Tibial Tubercle Avulsion Fracture

ExitCare ImageTibial tubercle avulsion fractures occur when the tendon between the kneecap and shinbone (patellar tendon) causes a complete or incomplete break of the shinbone just below the knee joint (tibial tubercle). The tibial tubercle is where the tendon of the thigh muscle (quadriceps) attaches. In adolescents, a growth plate exists in this area, making it vulnerable to injury. Adults are more likely to have a tendon rupture instead of a tibial tubercle avulsion fracture.

SYMPTOMS

  • Pain, swelling, warmth, and tenderness below the knee.

  • Occasionally, swelling of the knee joint.

  • Inability to straighten the leg fully.

CAUSES

Tibial tubercle avulsion fractures are often caused be a sudden force (jumping or landing) that puts pressure on the growth plate that exceeds its strength. Another common cause of injury is kicking a ball and having the foot strike the ground or an opponent. This condition can also occur from untreated inflammation of the tibial tubercle growth plate, and activity.

RISK INCREASES WITH:

  • Sports that require jumping (basketball, high jump).

  • Contact sports and sports with kicking (soccer, football).

  • Being overweight.

  • Boys between 12 and 16.

  • Poor knee strength and flexibility.

  • Tibial tubercle inflammation (Osgood-Schlatter Syndrome).

PREVENTION

  • Lose weight, if overweight.

  • Warm up and stretch properly before activity.

  • Allow tibial tubercle inflammation to go away completely before returning to sports.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Learn and use proper technique when playing sports.

PROGNOSIS

With proper treatment, full recovery from symptoms can be expected. However, surgery may be required.

RELATED COMPLICATIONS

  • Failure to heal (nonunion).

  • Healing in a poor position (malunion).

  • Injury to meniscal cartilage, resulting in locking and swelling of the knee.

  • Hindrance of normal bone growth in children.

  • Injury to the articular cartilage.

  • Arthritis of the knee joint.

  • Knee stiffness (loss of knee motion).

  • Injury to ligaments of the knee (ACL or medial collateral ligament).

  • Risks of surgery: infection, bleeding, injury to nerves (numbness, weakness, paralysis), need for further surgery.

  • Persistent bump (prominence) below the kneecap.

  • Knee pain.

  • Kneecap too low or too high.

TREATMENT

Treatment first involves the use of ice and medicine to reduce pain and inflammation. If the fracture is in proper alignment or can be realigned (reduced) without surgery, the knee is restrained for 4 to 6 weeks, to allow for healing. If the bones are not in the proper position, surgery is needed to realign the bones with pins and screws. After surgery, the knee must be restrained to allow for healing. Strengthening and stretching exercises may be needed after restraint to regain strength and a full range of motion. These exercises may be done at home or with a therapist. Unless they cause additional pain, the hardware placed in the joint during surgery is not often removed.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often recommended.

  • Do not take pain medicine for 7 days before surgery.

  • Stronger pain relievers may be prescribed. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve.

  • You experience pain, numbness, or coldness in the foot.

  • Blue, gray, or dark color appears in the toenails.

  • Any of the following occur after surgery: fever, increased pain, swelling, redness, drainage of fluids, or bleeding in the affected area.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)