# Suture Anchor Repair for Distal Patellar Tendon Avulsion in Tibial Tubercle Fractures: A Technical Description and Report of Two Cases

## TL;DR

This paper describes a surgical technique using suture anchors to repair patellar tendon avulsion in tibial tubercle fractures, with successful outcomes in two adolescent patients.

## Contribution

A novel surgical method combining screw fixation and suture anchor repair for tibial tubercle fractures with distal patellar tendon avulsion is introduced.

## Key findings

- Two patients returned to competitive sports four months post-surgery without complications.
- The suture anchor technique enabled complete repair of the extensor mechanism.
- The method is described as reliable and biomechanically advantageous.

## Abstract

Tibial tubercle avulsion fractures, though rare, pose a significant challenge in pediatric orthopedics, particularly in athletic adolescents. For nondisplaced fractures, conservative treatment involves the use of braces or casts, while displaced fractures necessitate operative intervention, often through screw fixation. Concomitant soft tissue injuries should also be identified and addressed operatively to ensure complete repair of the extensor mechanism. This paper introduces a method for open reduction and internal fixation (ORIF) of tibial tubercle fractures with suture anchor repair of the distal patellar tendon avulsion. Two case examples of 14-year-old males with displaced fractures undergoing this procedure are presented. After standard screw fixation of the displaced fragment was performed, a single suture anchor was placed into the tibia and an onlay tension slide technique was utilized to secure the distal patellar tendon avulsion. Both patients underwent immobilization and protected weightbearing for four weeks with physical therapy initiated at six weeks. At four months postoperatively, both patients had returned to competitive sports without issue. The described technique may represent a reliable and reproducible method for addressing the distal patellar tendon avulsion component of tibial tubercle fractures. Its biomechanical advantages contribute to the complete repair of the extensor mechanism, enabling a successful return to competitive athletics without hardware complications.