Arthroscopically assisted reduction and internal fixation of a femoral anterior cruciate ligament osteochondral avulsion fracture in a 14-year-old girl via transphyseal inside-out technique

Abstract

Femoral avulsion fracture of the anterior cruciate ligament (ACL) in children and adolescents is rare, and its arthroscopic treatment is even more so. A femoral avulsion fracture of the ACL of a 14-year-old girl was arthroscopically reduced and fixed by a Kirschner wire (K-wire) via an inside-out technique. A 1.4-mm K-wire was drilled inside-out into the osseous defect of the lateral femoral condyle under arthroscopic visualization. The avulsed fragment was reduced and then drilled retrograde by the wire. After bending the intra-articular visible end of the K-wire by a knot pusher, the fragment was gently fixed by pulling the wire from outside. At 24 months, both knee stability and range of motion were the same in the operated and the healthy opposite leg. Magnetic resonance imaging evaluation and conventional radiographs showed an intact ACL without detectable disturbance in the growth plate. Only seven cases of a proximal avulsion of the ACL in children and adolescents have been published. Six were treated by open reduction and internal fixation, one by arthroscopic reduction without fixation.

Fig. 1

Anteroposterior (a) and lateral (b) view of the left knee with a femoral osteochondral avulsion fracture of the ACL (black arrow)

Fig. 2

Arthroscopic visualization of the 1.4-mm K-wire (a), drilled inside-out into the center of the osseous defect of the lateral femoral condyle. Schematic of surgical technique (b)

Fig. 3

Knot pusher and 1.4-mm K-wire (a). Bending technique of the K-wire (b, c)

Fig. 4

Postoperative anteroposterior radiograph of the left knee with the K-wire, distal end bent (a). Arthroscopic view with reduced femoral avulsion fragment fixated by the K-wire (b). Schematic of surgical technique (c)

Fig. 5

Anteroposterior radiograph of the left knee (a), sagittal MRI (b), and coronal MRI (c) at 24-month follow-up with intact ACL and without detectable disturbance of the growth plate of the distal femur