case_images: PMC11812486_01
case_images: Preoperative X-rays. Anteroposterior (AP) view of the right knee (A) and lateral view of the right knee (B) show a tibial tubercle flip avulsion fracture (white arrow). The AP view of the left knee (C) and lateral view of the left knee (D) show an avulsion fracture tibial tubercle minimally displaced (blue arrow).
case_images: cureus-0017-00000077319-i01.jpg
case_images: PMC11812486_01_cureus-0017-00000077319-i01.jpg
case_images: FIG1
case_images: Bilateral knee and hip X-rays ruled out hip injuries and confirmed bilateral tibial tubercle avulsions (Figure 1).
case_images: Preoperative MRI scan of both knees. A: Sagittal view of the right knee shows double avulsion of the tibial tubercle flipped (white arrow) and the patellar tendon stripped of the tibial tubercle (blue arrow). B: Axial view of the right knee shows a tibial tubercle flipped avulsion fracture (white arrow). C: Sagittal view of the left knee shows a minimally displaced tibial tubercle avulsion fracture (green arrow). D: Axial view of the left knee shows a tibial tubercle minimally displaced avulsion fracture (green arrow).
case_images: cureus-0017-00000077319-i02.jpg
case_images: PMC11812486_01_cureus-0017-00000077319-i02.jpg
case_images: FIG2
case_images: However, the MRI scans (Figure 2) showed an isolated tibial tubercle avulsion fracture, minimally displaced on the left side.
case_images: Intraoperative findings. Patellar tendon strip avulsion (blue arrow); tibial tubercle avulsion fracture reduced (black arrow); tibial tubercle proximal pole still attached to the periosteum (green arrow); torn medial retinaculum (white arrow)
case_images: cureus-0017-00000077319-i03.jpg
case_images: PMC11812486_01_cureus-0017-00000077319-i03.jpg
case_images: FIG3
case_images: Additionally, both the medial and lateral retinaculae were found to be torn (Figure 3).
case_images: Intraoperative management. A: Tibial tubercle open reduction internal fixation with two partially threaded 4 mm cannulated screws with small washers; B: Screw lengths and fracture reduction were confirmed under the image intensifier; C: The patellar tendon was repaired using a double whip stitch with Ethibond size 5 and two Depuy Mitek GII anchors; D: The medial retinaculum was repaired using a number 2 Orthocord.
case_images: cureus-0017-00000077319-i04.jpg
case_images: PMC11812486_01_cureus-0017-00000077319-i04.jpg
case_images: FIG4
case_images: The retinaculae were then repaired using number 2 Orthocord (DePuy Synthes) (Figure 4), and the wound was closed in layers.
case_images: X-rays obtained six months postoperatively. Anteroposterior (AP) view of the right knee (A) and lateral view of the right knee (B) show complete tibial tubercle fracture healing with screws, washers, and anchors in place. The AP view left knee (C) and lateral view of the left knee (D) show complete tibial tubercle fracture healing.
case_images: cureus-0017-00000077319-i05.jpg
case_images: PMC11812486_01_cureus-0017-00000077319-i05.jpg
case_images: FIG5
case_images: The patient was followed up at two weeks, six weeks, three months, six months (Figure 5), and one year postoperatively.