PMC9902919_01
Plain radiographs on the first visit.. Plain radiographs at the first visit revealed a high-riding patella without any obvious bone fracture around the knee.
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FIG1
Computed tomography image at the first visit.. Computed tomography image in a sagittal plane at the first visit revealed an apparent fragment of the lower pole of the patella (white arrow).
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FIG2
Magnetic resonance imaging at the first visit.. T2-weighted magnetic resonance imaging in a sagittal plane at the first visit revealed complete disruption of the patellar ligament (white arrowhead) and an osteochondral fragment avulsed from the patella (white arrow).
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FIG3
Magnetic resonance imaging (MRI) revealed complete disruption of the patellar ligament with an osteochondral fragment avulsed from the patella and attached to the ligament without any other abnormality in the intra-articular area (Figure 3).
Surgical findings.. Complete disruption of the patella ligament from the inferior pole of the patella and an avulsion fracture of the inferior pole (a) and articular cartilage of the patella (b), indicating a rupture of the extensor mechanism of the knee. The pull-out suturing technique was performed (c, d).
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FIG4
Perioperatively, complete disruption of the patella ligament from the inferior pole of the patella and an avulsion fracture of the inferior pole (3 mm) and articular cartilage of the patella (8 mm) (a rupture of the extensor mechanism of the knee) were noted (Figure 4).
Operative procedure.. The pull-out technique was used with transosseous no. 2 MaxBraid  sutures. Krackow sutures were also performed with a continuous locking loop technique commonly used in tendon repair.
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FIG5
Plain radiographs obtained immediately after the operation.. Good reduction and fixation were achieved.
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FIG6
Plain radiographs at ten months postoperatively (left) and the contralateral side (right).. Bone union was achieved. Patella height was almost same as the other side.
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FIG7
Compared to the patella height of the contralateral side, there was no difference at the final follow-up (Figure 7).