INTRODUCTION​

• The tibial tubercle is the bony prominence in the knee where the patellar tendon inserts

• A tibial tubercle avulsion is an injury to the bony insertion of the patellar tendon in the tibia

• Injury to the tibial tubercle can lead to knee pain, swelling and apprehension

• 98% of tibial tubercle fractures occur in males

• 2% of pediatric knee injuries with swelling are tibial tubercle avulsions

• Watson-Jones Classification system of tibial tubercle avulsions, modified by Ogden

• Type I – distal, through secondary ossification center

• Type II – through area between apophysis and epiphysis

• Type III – through epiphysis

• Type IV – through tubercle apophysis and physis

• Type V – avulsion of periosteal attachment

CAUSES

• Tibial spine avulsions usually occur in jumping sports – eccentric contraction of extensor mechanism during landing

SIGNS AND SYMPTOMS

• Tibial tubercle avulsions are almost always associated with immediate pain and swelling

• Patients oftentimes hear or feel a “pop” in their knee

TREATMENT​​

• Treatment of tibial tubercle avulsions depends on grade

• Type 1 & 2 injuries are usually treated with closed reduction and casting

• Reduction with knee in extension

• Cast molding above patella is important to maintain reduction

• Maintain in cast for 6 weeks

 PREVENTION​

• The best way to prevent a tibial tubercle avulsion is to work on strengthening hamstrings and learning proper landing mechanics 

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