The second case occurred in 2019. As in the first case, a previously healthy, normal weight, 14-year-old male, who played school-level competitive basketball, presented to our Emergencies (A&E) after jumping from ground level and landing on a hard flat surface. The symptoms and signs were identical to the first case with immediate pain and ROM limitation. Clinical evaluation found both knees swollen, with minimum possibility of passive movement and inability to weight bear. X-rays (Figure 3) showed a type IIA right knee avulsion fracture and a type IIB left knee avulsion fracture according to the Ogden modified classification.
The patient underwent surgery and had bilateral ORIF repair. For both knees, the fracture sight was debrided allowing for anatomical reduction, and osteosynthesis was achieved using the same hardware: one 4.5 mm partially threaded cannulated screw (Figure 4) placed distally to the physics with washer and precise reconstruction of the surrounding soft tissues. Intraoperatively complete detachment of the patellar tendon was documented for both knees (Figure 5) that has been treated by direct suturing.
In the case of the second male, post-operative care involved two full lower limb casts, no weight bearing for six weeks, followed by a gradual increase of knee flexion and weight bearing under physiotherapist guidance. Full subjective and clinical recovery with complete ROM were achieved by post-operative week 12 with full return to normal activity. Light on-field workouts were started at week 13, the first competitive sporting event at week 20, and return to pre-injury level was achieved at six months postoperatively. At a distance of one year, clinical and radiological evaluation confirmed a successful outcome and there was no need for hardware removal.