ACL avulsion fracture

Case contributed by Ali Alsmair
Diagnosis certain


The patient presented with posttraumatic knee pain and restricted movement

Patient Data

Age: 40 years
Gender: Female

Evidence of an avulsion fracture of the tibial attachment of ACL with a rotation of the avulsed bony fragment.

No evidence of bone contusion at the site of the avulsed bone, with degenerative changes between the tibia and the bony fragment, manifested as subchondral cystic changes, these changes are suggestive of chronicity of the injury.

Features are consistent with type 4 ACL avulsion fracture according to Meyers and McKeevers classification.

Loss of cartilage of medial patellar facet with underlying bone marrow edema and cystic changes, consistent with grade 4 chondromalacia patella of medial patellar facet.

Minimal joint effusion.

The PCL, menisci, collaterals, both retinacula and quadriceps and patellar tendons are intact.

No Baker's cyst.

No patellar dislocation.

Case Discussion

Loss of bone marrow edema of the fractured bones with associated degenerative changes are signs of chronicity of the injury.

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