Avulsion fracture of anterior cruciate ligament from femoral attachment in a skeletally mature patient – A case report

Abstract

Introduction: Avulsion of femoral attachment of anterior cruciate ligament (ACL) has been described in skeletally immature population, but has not been reported till now in adults with mature skeleton. This injury occurs due to high energy trauma. Case report: We are presenting a rare case of avulsion fracture of femoral attachment of ACL in a skeletally mature 20-year adult male. Patient presented to us 4 weeks following the injury and the injury had been missed in the earlier evaluation performed elsewhere. Due to the delay in presentation, the bone fragment reattachment was not technically feasible and the instability was managed with arthroscopic ACL reconstruction using Bone-Patellar tendon-Bone graft fixed with biodegradable interference screws. Conclusion: Avulsion injuries occur more often on the side of the tibial eminence and most surgeons are familiar with these injuries. Femoral avulsion injury has not been reported in adults till now. It is important to be aware of femoral side avulsions also since early diagnosis offers the possibility of reattachment of avulsed bone fragment. Delayed diagnosis leads to retraction and softening/resorption of the avulsed bone fragment and requires ACL reconstruction with patellar tendon or hamstring grafts.