New insights into diagnosis and treatment of tibial tubercle avulsion fractures in young athletes

As youth engagement in high-energy sports surges, so does the prevalence of sport-related injuries. Among them, tibial tubercle avulsion fractures (TTAFs) represent a small but serious subset, accounting for less than 3% of pediatric fractures. These injuries commonly affect adolescent boys and are associated with risk factors such as delayed skeletal maturity, Osgood-Schlatter disease, and abnormal body mass index. Diagnosis can be complex, as symptoms mimic other knee conditions, and imaging beyond basic X-rays is often required. Despite several classification systems, no consensus exists on standardized treatment protocols. Due to these challenges, there is a growing need for in-depth studies to better understand and manage TTAFs.

In a recent review (DOI: 10.1002/pdi3.2521) published in Pediatric Discovery (2025), researchers from the Children’s Hospital of Chongqing Medical University and Sichuan University examined the causes, diagnosis, and treatment of TTAFs in children and adolescents. These injuries, though rare, are becoming more frequent due to rising sports participation among youth. The article reviews decades of literature and new clinical findings to offer guidance for orthopedic surgeons facing this unique challenge in pediatric care.

The study delves into how TTAFs occur—often during sudden movements like jumping or landing, when the quadriceps muscle forcefully contracts and pulls on the tibial tubercle. The authors explain how specific anatomical features and the stages of bone development make adolescents particularly vulnerable. While boys face higher risk due to later growth plate closure and greater quadriceps strength, the presence of Osgood-Schlatter disease or extreme BMI—whether high or low—also heightens susceptibility. Diagnostic tools such as CT and MRI are recommended to detect hidden soft tissue damage and guide surgical planning. Multiple classification systems are discussed, with the Ogden system remaining the most widely used despite its limitations. Treatment options range from conservative casting for stable fractures to surgical methods like open reduction internal fixation (ORIF) for displaced or complex cases. The review underscores the variability in clinical decisions due to the lack of evidence-based guidelines and highlights the importance of monitoring for complications like compartment syndrome, which can be life-altering if untreated.

Many of these young patients are active in sports and unaware of their risk until an injury sidelines them. What this review emphasizes is the need for vigilance—not just in diagnosis, but in understanding the subtle risk factors like growth plate maturity and muscle force imbalances. With proper identification and early treatment, most children recover fully and return to their activities.”

Dr. Xing Liu, senior orthopedic surgeon at Chongqing Medical University

This study provides clinicians with a critical update on recognizing and treating TTAFs in pediatric patients. Its insights help bridge the gap between injury mechanism, clinical presentation, and long-term recovery strategies. As sports-related injuries in children grow more common, this knowledge equips orthopedic specialists with the tools to make timely interventions and reduce complications. Looking forward, developing unified clinical guidelines and further exploring risk factors like BMI and OSD may improve both treatment precision and outcomes. With appropriate care, young patients can return to full function—sometimes even stronger than before.