Double-Row Suture Anchor Repair of a Tibial Tubercle Avulsion Fracture in an Adolescent Athlete: A Case Report

Tibial tubercle avulsion fractures are uncommon injuries that typically occur in skeletally immature adolescent males. Traditional fixation methods for these injuries utilize metal hardware, which carries risks including hardware prominence, irritation, need for a removal procedure, and potential interference with future MRIs. In this case report, we describe a surgical technique for the treatment of a tibial tubercle avulsion fracture in a skeletally immature adolescent athlete with a double-row suture anchor technique. A 15-year-old skeletally immature male sustained a left Ogden Type 1B tibial tubercle avulsion fracture while playing basketball. A left knee x-ray series and MRI confirmed a tibial tubercle avulsion fracture with no other knee injuries. After performing a midline, longitudinal approach centered over the fracture site, two double-loaded biocomposite suture anchors were placed just proximal to the fracture site. The sutures were passed from deep to superficial through the distal patellar tendon, just proximal to the fracture fragment. The fracture was reduced and provisionally held with a K-wire. The proximal sutures were tied in horizontal mattress fashion over the tendon. The remaining sutures were incorporated into two distal suture anchors, which were tensioned and placed distal to the fracture site, reducing and compressing the fracture. The patient was placed in a hinged knee brace locked in extension postoperatively. The patient progressed uneventfully through the postoperative course with no complications. At 5 months, the patient had returned to jogging. At 7 months, the patient had returned to sport-specific training and was cleared for full athletic activity. At final follow up at 9 months postoperatively, the patient had returned to playing tackle football without pain, weakness, or any symptoms. This technique has many potential benefits compared to traditional fixation methods, including lower risk of hardware complications or need for future hardware removal procedures.