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  • The tibial tubercle is the bony prominence in the knee where the patellar tendon inserts

  • A tibial tubercle avulsion is an injury to the bony insertion of the patellar tendon in the tibia

  • Injury to the tibial tubercle can lead to knee pain, swelling and apprehension

  • 98% of tibial tubercle fractures occur in males

  • 2% of pediatric knee injuries with swelling are tibial tubercle avulsions

  • Watson-Jones Classification system of tibial tubercle avulsions, modified by Ogden

  • Type I – distal, through secondary ossification center

  • Type II – through area between apophysis and epiphysis

  • Type III – through epiphysis

  • Type IV – through tubercle apophysis and physis

  • Type V – avulsion of periosteal attachment


  • Tibial spine avulsions usually occur in jumping sports – eccentric contraction of extensor mechanism during landing


  • Tibial tubercle avulsions are almost always associated with immediate pain and swelling

  • Patients oftentimes hear or feel a “pop” in their knee


  • Treatment of tibial tubercle avulsions depends on grade

  • Type 1 & 2 injuries are usually treated with closed reduction and casting

  • Reduction with knee in extension

  • Cast molding above patella is important to maintain reduction

  • Maintain in cast for 6 weeks


  • The best way to prevent a tibial tubercle avulsion is to work on strengthening hamstrings and learning proper landing mechanics 

tibial tubercle avulsion capture 1.PNG
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