Anterior cruciate ligament avulsion fracture

Last revised by Tariq Walizai on 19 Dec 2024

Anterior cruciate ligament (ACL) avulsion fractures, also known as tibial eminence avulsion fractures, are a type of knee avulsion fracture. They typically involve separation of the tibial attachment of the ACL to variable degrees, although separation at the femoral attachment is rare 5.

This injury is more common in children aged 8-14 years than in adults. It has been hypothesized that this may be due to the relative weakness of incompletely ossified bone relative to ligamentous fibers 7 or the relatively increased elasticity of ligaments in children 8.

They are usually caused by forceful hyperextension of the knee or by a direct blow over the distal end of the femur with the knee flexed.

Depending on the type, a tibial avulsion is typically seen as a fracture fragment in variable orientation involving the tibial eminence. There may be anterior translation of the femur on the tibia on the lateral view.

Non-displaced fractures can be treated non-operatively in near or full extension immobilization 9. Displaced fractures need to be reduced with various surgical approaches, some include internal fixation 9.

Cases and figures

  • Figure 1: classification - diagram
  • Case 1
  • Case 2
  • Case 3
  • Case 4
  • Case 5
  • Case 6
  • Case 7
  • Case 8
  • Case 9
  • Case 10
  • Case 11
  • Case 12
  • Case 13: tibial spine fracture
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