Transosseous Sutures Repair of Patellar Sleeve Fractures in Pediatric Patient: a report of two cases

Patellar sleeve fractures are a rare yet significant type of injury in the pediatric population. They commonly occur at the inferior pole of the patella and are often missed due to the subtle radiographic appearance, especially when no bony fragment is evident. This report describes two cases of displaced patellar sleeve fractures in 10- and 11-year-old boys, both managed successfully with open reduction and internal fixation using transosseous sutures. Diagnosis in both cases was based on the presence of patella alta, significant hemarthrosis, and identification of osteochondral fragments on imaging. Intraoperatively, large osteochondral avulsion fragments involving both cartilage and periosteum were visualized and anatomically reduced. Transosseous sutures were passed through drilled patellar tunnels and securely tied to reestablish continuity of the extensor mechanism. Both patients were immobilized in long leg casts and underwent structured physiotherapy following cast removal. Follow-up over a one-year period demonstrated excellent clinical outcomes, including full range of motion, absence of pain, and normal patellar alignment on imaging. These cases underscore the importance of early recognition and timely surgical intervention for displaced patellar sleeve fractures. Transosseous suture fixation is a safe and effective method for restoring extensor mechanism integrity without the use of metal hardware, reducing the risk of implant-related complications and growth disturbances. Clinicians, particularly those in emergency settings, should maintain a high index of suspicion for this injury pattern in children presenting with knee trauma, patella alta, and extensor lag, even in the absence of a visible fracture on initial radiographs.