different authors have reported their experiences and hypothesis concerning the mechanism behind this injury that has yet to be clearly defined. However most of them mentioned an eccentric load over a knee in forced flexion, leading us to believe that this could be the main source of this unique type of disruption of the extensor apparatus of the knee. Moreover the diagnosis can be quite challenging with many authors advocating for the use of advanced imaging. Treatment options are multiples and the choice relies for the most part on the practitioner preference. From what emerged from the available data it is almost exclusively surgical. Independently from the selected technique, the outcomes are generally favorable.
VL - 9
IS - 4
ER -

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Author Information

Elisa Mareddu

Orthopaedics and Traumatology Department, Ensemble Hospitalier de la C?te, Morges, Switzerland
Jocelyn Corbaz

Orthopaedics and Traumatology Department, Ensemble Hospitalier de la C?te, Morges, Switzerland
Romain Desmarchelier

Orthopaedics and Traumatology Department, Ensemble Hospitalier de la C?te, Morges, Switzerland
Aurélien Traverso

Orthopaedics and Traumatology Department, Ensemble Hospitalier de la C?te, Morges, Switzerland

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APA Style

Elisa Mareddu, Jocelyn Corbaz, Romain Desmarchelier, Aurélien Traverso. (2021). Bifocal Patellar Tendon Avulsion Fracture in a Child. Journal of Surgery, 9(4), 188-192. https://doi.org/10.11648/j.js.20210904.18

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ACS Style

Elisa Mareddu; Jocelyn Corbaz; Romain Desmarchelier; Aurélien Traverso. Bifocal Patellar Tendon Avulsion Fracture in a Child. J. Surg. 2021, 9(4), 188-192. doi: 10.11648/j.js.20210904.18

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AMA Style

Elisa Mareddu, Jocelyn Corbaz, Romain Desmarchelier, Aurélien Traverso. Bifocal Patellar Tendon Avulsion Fracture in a Child. J Surg. 2021;9(4):188-192. doi: 10.11648/j.js.20210904.18

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@article{10.11648/j.js.20210904.18,
  author = {Elisa Mareddu and Jocelyn Corbaz and Romain Desmarchelier and Aurélien Traverso},
  title = {Bifocal Patellar Tendon Avulsion Fracture in a Child},
  journal = {Journal of Surgery},
  volume = {9},
  number = {4},
  pages = {188-192},
  doi = {10.11648/j.js.20210904.18},
  url = {https://doi.org/10.11648/j.js.20210904.18},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20210904.18},
  abstract = {The avulsion fracture of the patellar tendon from its proximal and distal attachment is extremely rare. Only a few cases have been described in the English literature and many aspects are still poorly understood. During our practice we came across the case of a 13 year old boy with the above mentioned lesion that we present hereby. Other than describing our experience we tried to tackle the different questions surrounding this lesion, with a careful analysis of the previous reports. A “weaker bone” was considered the main risk factor without any connection with a particular disease or condition. We found out that it is a mainly a pediatric problem, due to the particular bone structure of this population, with many of the subjects being affected by Osgood–Schlatter disease. Different authors have reported their experiences and hypothesis concerning the mechanism behind this injury that has yet to be clearly defined. However most of them mentioned an eccentric load over a knee in forced flexion, leading us to believe that this could be the main source of this unique type of disruption of the extensor apparatus of the knee. Moreover the diagnosis can be quite challenging with many authors advocating for the use of advanced imaging. Treatment options are multiples and the choice relies for the most part on the practitioner preference. From what emerged from the available data it is almost exclusively surgical. Independently from the selected technique, the outcomes are generally favorable.},
 year = {2021}
}

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