Proximal anterior cruciate ligament avulsion fracture in a skeletally immature athlete: a case report and method of physeal sparing repair

Abstract

Traumatic rupture of the anterior cruciate ligament (ACL) in adulthood is relatively common and surgical reconstruction is frequently required to allow return to high-level activities. There is growing evidence to suggest that ACL rupture in children is more common than previously thought and a poor outcome is associated with conservative management. The site of rupture in childhood is predominantly tibial avulsion, but mid-substance tears have also been reported. We report a case of a proximal ACL avulsion in an 11-year-old athlete and discuss a method of extra-physeal repair. There are very few previous reports of proximal avulsion fractures in skeletally immature patients.

Arthroscopically assisted reduction and internal fixation of a femoral anterior cruciate ligament osteochondral avulsion fracture in an 11-year-old girl: A case report

“…Increasing evidence indicates that ACL ruptures among children are more common than previously thought and that poor clinical outcomes are most likely related to conservative management of the case. [ 8 , 18 ] ACL avulsion fractures of the femoral condyle can be repaired openly using a medial parapatellar incision and pullout sutures through drill holes, as reported by many authors. [ 7 , 14 ] After that, an increasing number of specialists performed arthroscopic repairs, resulting in excellent functional results and cosmetic results as a long surgical scar is not left behind.…”

Femoral Avulsion of the Anterior Cruciate Ligament in a Multiligament Setting: A Unique Case

“…Mechanism of injury varied from road traffic accidents to sporting injuries. Fixation of these avulsions varied from open to arthroscopic techniques using suspensory devices, K-wires and screws 1 – 10) . None of them, however, reported ACL avulsions associated with a meniscus tear and an MCL injury.…”

Arthroscopically assisted reduction and internal fixation of a femoral anterior cruciate ligament osteochondral avulsion fracture in a 14-year-old girl via transphyseal inside-out technique

“…There is growing evidence to suggest that ACL rupture in children is more common than previously thought and a poor outcome is associated with conservative management [3, 10]. The site of rupture in children and adolescents is predominantly tibial avulsion, but midsubstance tears have also been reported [3]. However, femoral osteochondral avulsion fracture of the ACL in children and adolescents is a rarity.…”

“…Other authors also treated femoral osteochondral avulsion fractures of the ACL using parapatellar incisions and pullout sutures through drill holes [2, 3, 7]. …”

“…Bone avulsions are more frequent due to weaker epiphyseal insertion compared to strong elastic ligaments [2]. A tibial avulsion of the ACL is the most common form and also the most common osseous lesion in knee injuries of the growing skeleton [3]. In contrast, femoral osteochondral avulsion fracture of the ACL in children is a rarity.…”