Avulsion fracture of the medial head of the gastrocnemius muscle associated with multiple ligament injuries before closure of the growth plate: a case report

Abstract

BackgroundAvulsion fracture of the medial head of the gastrocnemius muscle is a very rare phenomenon. There are no reports of avulsion fractures associated with multiple ligament injuries before closure of the growth plate. The authors present a case of avulsion fracture of the insertion of the medial head of the gastrocnemius muscle associated with posterior cruciate ligament injury and an avulsion fracture of the medial collateral ligament at the femoral attachment.Case presentationA 15-year-old Japanese boy was injured by contact with another player while playing soccer. He was immediately admitted to the authors’ hospital with knee pain. Radiography and computed tomography revealed an avulsion fracture of the medial collateral ligament at the femoral attachment and an avulsion fracture of the medial head of the gastrocnemius muscle. In examination under anesthesia, the Lachman test was negative and posterior drawer test was positive. Fixation of the avulsion fractures of the medial collateral ligament and medial head of the gastrocnemius was performed 9 days after the injury. After fixation, valgus instability at full extension had disappeared. The knee was immobilized in a brace for 2 weeks postoperatively. One year postoperatively, the posterior drawer test was slightly positive; however, our patient was able to ambulate without pain and returned to sports without feeling instability in his knee.ConclusionA rare case of avulsion fracture of the gastrocnemius muscle combined with multiple ligament injuries before closure of the growth plate is described. A satisfactory result was obtained by fixation of the avulsed bone fragments of the gastrocnemius muscle and medial collateral ligament. The authors believe that avulsion fracture of the medial head of the gastrocnemius muscle associated with posterior cruciate ligament injury should be repaired.

Surgical Treatment of Medial Gastrocnemius Tear

“…Although most of these tendinous injuries can be treated without surgery, [10][11][12]14 some patients are unable to regain the strength required for athletic performance after nonoperative care.…”

“…[10][11][12][13][14] The most commonly reported mechanism of injury is forced ankle dorsiflexion with the knee in extension, which places the greatest strain at the medial gastrocnemius insertion. 11 While the majority of these tendinous injuries can be treated without surgery, [10][11][12]14 some patients are unable to regain the strength require for athletic performance after nonoperative care. In these cases, surgical repair may be considered; however, surgical technique or outcomes studies are scarce on this relatively uncommon injury.…”