Sleeve fractures of the patella: current concepts in diagnosis and surgical management.

PURPOSE OF REVIEW: Patella sleeve fractures are the most common patellar fracture in children yet remain frequently missed. Additionally, the options for their repair have grown. This review revisits how the injury is recognized and how the expanding range of fixation choices should be navigated.

RECENT FINDINGS: Recent cohorts confirm that recognition rests on the examination rather than the radiograph, as the injury is frequently confused with Sinding-Larsen-Johansson syndrome. In sleeve fractures that are displaced or minimally displaced and in which the extensor mechanism is disrupted, operative treatment is recommended. Transosseous suture remains the most common technique, with suture anchors used for smaller fragments. No fixation method has proven superior, as no comparative trials have been conducted in pediatrics. Functional outcomes are good across treatment groups. However, patients with operative injuries return to sport more slowly, and hardware removal is common.

SUMMARY: Patient outcomes depend less on the choice of fixation than on timely recognition. A high index of suspicion and knowledge of this type of injury help facilitate an accurate diagnosis. MRI-confirmed chondral injury and fracture-specific repair yield reliable outcomes. A delayed diagnosis remains the principal avoidable cause of treatment failure.