Avulsion tibial eminence - ACL origin

Case contributed by Chris O'Donnell


Acute knee pain following a sporting injury

Patient Data

Age: 12
Gender: Female

Large joint effusion associated with an ossicle in the intercondylar notch

So-called Grade 3 avusion and separation of the anterior tibial eminence with attached ACL origin and anterior horn lateral meniscus.  Note the intermeniscal ligament (arrows) joining the anterior horns of both menisci is interpositioned between the avulsed bone fragment and if not repositioned can prevent union of the bone fragment

Reattached fracture fragment using button sutures

Case Discussion

In children the bone is often less forgiving than the ligament thus bone avulsion of the ACL occurs rather than ligament rupture.  This leads to a better outcome as the bone can be reattached without requirement for ligament allograft.

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