Injury to the extensor mechanism of the knee due to avulsion of the anterior tibial tuberosity

Authors

Keywords:

avulsion, elderly, fractures, patellar fracture, patellar ligament

Abstract

Introduction: De Morgan first described Fractures of the anterior tibial tuberosity in 1853. They constitute between 1% and 3% of knee extensor mechanism injuries.

Objective: To present a case with injury to the knee extensor mechanism due to avulsion of the anterior tibial tuberosity in an elderly adult.

Clinical Case: A case was presented of a 70-year-old woman who fell from standing height with her knees flexed. The injury was accompanied by swelling, ecchymosis, inability to extend the left knee, a high-riding patella, and a palpable defect over de tibial tuberosity. Radiographs revealed a discontinuity at the tibial tuberosity of the left knee. Open reduction and internal fixation were performed using compression screws and cerclage due to an extensor mechanism injury caused by avulsion of the left tibial tuberosity.

Conclusions: Injuries to the knee extensor mechanism due to avulsion of the tibial tuberosity in the elderly are rare and are due to poor bone quality associated with a hyperflexion mechanism. Early diagnosis and repair are the treatment objectives for improved joint function.

Downloads

Download data is not yet available.

Author Biographies

Lián Aguila Fernández, Universidad de Ciencias Médicas de las FAR

Especialista de prier grado en Ortopedia y Traumatología y en MGI. Profesor Instructor en el Servicio de Ortopedia y Traumatología del Hospital Militar Central Dr. Luis Díaz Soto. Miembro del Grupo Nacional de Artroscopía.

Raúl Solar López, HMC Dr. Luis Díaz Soto

Especialista de primer Grado en Ortopedia y Traumatología 

Arturo Alejandro González López , Hospital Militar Central “Dr. Luis Díaz Soto. La Habana, Cuba.

Especialista de primer grado en Ortopedia y Traumatología. Especialista de primer grado en MGI. Miembro del Grupo de Miembro Superior. Miembro del Grupo Nacional de Cirugía Espinal. Profesor Instructor en Ortopedia y Traumatología 

Milagro Isabel Peña Aguilar, Hospital Militar Central “Dr. Luis Díaz Soto. La Habana, Cuba.

Especialista de primer grado en Ortopedia y Traumatología. Especialista de primer grado en MGI. Miembro del Grupo de Cirugía de Miembro Superior.

Osmani Martínez Nápoles , Hospital Militar Central “Dr. Luis Díaz Soto. La Habana, Cuba.

Especialista de primer grado en Ortopedia y Traumatología. Especialista de primer grado en MGI. Miembro del Grupo de Cirugía de Miembro Superior. Profesor Instructor en Ortopedia y Traumatología.

References

1. Rodríguez Álvarez JP, Ojeda Castellano JS, Medina Macías SM, Muratore Moreno G, Chirino Cabrera A, Navarro Navarro R. Roturas del aparato extensor de la rodilla [Internet]. Rev Canarias Médica y Quirúrgica. 2006 [acceso: 03/04/2025]; 3(9):19-29. Disponible en: https://accedacris.ulpgc.es/bitstream/10553/6179/1/0514198_00009_0003

2. Agrelo D, Apecechea C, Diego J, Chima García JP. Fractura avulsion bilateral de tuberosidad anterior de la tibia [Internet]. Rev Asoc Argent Traumatol Deporte. 2021 [acceso: 05/04/2025]; 28(1):1-8. Disponible en: https://pesquisa.bvsalud.org/porta/resource/pt/biblio-1358325

3. Vega Fernández E, Servin de la Mora A. Fractura por avulsión de la tuberosidad anterior de la tibia en adolescentes [Internet]. Rev Cubana Ortop Traumatol. 2016 [acceso: 05/04/2025]; 30(2):228-36. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-215X2016000200009&lng=es

4. Lee DH, Lee HS, Kong CG, Lee SW. Isolated Avulsion Fracture of the Tibial Tuberosity in an Adult Treated with Suture-Bridge Fixation: A Rare Case and Literature Review [Internet]. Rev Medicina (Kaunas). 2023; 59(9):1565. DOI: 10.3390/medicina59091565

5. Caruso FP, González D, Muñoz D, Moyano F, Falco S. Fractura por avulsión de la tuberosidad anterior de la tibia en pacientes pediátricos. Reporte de un caso [Internet]. Rev Asoc Argent Ortop Traumatol. 2024; 89(3):290-8. DOI: 10.15417/issn.1852-7434.2024.89.3.1729

6. Domínguez GLG, Domínguez CLG. Fractura avulsión de la tuberosidad anterior tibial tipo III [Internet]. Rev Acta Med. 2024; 22(4):323-5. DOI: 10.35366/117526

7. Brown E, Sohail MT, West J, Davies B, Mamarelis G, Sohail MZ. Tibial Tuberosity Fracture in an Elderly Gentleman: An Unusual Injury Pattern [Internet]. Case Rep Orthop. 2020; 2020(1):8650927. DOI: 10.1155/2020/8650927

8. Jarjess K R, Juma S L, Haddad J, Yousif MJ. Tibial Tuberosity Avulsion in an Adult Female With Patellar Tendon and Retinacular Repair Enhanced by Platelet-Rich Plasma (PRP) Augmentation: A Case Report [Internet]. Rev Cureus. 2025; 17(3):e79953. DOI: 10.7759/cureus.79953

9. Medus M, Maestu R. Avulsión de la tuberosidad tibial anterior combinada con desinserción del tendón rotuliano en paciente con fisis abierta. Resolución quirúrgica. Reporte de un caso [Internet]. Rev Artroscopia. 2022 [acceso: 05/04/2025]; 29(1):33-8. Disponible en: https://raaot.org.ar/index.php/AAOTMAG/article/view/1729/5659

10. Orihuela Fuchs VA, Fernández Palomo LJ, Peláez DP. Avulsión de la tuberosidad tibial: reporte de un caso y revisión de la literatura [Internet]. Rev Fac Med Mex. 2015 [acceso: 05/04/2025]; 58(6):18-23. Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0026-17422015000600018&lng=es

11. Pires e Albuquerque R, Campos AS, de Araújo GC, Gameiro VS. Fracture of tibial tuberosity in an adult [Internet]. BMJ Case Rep. 2013; 2013: bcr2013202411. DOI: 10.1136/bcr-2013-202411

12. Yao X, Liu H, Ma Y, Hu M, Wang C, Miao H, et al. Classification and treatment strategies of tibial tubercle fractures in adults [Internet]. Orthop Surg. 2024; 16(8):1903-11. DOI: 10.1111/os.14122

13. Kale P, Shrivastava S, Pundkar A, Balusani P. Harnessing healing power: a comprehensive riview on platelet-rich plasma in compound fracture care [Internet]. Cureus. 2024; 16: e52722. DOI: 107759/cureus.52722

14. Choi YH, Park D. A novel technique of tibial tuberosity fracture fixation with two knotless suture anchors in an adult: A case report and literature review [Internet]. Acta Orthop Traumatol Turc. 2022; 56(6):416-20. DOI: 10.5152/j.aott.2022.22102.

15. Parinyakhup W, Boonriong T. Tension band suture in isolated tibial tubercle avulsion: a case report and review literatures [Internet]. Int J Surg Case Rep. 2020; 71(1):5. DOI: 10.1016/j.ijscr.2020.04.029

Downloads

Published

2025-09-30

How to Cite

1.
Aguila Fernández L, Solar López R, González López AA, Peña Aguilar MI, Martínez Nápoles O. Injury to the extensor mechanism of the knee due to avulsion of the anterior tibial tuberosity. Rev. cuba. med. mil [Internet]. 2025 Sep. 30 [cited 2025 Oct. 3];54(4):e025076673. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/76673

Issue

Vol. 54 No. 4 (2025): October - December (In Progress)

Section

Case Presentation

License

Copyright (c) 2025 Lián Aguila Fernández, Raúl Solar López, Arturo Alejandro González López , Milagro Isabel Peña Aguilar, Osmani Martínez Nápoles

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Authors who have publications with this Journal accept the following terms:

  • The authors will retain their copyright and guarantee the Journal the right of first publication of their work, which will simultaneously be subject to the Creative Commons Attribution License. The content presented here can be shared, copied and redistributed in any medium or format; Can be adapted, remixed, transformed or created from the material, using the following terms: Attribution (giving appropriate credit to the work, providing a link to the license, and indicating if changes have been made); non-commercial (you cannot use the material for commercial purposes) and share-alike (if you remix, transform or create new material from this work, you can distribute your contribution as long as you use the same license as the original work).
  • The authors may adopt other non-exclusive license agreements for the distribution of the published version of the work (for example: depositing it in an institutional electronic archive or publishing it in a monographic volume) as long as the initial publication in this Journal is indicated.
  • Authors are allowed and recommended to disseminate their work through the Internet (e.g., in institutional electronic archives or on their website) before and during the submission process, which can produce interesting exchanges and increase citations. of the published work.