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Dear Doctor

March 2018


My 10 year old son was recently seen in Urgent Care for knee pain and diagnosed with Patellar Sleeve Fracture. My son was running during PE and felt a pop in his knee. Is this normal for a child and is surgery the only way to treat. I was told to contact a Pediatric Orthopedic Surgeon because he will need a surgery. How did this happen without any physical contact such as a fall?

- Kashawna - Louisiana (Parent)


Thank you very much for your question. Patellar sleeve fractures often occur around the time that the patella (or knee cap bone) becomes fully bony, between 8 and 12 years of age. They may occur while participating in everyday activities including outside play or gym class. Often, the injury is due to a sudden contraction or firing of the thigh muscles called the quadriceps, usually when the knee is flexed or bent. Think of this as landing down from a jump. An audible “pop” is common including rapid swelling in the front part of the knee and an inability to walk on the limb afterwards. When medically evaluated, the knee cap may be much higher than the opposite knee, and swelling is often initially quite prominent. A subsequent X-ray may note a very tiny sliver of bone remaining attached to the patellar tendon (knee cap tendon) and the knee cap itself largely intact and possibly pulled more upward. The reason why this is called a “patellar sleeve” fracture is that the break actually occurs between the bone and cartilage components of the knee cap and the tiny sliver of bone seen on xray are actually attached to a much larger piece of cartilage, like the upper bone was pulled out of the cartilage shell “sleeve”. These injuries can be treated with or without surgery, but it depends on what the actual knee is doing. If a person is able to hold the knee relatively straight in an active fashion (straightening the knee), then the injury may safely be treated in a long leg cylinder type cast for 6 weeks. If a person cannot keep the knee straight, known as an extensor lag, then the injury requires surgery to correct and enable the person to be able to walk properly in the future once the fracture is completely healed.

Having your child evaluated by a pediatric orthopaedic surgeon will help to determine the proper treatment option with the best likelihood for full recovery.

- Kashawna - Louisiana (Parent)