Department of Orthopedic Surgery and The Sports Medicine Center, Mayo Clinic, Rochester, Minnesota.
J Knee Surg. 2021 Feb;34(3):242-246. doi: 10.1055/s-0039-1694742. Epub 2019 Aug 21.
Patellar sleeve fractures primarily occur in the adolescent population from a rapid contraction of the quadriceps with the knee in a flexed position. Several small case reports describe operative reduction and fixation for displaced fractures. However, there is sparse literature on nonoperative management of these injuries. Retrospective review and prospective follow-up of all patients diagnosed with patellar sleeve fracture between 1991 and 2014 at a single institution. Patients with superior pole avulsion fractures, history of prior knee surgery, and fractures managed operatively were excluded. Patients with a clinical diagnosis without support of advanced imaging were also excluded. Radiographs and magnetic resonance imaging (MRI) were reviewed for initial fracture displacement, time until fracture union, and the presence of patellar tendon ossification. Outcome was assessed using the Tegner's activity scale, Kujala's Score and the International Knee Documentation Committee (IKDC) subjective knee evaluation score at final follow-up. Eighteen nonoperatively treated distal patellar pole sleeve fractures were identified, while five patients had advanced imaging to support their diagnosis. All were males with a mean age of 15.1 (range: 12-18). Traumatic and sport-related injuries were noted in the majority of patients. Only one patient had any appreciable displacement, but still < 2 mm. Final radiographic evaluation revealed fracture healing without patellar tendon ossification in all patients. All five patients had full terminal knee extension and symmetric range of motion. Mean IKDC score was 96.4 (range: 82-100) mean Tegner's activity score was 60 (range: 5-8), and mean Kujala's score was 89.7 (range: 63-100) at final follow-up. Of the five cases, three patients presented in a delayed fashion, and all went on to have surgical treatment. Two required arthroscopic loose body removal, while the other had an open patellar debridement and platelet-rich plasma (PRP) injection. Minimally displaced patellar sleeve fractures can be successfully managed nonoperatively with excellent clinical outcomes. However, delayed in presentation may be associated with worse outcome. This study of case series reflects level of evidence IV.
髌骨袖状骨折主要发生在青少年中，其原因是股四头肌快速收缩，同时膝关节处于弯曲位置。有几例小病例报告描述了移位骨折的手术复位和固定。然而，对于这些损伤的非手术治疗，文献报道很少。对 1991 年至 2014 年在一家机构诊断为髌骨袖状骨折的所有患者进行回顾性研究和前瞻性随访。排除了上极撕脱骨折、既往膝关节手术史和手术治疗的患者。也排除了没有影像学支持的单纯临床诊断的患者。对 X 线片和磁共振成像（MRI）进行评估，以确定初始骨折移位、骨折愈合时间以及髌腱骨化的存在。使用 Tegner 活动量表、Kujala 评分和国际膝关节文献委员会（IKDC）主观膝关节评估评分在最终随访时评估结果。确定了 18 例非手术治疗的髌骨远端袖状骨折，其中 5 例有影像学检查支持其诊断。所有患者均为男性，平均年龄 15.1 岁（范围：12-18 岁）。大多数患者均有创伤性和运动相关损伤。只有 1 例患者有明显的移位，但仍<2mm。最终影像学评估显示所有患者均愈合，无髌腱骨化。所有 5 例患者均有完全的膝关节终末伸展和对称的关节活动范围。平均 IKDC 评分为 96.4（范围：82-100），平均 Tegner 活动评分为 60（范围：5-8），平均 Kujala 评分为 89.7（范围：63-100）。在这 5 例病例中，有 3 例患者就诊时间延迟，均接受了手术治疗。其中 2 例需要关节镜下清除游离体，另 1 例则进行了开放性髌骨清创和富含血小板的血浆（PRP）注射。轻度移位的髌骨袖状骨折可以通过非手术治疗获得良好的临床效果。然而，延迟就诊可能与更差的结果有关。本病例系列研究为证据等级 IV。
