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Displaced Longitudinal Stress Fracture of the PatellaA Case Report
Petri J. Sillanpää, MD, PhD1; Antti Paakkala, MD, PhD1; Timo Paakkala, MD, PhD1; Heikki Mäenpää, MD, PhD1; Jarmo Toivanen, MD, PhD2
1 Departments of Orthopaedic Surgery and Trauma (P.J.S. and H.M.) and Radiology (A.P. and T.P.), Tampere University Hospital, Teiskontie 35, FIN-33521, Tampere, Finland
2 Department of Orthopaedic Surgery, Koskiklinikka, Koskikeskus, PL 17, FIN-33101, Tampere, Finland
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at Tampere University Hospital and Koskiklinikka Hospital, Tampere, Finland

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Oct 06;92(13):2344-2347. doi: 10.2106/JBJS.I.01472
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Stress fractures often occur in physically active individuals as a result of repetitive strenuous muscle and tendon forces acting on bones that have not adapted to such forces1-3. To our knowledge, the literature contains no reports of displaced longitudinal stress fractures of the patella requiring open reduction and internal fixation. The quadriceps muscle and patellar tendon produce extensive forces that can result in a displaced transverse patellar stress fracture2-7. The less strong vertical patellar restraints, including the medial patellofemoral ligament8, produce most of the ligamentous patellar stability in the lateral direction near knee extension8. In cases of acute traumatic patellar dislocation, the osseous structure of the patella is compromised mostly in the lateral direction—e.g., by avulsion of the medial patellofemoral ligament insertion—causing a medial margin fracture of the patella9. We are not aware of any previous reports of repetitive stress causing a displaced longitudinal patellar stress fracture.
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