An Unusual Case of Bilateral Tibial Tubercle Avulsion With Complete Avulsion of the Unilateral Patellar Tendon

This is a case report of a 15-year-old male patient who presented with bilateral tibial tubercle avulsions and a unilateral complete patellar tendon stripping following a fall on both knees while playing football. The left knee was treated conservatively, while the right underwent open reduction internal fixation and patella tendon repair. The case was followed for one year postoperatively. Complete soft tissue and fracture healing were reported bilaterally. A modified Lysholm score of 84 compared to 95 pre-injury and a Tegner score of four compared to nine pre-injury were recorded. This case report highlights the absence of a consensus on the management of bilateral tibial tubercle avulsion fractures. To the best of our knowledge, it also marks the first documented instance of an additional concomitant unilateral patellar tendon avulsion. In this report, we have described the unique mechanism of injury and how a preoperative knee MRI scan is highly advisable to delineate associated injuries. We implemented a novel surgical technique combining internal fixation with a double-row-like technique addressing the bony and soft tissue elements, respectively. A supervised, gradually progressive rehabilitation program is recommended. This injury can massively affect an individual's function level despite careful planning; therefore, we recommend future studies investigating potential underlying subclinical musculoskeletal disorders in similar cases that can help shape sport selection for different individuals.