MRI manifestations and associated injuries in adolescent tibial tuberosity fractures: A retrospective study

Tibial tuberosity fractures are rare physeal injuries in adolescents and are frequently overlooked on radiographs, despite a high risk of associated soft tissue injury. This study analyzed magnetic resonance imaging (MRI) findings and concurrent injuries in 63 cases to improve diagnostic accuracy and guide clinical management. This study aimed to investigate the MRI features and associated injury patterns of tibial tuberosity fractures in adolescents.

A retrospective analysis was performed on 63 adolescent patients with tibial tuberosity fractures admitted to our hospital between June 2017 and January 2025. The cohort comprised 62 males and 1 female, with ages ranging from 11 to 16 years (mean: 13.9 years). Fractures occurred on the right side in 22 cases, the left side in 40 cases, and bilaterally in 1 case. Body mass index (BMI) ranged from 20.8 to 33.3 kg/m², with a mean of 26.8 kg/m². Upon admission, all patients underwent MRI examinations within 48 h (3.0 T, including T1-, T2-, and STIR-weighted sequences). Fracture types were classified according to the Ogden classification, and associated injuries involving ligaments and the meniscus were simultaneously documented.

MRI revealed patellar tendon injuries in all patients (patellar tendon rupture in 6 cases). Associated injuries included anterior cruciate ligament (ACL) injuries in 28 cases (44.4 %) and posterior cruciate ligament (PCL) injuries in 3 cases (4.8 %). Meniscal injuries were observed in 25 cases (39.7 %), comprising 9 cases of grade I, 12 cases of grade II, and 4 cases of grade III. Peripatellar retinacular injuries were present in 28 cases (44.4 %), and medial or lateral collateral ligament injuries of the knee were identified in 13 cases (20.6 %). Additional associated injuries included 1 case (1.6 %) of fibular fracture, 10 cases (15.9 %) of patellar fracture, and 5 cases (7.9 %) of patellar subluxation.

Plain radiography is the preferred imaging modality for diagnosing tibial tuberosity fractures in adolescents, while computed tomography (CT) can be useful for further classification of fracture types. In cases where concomitant soft tissue injuries-such as those involving the patellar ligament or meniscus-are suspected, MRI provides significant diagnostic value and plays a crucial role in surgical planning and complication prevention.

Level III.