A Rare Combination of Patellar Sleeve Fracture, Tendon Avulsion, and Retinacular Disruption in a Child: Diagnostic and Operative Insights

A 13-year-old boy presented with acute right knee pain, significant effusion, and a complete loss of active extension following a football injury. Radiographs demonstrated patella alta and increased density within the infrapatellar fat pad. Intraoperative exploration revealed a rare "triple injury" triad: a displaced inferior pole patellar sleeve fracture, a distal patellar tendon avulsion from the tibial insertion, and near-complete medial and lateral retinacular disruption. Surgical reconstruction was performed using suture-tape fixation with anchors for the patellar sleeve, tendon reinsertion utilizing Krakow sutures with screw augmentation, and primary retinacular repair. Following a structured postoperative rehabilitation program, the patient achieved an excellent functional outcome with restored full range of motion. This case highlights a complex multilevel extensor mechanism disruption in a skeletally immature patient and the surgical approach used for anatomical restoration.