J Knee Surg 2021; 34(03): 242-246
DOI: 10.1055/s-0039-1694742
Original Article

Nonoperative Management of Minimally Displaced Patellar Sleeve Fractures

Paul L. Sousa
1   Department of Orthopedic Surgery and The Sports Medicine Center, Mayo Clinic, Rochester, Minnesota
,
Michael J. Stuart
1   Department of Orthopedic Surgery and The Sports Medicine Center, Mayo Clinic, Rochester, Minnesota
,
Matthew R. Prince
1   Department of Orthopedic Surgery and The Sports Medicine Center, Mayo Clinic, Rochester, Minnesota
,
Diane L. Dahm
1   Department of Orthopedic Surgery and The Sports Medicine Center, Mayo Clinic, Rochester, Minnesota
› Author Affiliations

Abstract

Patellar sleeve fractures primarily occur in the adolescent population from a rapid contraction of the quadriceps with the knee in a flexed position. Several small case reports describe operative reduction and fixation for displaced fractures. However, there is sparse literature on nonoperative management of these injuries. Retrospective review and prospective follow-up of all patients diagnosed with patellar sleeve fracture between 1991 and 2014 at a single institution. Patients with superior pole avulsion fractures, history of prior knee surgery, and fractures managed operatively were excluded. Patients with a clinical diagnosis without support of advanced imaging were also excluded. Radiographs and magnetic resonance imaging (MRI) were reviewed for initial fracture displacement, time until fracture union, and the presence of patellar tendon ossification. Outcome was assessed using the Tegner's activity scale, Kujala's Score and the International Knee Documentation Committee (IKDC) subjective knee evaluation score at final follow-up. Eighteen nonoperatively treated distal patellar pole sleeve fractures were identified, while five patients had advanced imaging to support their diagnosis. All were males with a mean age of 15.1 (range: 12–18). Traumatic and sport-related injuries were noted in the majority of patients. Only one patient had any appreciable displacement, but still < 2 mm. Final radiographic evaluation revealed fracture healing without patellar tendon ossification in all patients. All five patients had full terminal knee extension and symmetric range of motion. Mean IKDC score was 96.4 (range: 82–100) mean Tegner's activity score was 60 (range: 5–8), and mean Kujala's score was 89.7 (range: 63–100) at final follow-up. Of the five cases, three patients presented in a delayed fashion, and all went on to have surgical treatment. Two required arthroscopic loose body removal, while the other had an open patellar debridement and platelet-rich plasma (PRP) injection. Minimally displaced patellar sleeve fractures can be successfully managed nonoperatively with excellent clinical outcomes. However, delayed in presentation may be associated with worse outcome. This study of case series reflects level of evidence IV.



Publication History

Received: 10 December 2018

Accepted: 03 July 2019

Article published online:
21 August 2019

© 2019. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Ray JM, Hendrix J. Incidence, mechanism of injury, and treatment of fractures of the patella in children. J Trauma 1992; 32 (04) 464-467
  • 2 Dai LY, Zhang WM. Fractures of the patella in children. Knee Surg Sports Traumatol Arthrosc 1999; 7 (04) 243-245
  • 3 Hunt DM, Somashekar N. A review of sleeve fractures of the patella in children. Knee 2005; 12 (01) 3-7
  • 4 Houghton GR, Ackroyd CE. Sleeve fractures of the patella in children: a report of three cases. J Bone Joint Surg Br 1979; 61-B (02) 165-168
  • 5 Wu CD, Huang SC, Liu TK. Sleeve fracture of the patella in children. A report of five cases. Am J Sports Med 1991; 19 (05) 525-528
  • 6 Singh RP, Shah RK, Srivastava MP. Treatment of inferior patellar pole avulsion fractures with pole resection and patellotibial cerclage wire. Nepal Med Coll J 2007; 9 (02) 93-95
  • 7 Al-Khateeb H, Willett K. Sleeve fracture of the patella: an unusual mechanism of injury. J Trauma 2008; 65 (01) E8-E9
  • 8 Guy SP, Marciniak JL, Tulwa N, Cohen A. Bilateral sleeve fracture of the inferior poles of the patella in a healthy child: case report and review of the literature. Adv Orthop 2011; 2011: 428614
  • 9 Bates DG, Hresko MT, Jaramillo D. Patellar sleeve fracture: demonstration with MR imaging. Radiology 1994; 193 (03) 825-827
  • 10 Gao GX, Mahadev A, Lee EH. Sleeve fracture of the patella in children. J Orthop Surg (Hong Kong) 2008; 16 (01) 43-46
  • 11 Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H. [Patella infera. Apropos of 128 cases]. Rev Chir Orthop Repar Appar Mot 1982; 68 (05) 317-325
  • 12 Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985; (198) 43-49
  • 13 Kujala UM, Kvist M, Osterman K, Friberg O, Aalto T. Factors predisposing Army conscripts to knee exertion injuries incurred in a physical training program. Clin Orthop Relat Res 1986; (210) 203-212
  • 14 Hefti F, Müller W, Jakob RP, Stäubli HU. Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1993; 1 (3,4): 226-234
  • 15 Gupta RR, Johnson AM, Moroz L, Wells L. Patellar sleeve fractures in children: a case report and review of the literature. Am J Orthop 2006; 35 (07) 336-338
  • 16 Kaar TK, Murray P, Cashman WF. Transosseous suturing for sleeve fracture of the patella: case report. Ir J Med Sci 1993; 162 (04) 148-149
  • 17 Bruijn JD, Sanders RJ, Jansen BR. Ossification in the patellar tendon and patella alta following sports injuries in children. Complications of sleeve fractures after conservative treatment. Arch Orthop Trauma Surg 1993; 112 (03) 157-158
  • 18 Hadlow AT, Medlicott PA. Bilateral simultaneous sleeve fractures of the patella in secondary hyperparathyroidism. Injury 1987; 18 (06) 417-418
  • 19 Gardiner JS, McInerney VK, Avella DG, Valdez NA. Pediatric update # 13. Injuries to the inferior pole of the patella in children. Orthop Rev 1990; 19 (07) 643-649
  • 20 Boström A. Fracture of the patella. A study of 422 patellar fractures. Acta Orthop Scand Suppl 1972; 143: 1-80
  • 21 Belman DA, Neviaser RJ. Transverse fracture of the patella in a child. J Trauma 1973; 13 (10) 917-918
  • 22 Crawford AH. Fractures about the knee in children. Orthop Clin North Am 1976; 7 (03) 639-656
  • 23 Andrews JR, Hughston JC. Treatment of patellar fractures by partial patellectomy. South Med J 1977; 70 (07) 809-813 , 817