title: Distal patellar tendon avulsion in association with high-energy knee trauma: A case series and review of the literature.
abstract: BACKGROUND
  Patellar tendon rupture is rare in the general population. Typically, failure occurs proximally or at the mid-substance. Distal avulsion from the tibial tubercle in adults is rare and not well described in the orthopedic literature.
  
  
  METHODS
  We present the largest series of patients with distal patellar tendon injury with associated multi-ligamentous disruption of the knee. A series of six patients with distal patellar tendon avulsion were identified at a single institution. The cases were reviewed and are presented.
  
  
  RESULTS
  Each case of distal patellar tendon rupture was associated with high-energy trauma to the knee. There was multi-ligamentous disruption in all cases, associated tibial plateau fracture in one case, and a compartment syndrome diagnosed in another. We propose that distal patellar tendon avulsion is a distinct pathology of the extensor mechanism in healthy adults. When present, it should prompt clinicians to assess patients for occult knee dislocation, monitor their neurovascular status, and obtain an MRI to evaluate for associated multi-ligamentous injury.
  
  
  CONCLUSIONS
  We propose a modification to the Schenk classification to include extensor mechanism injury to help guide steps of operative intervention.
authors.affiliation: NYU Hospital for Joint Diseases, 301 E17th Street, New York, NY 10003, United States. Electronic address: brian.capogna@nyumc.org.
authors.forename: Brian
authors.initials: B
authors.lastname: Capogna
authors.affiliation: NYU Hospital for Joint Diseases, 301 E17th Street, New York, NY 10003, United States.
authors.forename: Eric
authors.initials: E
authors.lastname: Strauss
authors.affiliation: NYU Hospital for Joint Diseases, 301 E17th Street, New York, NY 10003, United States.
authors.forename: Sanjit
authors.initials: S
authors.lastname: Konda
authors.affiliation: NYU Hospital for Joint Diseases, 301 E17th Street, New York, NY 10003, United States.
authors.forename: Alan
authors.initials: A
authors.lastname: Dayan
authors.affiliation: NYU Hospital for Joint Diseases, 301 E17th Street, New York, NY 10003, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Alaia
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000150:complications / Q000601:surgery*; D008023:Ligaments, Articular / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017847:Patellar Ligament / Q000293:injuries* / Q000601:surgery*; D055815:Young Adult
keywords: ACL tear; Knee dislocation; Multi-ligamentous injury; PCL tear; Patellar tendon rupture