ABS 099: Risk Factors for Tibial Tubercle Avulsion Fracture​ and Patellar Sleeve Fracture​

Noa Pecarsky ³ , Kaitlyn O'Malley ⁴ , Sulagna Sarkar MS ¹ , James Wilkes PhD, MEd, ATC ² , Edward Re MD ¹

¹ Sports Medicine and Performance Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
² Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
³ University of South Carolina
⁴ Northwestern University

Van Wickle (2025) Volume 1, ABS 099

Introduction: Osgood-Schlatter Disease (OSD) and Sinding-Larsen-Johansson Syndrome (SLJS) are types of apophysitis of the knee, where OSD involves abnormal bone ossification at the tibial tubercle, and SLJS at the inferior pole of the patella.  Tibial tubercle avulsion fractures involve an avulsion at the anterior proximal tibia with varying degrees of bone and/or articular cartilage attachment at the distal patellar tendon, while patellar sleeve fractures involve an avulsion often located at the inferior pole of the patella. These fractures are most often seen after injuries involving sudden contraction of the quadriceps muscles and share both anatomical location and biomechanical mechanisms with OSD and SLJS, respectively. We hypothesized that those with OSD or SLJS (apophysitis) will present with a fracture, specifically distal and proximal, respectively, at a higher rate than those without apophysitis

Methods: We queried the electronic health record (EHR) for patients at Children's Hospital of Philadelphia who were diagnosed with OSD, SLJS, tibial tubercle avulsion fracture or patellar sleeve avulsion fracture between 2017 and March 2024. Additional inclusion criteria was age 0-18, with AP/lateral knee x-rays, and skeletal immaturity. Age, sex, height and height percentile, BMI and BMI percentile, flexibility and range of motion measurements, number of sports played, presence or absence of history of OGS, presence or absence of history of SLJS, ICD-10 Codes (2013/2014 ICD-10 was enacted) were extracted from the EHR. This study was approved by the CHOP IRB (#20-017341).

Results: A total of 2348 patients presented with inclusion criteria. Logistic regression showed that tibial avulsion fracture was significantly (OR=5.71, p<0.001) associated with OSD diagnosis, and patellar sleeve fracture was significantly (OR=14.75, p<0.001) associated with SLJS diagnosis.

Discussion: Our findings suggest clinicians should be aware of apophysitis that relate to specified avulsion fractures. Future research should focus on determining if this is a causal relationship and identify individual factors that may lead to increased risk for developing OSD or SLJS, and associated fractures.