Isolated Tibial Tubercle Fracture With and Without Combined Patellar Tendon Avulsion: Early Outcomes, Complications, and Reoperations

Background: Tibial tubercle fractures (TTF) are uncommon injuries, comprising <3% of proximal tibial fractures. Rarely, they occur in conjunction with patellar tendon avulsion (PTA). We aimed to compare reoperation rates and short-term postoperative outcomes in patients with TTF versus combined injuries. Methods: A retrospective review of patients presenting to a single tertiary pediatric hospital with a TTF who underwent open treatment and fixation of tibial tuberosity fractures was performed. Demographics, operative details, injury patterns, complications, and postoperative milestones were analyzed. Operative reports were reviewed to identify concomitant PTA. Outcomes analyzed included reoperation rates, weeks to full weight-bearing (FWB), full range of motion (FROM), and return to sport (RTS). Patients with <4 months of clinical follow-up were excluded from the analysis. Results: We identified 117 fractures in 111 patients (mean age: 13.75 +/- 1.27, 5% female). One-hundred and one fractures were isolated TTF and 16 were combined TTF with PTA. There was no significant difference in secondary surgery (P=0.13) or complication rates (P=0.20). The duration in the hinged knee brace was significantly higher in the combined injury group (12.95 wk) than in the isolated injury group (9.77 wk) (P=0.0024). There was no significant difference in time to FWB (P=0.25), FROM (P=0.86) or time to RTS (P=0.40). Conclusion: No current postoperative guidelines exist for combined TTF and PTA. Our data suggest that combined injury can be largely managed similarly to isolated TTF. However, combined injuries may require a longer bracing period.