Introduction Knee injuries in soccer and rugby are a common occurrence as it involves active foot work with fast mobility. Avulsion fracture of anterior cruciate ligament is a common injury but its combina- tions with fracture patella at the same time is unique in this case. To the best of our knowledge such a combined injury has not been reported. Case Report A 24-year-old Caucasian male sustained injury to his left knee during a rugby tackle. He was unable to describe the mechanism of injury but gave history of snapping sensation in the knee with immediate swelling. He was unable to weight-bear and could not continue the game. Apart from this he was fit and healthy. He was seen in A&E about two hours after the injury. Examina- tion revealed that knee was markedly swollen with bruising on the medial side. Patient was able to straighten leg, but it was not possible to test the ligaments due to pain. Plain radiographs revealed fracture of anterior tibial eminence and fracture of low- er pole of patella (Fig. 1). MRI scan confirmed the same findings and also showed an intact medial meniscus, sprain of medial col- lateral ligament, and absence of any other intra-articular injury (Fig. 2). One can speculate that while anchoring himself to the ground, he forcibly flexed his knee and fell on the ground. Examination under anesthesia (EUA) revealed that there was grade 2 instability of medial collateral ligament. The Lachman and anterior drawer tests were positive. Surgery was carried out by an anterior midline longitudinal incision. The anterior tibial eminence fracture was reduced and held with a partially threaded cancellous screw. As the lower pole fragment of the pa- tella was quite small, this was reduced and held with a Mitec su- ture with 1 Ethibond. The repair was protected by a figure of 8 load sharing cable (Fig. 3). No other intra-articular injury was identified and patellar retinacula were intact. Post-operatively, the knee was immobilized in a Donjoy ROM brace in full exten- sion. Isometric quadriceps and hamstrings exercises were rec- ommended at 2 weeks. Range of movement was increased grad- ually from 0 ±30 degrees at 2 weeks to 90 degrees at 6 weeks. The patient was referred for physiotherapy and was allowed to start weight bearing at 6 weeks. At the end of six months, patient had full range of movements and was allowed to start non-con- Abstract A rare sport injury having patellar fracture and anterior cruciate ligament avulsion fracture is being reported. This case was note- worthy as it involved rare combination of two separate injuries often seen in sportsmen. Our experience with operative inter- vention and postoperative rehabilitation with a supervised phys- iotherapy regimen has yielded good results. Key words Patellar fracture ´ anterior cruciate ligament ´ anterior tibial emi- nence Orthopedics & Biomechanics 120 Affiliation Department of Orthopaedics, Maidstone General Hospital, Maidstone, Kent, United Kingdom Correspondence M. S. Siddiqui ´ 226 Hilton Drive ´ Aberdeen AB24 4NA ´ United Kingdom ´ E-mail: manalsiddiquis@hotmail.com Accepted after revision: September 30, 2004 Bibliography Int J Sports Med 2005; 26: 120±121  Georg Thieme Verlag KG ´ Stuttgart ´ New York ´ DOI 10.1055/s-2004-830496 ´ Published online December 22, 2004 ´ ISSN 0172-4622 M. A. Fazal M. S. Siddiqui Avulsion Fracture of Inferior Pole of Patella and Tibial Spine ± A Case Report of Rare Combination of Knee Injury