(Kiosk 2) Presentation of a Patellar Sleeve Fracture in a 16 Year Old Male Soccer Player After a Non-contact Injury

Case Diagnosis: A 16 year old male professional soccer player presents in clinic after a non-contact injury with knee joint laxity and MRI reveals an inferior pole patellar sleeve fracture.

Case Description or Program Description: The patient presented to clinic one week post injury. The injury occurred as the player was running and stepped forward to receive the ball but missed and fell to the ground. Since injury onset, the patient has been able to walk and squat with both legs but is unable to perform single leg squats. He localizes the pain to the patella and denies any ecchymosis or edema. Upon exam there is tenderness to palpation of the patellar tendon however the patient is able to extend their leg against mild resistance. Anterior drawer test displays greater anterior displacement of the femur on the injured side. Patient is suspected to have a partial ACL tear and is sent for imaging.

Setting: Orthopedic Outpatient Clinic

Assessment/Results: MRI revealed an inferior pole patellar sleeve (avulsion) fracture with an intact ACL. Patient is currently undergoing surgical evaluation and further treatment as well as return to play will be discussed.

Discussion (relevance): The patella begins ossifying at age 3 and patellar sleeve fractures are traditionally thought to occur in children ages 8-12. Patellar sleeve avulsions are rare injuries themselves, comprising less than 1 percent of all pediatric fractures. They can occur from a sudden forceful contraction of the quadriceps muscle with a flexed knee. Patients typically present with severe anterior knee pain and inability to bear weight. It is important to recognize that they can occur in the adolescent population and may present with atypical symptoms.

Conclusions: Patellar sleeve fractures in adolescents need to be considered when evaluating injuries to the knee to ensure appropriate treatment and better outcomes in this population.