The Open Orthopaedics Journal

ISSN: 1874-3250 ― Volume 15, 2021

Bifocal Disruption of the Patellar Tendon with Avulsion of the Tibial Tuberosity: A Case Report

Takuya Sekiguchi1, 2, Yoshihiro Hagiwara2, *, Masahito Honda3, Eiji Itoi2
1 Department of Orthopedic Surgery, Iwate Prefectural Central Hospital, 1-4-1 Ueda, Morioka, 020-0066, Japan
2 Department of Orthopedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
3 Department of Orthopedic Surgery, Takeda General Hospital, 3-27 Yamaga-machi, Aizuwakamatsu, 965-8585, Japan



Bifocal disruption of the knee extensor system is rare. Coincident bifocal proximal and distal disruptions of the patellar tendon are extremely rare in adults.

Case Report:

A 38-year-old man presented to our clinic with severe right knee pain after falling down the stairs and abruptly bending the right knee. Plain radiographs of this knee showed tibial avulsion and a high riding patella, suggesting underlying Osgood-Schlatter disease, which was also present to a milder degree in the left knee. Magnetic resonance imaging confirmed an avulsion of the tibial tuberosity and showed concomitant avulsion of the patellar tendon without bone marrow edema. Computed tomography showed that the fragment of the tibial tuberosity had a dull-edged margin, and cortical bones were partially exposed. During surgery, the patellar tendon was divided into superficial and deep layers. The superficial layer was peeled from an attachment at the patella, while the deep layer was from the tibia and contained the fragment of the tibial tuberosity. The detached side of the fragment and tibia were coated with dense, fibrous tissue. Surgical repair was performed, with excellent outcomes. Radiographic and intraoperative findings suggested Osgood-Schlatter disease, which might cause avulsion of the tibial tuberosity.


This is the first case of the bifocal proximal and distal rupture of the patellar tendon with the avulsion of the tibial tuberosity. Bifocal disruption of the patellar tendon should be considered in patients presenting with avulsion of the tibial tuberosity and suspected Osgood-Schlatter disease.

Keywords: Knee, Bifocal disruption, Patellar tendon rupture, Tibial Tuberosity, Osgood-Schlatter disease, Patellar tendon.

Article Information

Identifiers and Pagination:

Year: 2020
Volume: 14
First Page: 120
Last Page: 124
Publisher Id: TOORTHJ-14-120
DOI: 10.2174/1874325002014010120

Article History:

Received Date: 02/03/2020
Revision Received Date: 07/07/2020
Acceptance Date: 14/08/2020
Electronic publication date: 22/10/2020
Collection year: 2020

© 2020 Klinkhardt et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; Tel: +81-22-7177245, Fax: +81-22-7177238;

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