Introduction

Fractures of the tibial tubercle are uncommon in adolescents, accounting for less than 1% of physeal injuries. Most cases are isolated osseous avulsions, whereas associated patellar tendon rupture is much less common and has been described mainly in isolated case reports and small series [1,2].

Tibial tubercle fractures are commonly classified according to the Ogden classification, which is based on the location and extent of the fracture through the apophysis and proximal tibial physis. These injuries typically result from a sudden, forceful contraction of the quadriceps during jumping or landing activities in adolescents. Although most fractures occur as isolated injuries, the associated patellar tendon rupture may be overlooked during the initial assessment because of its rarity and the prominence of the osseous injury [1].

During skeletal maturation, the tibial tubercle apophysis and patellar tendon represent vulnerable transitional structures exposed to high tensile forces [3].

Failure to recognize the tendinous component at presentation may lead to delayed treatment and suboptimal restoration of the extensor mechanism [4]. We describe a multicenter series of adolescent patients with combined tibial tubercle fracture and patellar tendon rupture, with emphasis on radiographic findings, surgical management, and functional outcomes. We also highlight complete rotational displacement of the tibial tubercle fragment as a potential diagnostic clue to associated tendon injury [5].

Written informed consent for publication of anonymized clinical data and images was obtained from the patients' legal guardians.