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The authors are from the Medical College of Wisconsin (DSD, SEV) and the Children's Hospital of Wisconsin (SEV), Milwaukee, Wisconsin.
The authors have no relevant financial relationships to disclose.
In the pediatric population, patellar fractures account for less than 6% of all fractures, with sleeve fractures making up 42% to 57% of patellar fractures. 1-3 Patellar sleeve fractures occur when a large amount of resisted force is applied to the patella. 2 They need to be treated early either nonoperatively (nondisplaced or minimally displaced fractures) or surgically (displaced fractures). 4 In this report, the authors discuss an unusual presentation and novel surgical treatment option for a patellar sleeve fracture.
Case Report
A 16-year-old male soccer player presented with right knee pain and associated right lower extremity weakness. The provoking injury had occurred 3 years earlier when the patient was riding his bicycle and collided with a parked car, with the right knee making impact. Following the accident, his knee was painful and swollen and he had limited range of motion; however, he did not seek professional medical care.
During the next 2 months, the pain, swelling, and limited range of motion resolved. The patient progressed back to high-intensity physical activities. He had mild discomfort while playing sports, which he reported as a 2 at its worse (0-10 scale). He also reported difficulty with building strength in his right lower extremity. He noticed that his left quadriceps had hypertrophied, but the right lower extremity lacked that corresponding change.
On physical examination, he had significantly abnormal patella alta on his right with an irregular and firm density inferior to the right patella. Range of motion was decreased to 5[degree] to 135[degree] (normal, 0[degree]-135[degree]) in the right leg with both active and passive measurements.
Radiographs revealed 2 bone formations along the patellar tendon, measuring 4 x 0.5 cm and 2 x 0.5 cm. Also, there was no joint effusion on the radiographs ( Figure 1 ).
A patellar sleeve fracture was diagnosed...