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Tibial Tubercle Avulsion
A. Carlson Merrow, Jr., MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Tibial tuberosity fracture
            • Definitions

              • Tibial tubercle ossification center is site of distal patellar tendon attachment
              • During adolescence, substantial traction force may acutely avulse this ossification center from its underlying physis with varying degrees of physeal & bony extension into proximal tibia

            IMAGING

            • General Features

              • Imaging Recommendations

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • General Features

                    • Staging, Grading, & Classification

                      CLINICAL ISSUES

                      • Presentation

                        • Demographics

                          • Natural History & Prognosis

                            • Treatment

                              Selected References

                              1. Haber DB et al: Tibial tubercle fractures in children and adolescents: a large retrospective case series. J Pediatr Orthop B. 30(1):13-8, 2021
                              2. Cole WW 3rd et al: Epidemiology, diagnosis, and management of tibial tubercle avulsion fractures in adolescents. JBJS Rev. 8(4):e0186, 2020
                              3. Formiconi F et al: Outcomes of surgical treatment of the tibial tuberosity fractures in skeletally immature patients: an update. Eur J Orthop Surg Traumatol. 30(5):789-98, 2020
                              4. Franz P et al: Tibial tubercle avulsion fractures in children. Curr Opin Pediatr. 32(1):86-92, 2020
                              5. Riccio AI et al: Functional outcomes following operative treatment of tibial tubercle fractures. J Pediatr Orthop. 39(2):e108-13, 2019
                              6. Yue I et al: Bilateral tibial tubercle avulsion fractures: a pediatric orthopedic injury at high risk for compartment syndrome. Am J Emerg Med. 37(8):1603.e3-1603.e5, 2019
                              7. Yousef MAA: Combined avulsion fracture of the tibial tubercle and patellar tendon rupture in pediatric population: case series and review of literature. Eur J Orthop Surg Traumatol. 28(2):317-23, 2018
                              8. Pretell-Mazzini J et al: Outcomes and complications of tibial tubercle fractures in pediatric patients: a systematic review of the literature. J Pediatr Orthop. 36(5):440-6, 2016
                              9. Merrow AC et al: Avulsion fractures of the pediatric knee. Pediatr Radiol. 44(11):1436-45; quiz 1433-6, 2014
                              10. Jakoi A et al: Tibial tubercle avulsion fractures in adolescent basketball players. Orthopedics. 35(8):692-6, 2012
                              11. Dupuis CS et al: Injuries and conditions of the extensor mechanism of the pediatric knee. Radiographics. 29(3):877-86, 2009
                              12. Zrig M et al: Acute tibial tubercle avulsion fractures in the sporting adolescent. Arch Orthop Trauma Surg. 128(12):1437-42, 2008
                              13. Georgiou G et al: Simultaneous bilateral tibial tubercle avulsion fracture in an adolescent: a case report and review of the literature. Knee Surg Sports Traumatol Arthrosc. 15(2):147-9, 2007
                              14. Slobogean GP et al: Osteogenesis imperfecta presenting as simultaneous bilateral tibial tubercle avulsion fractures in a child. J Pediatr Orthop. 25(3):411; author reply 411, 2005
                              15. McKoy BE et al: Acute tibial tubercle avulsion fractures. Orthop Clin North Am. 34(3):397-403, 2003
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Imaging

                                  • Top Differential Diagnoses

                                    • Pathology

                                      • Clinical Issues

                                        TERMINOLOGY

                                        • Synonyms

                                          • Tibial tuberosity fracture
                                        • Definitions

                                          • Tibial tubercle ossification center is site of distal patellar tendon attachment
                                          • During adolescence, substantial traction force may acutely avulse this ossification center from its underlying physis with varying degrees of physeal & bony extension into proximal tibia

                                        IMAGING

                                        • General Features

                                          • Imaging Recommendations

                                            DIFFERENTIAL DIAGNOSIS

                                              PATHOLOGY

                                              • General Features

                                                • Staging, Grading, & Classification

                                                  CLINICAL ISSUES

                                                  • Presentation

                                                    • Demographics

                                                      • Natural History & Prognosis

                                                        • Treatment

                                                          Selected References

                                                          1. Haber DB et al: Tibial tubercle fractures in children and adolescents: a large retrospective case series. J Pediatr Orthop B. 30(1):13-8, 2021
                                                          2. Cole WW 3rd et al: Epidemiology, diagnosis, and management of tibial tubercle avulsion fractures in adolescents. JBJS Rev. 8(4):e0186, 2020
                                                          3. Formiconi F et al: Outcomes of surgical treatment of the tibial tuberosity fractures in skeletally immature patients: an update. Eur J Orthop Surg Traumatol. 30(5):789-98, 2020
                                                          4. Franz P et al: Tibial tubercle avulsion fractures in children. Curr Opin Pediatr. 32(1):86-92, 2020
                                                          5. Riccio AI et al: Functional outcomes following operative treatment of tibial tubercle fractures. J Pediatr Orthop. 39(2):e108-13, 2019
                                                          6. Yue I et al: Bilateral tibial tubercle avulsion fractures: a pediatric orthopedic injury at high risk for compartment syndrome. Am J Emerg Med. 37(8):1603.e3-1603.e5, 2019
                                                          7. Yousef MAA: Combined avulsion fracture of the tibial tubercle and patellar tendon rupture in pediatric population: case series and review of literature. Eur J Orthop Surg Traumatol. 28(2):317-23, 2018
                                                          8. Pretell-Mazzini J et al: Outcomes and complications of tibial tubercle fractures in pediatric patients: a systematic review of the literature. J Pediatr Orthop. 36(5):440-6, 2016
                                                          9. Merrow AC et al: Avulsion fractures of the pediatric knee. Pediatr Radiol. 44(11):1436-45; quiz 1433-6, 2014
                                                          10. Jakoi A et al: Tibial tubercle avulsion fractures in adolescent basketball players. Orthopedics. 35(8):692-6, 2012
                                                          11. Dupuis CS et al: Injuries and conditions of the extensor mechanism of the pediatric knee. Radiographics. 29(3):877-86, 2009
                                                          12. Zrig M et al: Acute tibial tubercle avulsion fractures in the sporting adolescent. Arch Orthop Trauma Surg. 128(12):1437-42, 2008
                                                          13. Georgiou G et al: Simultaneous bilateral tibial tubercle avulsion fracture in an adolescent: a case report and review of the literature. Knee Surg Sports Traumatol Arthrosc. 15(2):147-9, 2007
                                                          14. Slobogean GP et al: Osteogenesis imperfecta presenting as simultaneous bilateral tibial tubercle avulsion fractures in a child. J Pediatr Orthop. 25(3):411; author reply 411, 2005
                                                          15. McKoy BE et al: Acute tibial tubercle avulsion fractures. Orthop Clin North Am. 34(3):397-403, 2003