J Korean Fract Soc.  2016 Jul;29(3):200-205. 10.12671/jkfs.2016.29.3.200.

Avulsion of the Femoral Attachment of Anterior Cruciate Ligament Associated with Ipsilateral Femoral Shaft Fracture in Skeletally Mature Patient: A Case Report

• Byun SE
• Kim T
• Kim BH
• Kim JH
• Han SH
• Choi W

• KMID: 2344093
• DOI: http://doi.org/10.12671/jkfs.2016.29.3.200

Abstract

Avulsion fracture at the femoral attachment of the anterior cruciate ligament (ACL) is very rare and has been reported mostly in skeletally immature patients. Authors experienced a case of avulsion fracture at the femoral attachment of ACL in a skeletally mature, a 21-year-old male associated with ipsilateral femoral shaft fracture. Here, authors report on the case with a literature review. Care should be taken because an avulsion fracture at the femoral attachment of ACL can be accompanied by ipsilateral femoral shaft fracture in skeletally mature patients.

Keyword

Anterior cruciate ligament; Femoral attachment; Avulsion; Femoral shaft fracture

MeSH Terms

Anterior Cruciate Ligament*
Humans
Male
Young Adult

Figure

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  Fig. 1 Initial femur anteroposterior (A) and lateral (B) image show a right femoral shaft fracture. And initial knee anteroposterior (C) and lateral (D) image without a sign of fracture.

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  Fig. 2 Postoperative anteroposterior (A) and lateral (B) image show a fixed state of fracture with antegrade intramedullary nail.

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  Fig. 3 Axial (A) and coronal (B) image of computed tomography demonstrate a small bony fragment on the medial aspect of the lateral femoral condyle. And coronal (C), sagittal (D), axial (E), and oblique coronal (F) images show avulsion fracture at the femoral attachment of the anterior cruciate ligament (white arrows).

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  Fig. 4 Arthroscopic images show a grossly normal looking anterior cruciate ligament (A) and an intact anterior cruciate ligament with applied tension using probe (B) (black arrows).

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  Fig. 5 Postoperative 6 months femur anteroposterior (A) and lateral (B) image show healed femoral shaft fracture after the internal fixation. And postoperative 6 months knee anteroposterior (C) and lateral (D) image show no abnormal findings.

Reference

1. Bengtson H, Giangarra C. Osteochondral avulsion fracture of the anterior cruciate ligament femoral origin in a 10-year-old child: a case report. J Athl Train. 2011; 46:451–455.

2. Kawate K, Fujisawa Y, Yajima H, Sugimoto K, Tomita Y, Takakura Y. Avulsion of the cartilaginous femoral origin of the anterior cruciate ligament in a three-year-old child. A case report with a thirteen-year follow-up. J Bone Joint Surg Am. 2004; 86:1787–1792.

3. Griffith JF, Antonio GE, Tong CW, Ming CK. Cruciate ligament avulsion fractures. Arthroscopy. 2004; 20:803–812.

4. Song EK, Seon JK, Park SJ, Yoon TR. Clinical outcome of avulsion fracture of the anterior cruciate ligament between children and adults. J Pediatr Orthop B. 2009; 18:335–338.

5. Nagarj R, Bali T, Kumar MN. Avulsion fracture of anterior cruciate ligament from femoral attachment in a skeletally mature patient: a case report. Southeast Asian J Case Rep Rev. 2015; 4:1595–1600.

6. Matthews DE, Geissler WB. Arthroscopic suture fixation of displaced tibial eminence fractures. Arthroscopy. 1994; 10:418–423.

7. Caldas MTL, Malheiros DS, Lazzaroni AP, Avelino EA, Santos AJ. Injury of the knee ligaments associated with ipsilateral femoral shaft fractures. Rev Bras Ortop. 2013; 48:438–440.

8. van Raay JJ, Raaymakers EL, Dupree HW. Knee ligament injuries combined with ipsilateral tibial and femoral diaphyseal fractures: the "floating knee". Arch Orthop Trauma Surg. 1991; 110:75–77.

9. Trickey EL. Rupture of the posterior cruciate ligament of the knee. J Bone Joint Surg Br. 1968; 50:334–341.

10. Blacksin MF, Zurlo JV, Levy AS. Internal derangement of the knee after ipsilateral femoral shaft fracture: MR imaging findings. Skeletal Radiol. 1998; 27:434–439.