Extract
Rupture of the anterior cruciate ligament is rarely seen in children
because the ligament is stronger than the physes during childhood, meaning
that trauma to the knee will more likely result in a physeal
fracture1-3.
DeLee and Curtis, in 1983, reported only three cases of midsubstance rupture
of the anterior cruciate ligament in their study of 388 knee ligament injuries
in children4.
Although some recent studies have demonstrated an increasing prevalence of
midsubstance rupture of the anterior cruciate ligament in children and
adolescents, most of those ruptures occurred during puberty or
adolescence5-7.
Conversely, osteochondral avulsion fractures of the tibial origin of the
anterior cruciate ligament in children are relatively
common8-11.
Injuries that stress the anterior cruciate ligament most often result in an
osteochondral avulsion fracture of the tibial eminence. Although there have
been many studies of osteochondral avulsion fracture of the tibial eminence in
children, only four cases of osteochondral avulsion fracture of the femoral
origin of the anterior cruciate ligament have been
reported12-15.
It is also known that cartilaginous avulsion fractures of the tibial eminence
can occur but are very
rare16,17.
Furthermore, a review of the orthopaedic literature revealed only one report
of an isolated cartilaginous avulsion fracture of the femoral
origin18. That
fracture occurred in a three-year-old boy, but the duration of follow-up was
only ten weeks. Therefore, we are aware of no reports regarding the long-term
effects of cartilaginous avulsion fractures of the femoral origin of the
anterior cruciate ligament. It is known that residual anterior laxity occurs
after an osteochondral fracture of the tibial
eminence19-21.
Growth disturbance is also a concern. Mylle et al. reported on the premature
closure of the anterior half of the proximal physis of the tibia after
transepiphyseal fixation of an osteochondral fracture of the tibial
eminence22.