Anterior cruciate ligament avulsion fracture

Last revised by Andrea Molinari on 4 Dec 2022

Anterior cruciate ligament (ACL) avulsion fracture or tibial eminence avulsion fracture is a type of avulsion fracture of the knee. This typically involves separation of the tibial attachment of the ACL to variable degrees. Separation at the femoral attachment is rare 5.

It is more common in children than adults. It has been hypothesized that this may be due to the relative weakness of incompletely ossified bone relative to ligamentous fibers 7, or relatively increased elasticity of ligament in children 8.

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

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