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Patellar Sleeve Avulsion
A. Carlson Merrow, Jr., MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Not periosteal sleeve avulsion (as patella does not have periosteum)
            • Definitions

              • Avulsion injury of patella in skeletally immature patients
                • Small ossific fragment & larger sleeve of unossified "epiphyseal" cartilage avulsed from patella at
                  • Inferior pole by patellar tendon (more common)
                  • Superior pole by quadriceps tendon (less common)
                • ± articular cartilage injury

            IMAGING

            • General Features

              • Imaging Recommendations

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • General Features

                    CLINICAL ISSUES

                    • Presentation

                      • Demographics

                        • Natural History & Prognosis

                          • Treatment

                            DIAGNOSTIC CHECKLIST

                            • Consider

                              Selected References

                              1. Merrow AC et al: Avulsion fractures of the pediatric knee. Pediatr Radiol. 44(11):1436-45; quiz 1433-6, 2014
                              2. Shih KS et al: Simultaneous bilateral sleeve fracture of the patellae in a preadolescent athlete. ANZ J Surg. 84(10):791-2, 2014
                              3. Malone A et al: Bilateral sleeve fractures of the patella in a 12-year-old boy with hereditary spastic paraparesis and crouch gait. BMJ Case Rep. 2013, 2013
                              4. Dwek JR: The periosteum: what is it, where is it, and what mimics it in its absence? Skeletal Radiol. 39(4):319-23, 2010
                              5. Gettys FK et al: Superior pole sleeve fracture of the patella: a case report and review of the literature. Am J Sports Med. 38(11):2331-6, 2010
                              6. Dupuis CS et al: Injuries and conditions of the extensor mechanism of the pediatric knee. Radiographics. 29(3):877-86, 2009
                              7. Gao GX et al: Sleeve fracture of the patella in children. J Orthop Surg (Hong Kong). 16(1):43-6, 2008
                              8. Maripuri SN et al: Sleeve fracture of the superior pole of the patella with an intra-articular dislocation. A case report. J Bone Joint Surg Am. 90(2):385-9, 2008
                              9. Khanna G et al: Sleeve fracture at the superior pole of the patella. Pediatr Radiol. 37(7):720-3, 2007
                              10. Hunt DM et al: A review of sleeve fractures of the patella in children. Knee. 12(1):3-7, 2005
                              11. Ditchfield A et al: Case reports. Ultrasound diagnosis of sleeve fracture of the patella. Clin Radiol. 55(9):721-2, 2000
                              12. Bates DG et al: Patellar sleeve fracture: demonstration with MR imaging. Radiology. 193(3):825-7, 1994
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Imaging

                                  • Top Differential Diagnoses

                                    • Clinical Issues

                                      • Diagnostic Checklist

                                        TERMINOLOGY

                                        • Synonyms

                                          • Not periosteal sleeve avulsion (as patella does not have periosteum)
                                        • Definitions

                                          • Avulsion injury of patella in skeletally immature patients
                                            • Small ossific fragment & larger sleeve of unossified "epiphyseal" cartilage avulsed from patella at
                                              • Inferior pole by patellar tendon (more common)
                                              • Superior pole by quadriceps tendon (less common)
                                            • ± articular cartilage injury

                                        IMAGING

                                        • General Features

                                          • Imaging Recommendations

                                            DIFFERENTIAL DIAGNOSIS

                                              PATHOLOGY

                                              • General Features

                                                CLINICAL ISSUES

                                                • Presentation

                                                  • Demographics

                                                    • Natural History & Prognosis

                                                      • Treatment

                                                        DIAGNOSTIC CHECKLIST

                                                        • Consider

                                                          Selected References

                                                          1. Merrow AC et al: Avulsion fractures of the pediatric knee. Pediatr Radiol. 44(11):1436-45; quiz 1433-6, 2014
                                                          2. Shih KS et al: Simultaneous bilateral sleeve fracture of the patellae in a preadolescent athlete. ANZ J Surg. 84(10):791-2, 2014
                                                          3. Malone A et al: Bilateral sleeve fractures of the patella in a 12-year-old boy with hereditary spastic paraparesis and crouch gait. BMJ Case Rep. 2013, 2013
                                                          4. Dwek JR: The periosteum: what is it, where is it, and what mimics it in its absence? Skeletal Radiol. 39(4):319-23, 2010
                                                          5. Gettys FK et al: Superior pole sleeve fracture of the patella: a case report and review of the literature. Am J Sports Med. 38(11):2331-6, 2010
                                                          6. Dupuis CS et al: Injuries and conditions of the extensor mechanism of the pediatric knee. Radiographics. 29(3):877-86, 2009
                                                          7. Gao GX et al: Sleeve fracture of the patella in children. J Orthop Surg (Hong Kong). 16(1):43-6, 2008
                                                          8. Maripuri SN et al: Sleeve fracture of the superior pole of the patella with an intra-articular dislocation. A case report. J Bone Joint Surg Am. 90(2):385-9, 2008
                                                          9. Khanna G et al: Sleeve fracture at the superior pole of the patella. Pediatr Radiol. 37(7):720-3, 2007
                                                          10. Hunt DM et al: A review of sleeve fractures of the patella in children. Knee. 12(1):3-7, 2005
                                                          11. Ditchfield A et al: Case reports. Ultrasound diagnosis of sleeve fracture of the patella. Clin Radiol. 55(9):721-2, 2000
                                                          12. Bates DG et al: Patellar sleeve fracture: demonstration with MR imaging. Radiology. 193(3):825-7, 1994