Avulsion fracture of the tibial tuberosity with associated proximal patellar ligament avulsion. A case report and literature review

Avulsion fracture of the tibial tuberosity is an uncommon fracture, usually seen in the adolescent athlete as an isolated injury, that accounts for less than 1% of all physeal injuries. Associated avulsion of the distal insertion of the patellar ligament is a rare concurrent finding, with only 15 previous cases reported in the literature. Associated avulsion of the proximal insertion of the patellar ligament in patients with a tibial tuberosity avulsion fracture is even more rare, with no previous cases reported in the literature. Avulsion fracture of the tibial tubercle usually occurs when the knee is forcibly flexed against contracting quadriceps, or from forceful quadriceps contraction against a fixed tibia. The injury can be described using the Ogden et al. classification system, which has been modified by Frankl et al. to include associated patellar ligament avulsion. While management of this injury typically involves simple surgical repair, a high index of suspicion is required to preoperatively detect any associated patellar ligament injury.