Avulsed ACL origin
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Fat sitting in the suprapatellar pouch indicates an intra-articular fracture with leak of bone marrow into the joint (arrow on axial image).
Swollen ACL attached to the bone fragment (arrow on sagittal image).
In children the anterior cruciate ligament is often stronger than the bone thus the bone is avulsed rather than the ligament rupturing. In terms of repair the bone quite often does not sit flush with the underlying tibial eminence as the transverse meniscal ligament running between the anterior horns on both menisci interposes between the fragment and underlying bone (nicely demonstrated on MRI).