半月板縫合術後に生じた膝蓋骨上極裂離骨折（ｓｌｅｅｖｅ　ｆｒａｃｔｕｒｅ）の１例

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We report a case of sleeve fracture of the upper pole of the patella after medial meniscal repair. A sixteen-year-old boy presented a history of medial meniscal repair. He fell down the stairs, and landed on his knees, after which he could not walk with sudden pain in the left knee. Local examination showed severe effusion and localized tenderness on the upper pole of the patella. He was unable to extend the knee actively. Aspiration produced blood-stained fluid containing fat globules. Lateral radiograph showed avulsion of the upper pole of the patella. Surgical treatment was performed. The avulsed patella fragment of the upper pole included a sleeve of cartilage. The patella, its cartilage sleeve, and the extensor retinaculum were repaired. Three days later, he started passive knee flexion. Now he has regained/recovered full range of movements and is able to extend his knee completely. Patients with fracture of this type usually have a history of trauma or operation around the knee. It was concluded that the mechanism of the injury is inherent weakness at the growth plate of the patella during rapid growth in adolescence, combined with the detrimental effect of immobilization, with the quadriceps contracting against resistance. Accurate reduction and fixation are considered important to present development of the patella magna and persistence of anterior knee pain.
西日本整形・災害外科学会の論文