Anterior Tibial Spine Avulsion Fracture With Concomitant Tibial Side Anterior Cruciate Ligament Tear in an Adolescent Male: A Case Report

Volume 5 | Issue 2 | September-December 2020 | Page 13-16 | Ajit Swamy, Ishan Shevate, Girish Nathani, Yogesh Khandalkar

Author: Ajit Swamy [1], Ishan Shevate [1], Girish Nathani [1], Yogesh Khandalkar [1]

[1] Department of Orthopaedics, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra,
India.

Address of Correspondence:
Dr. Ishan Shevate,
Assistant Professor, Department of Orthopaedics, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India.
E-mail: ishanshevate@gmail.com

Abstract

Introduction: Tibial spine avulsion fractures are common in children and adolescents. Tibial spine avulsion fracture along with an Anterior cruciate ligament(ACL) tear are rarely reported in paediatric age group. We present a case of an adolescent child with avulsion of the anterior tibial spine with a complete tear of antero-medial bundle and near-total tear of a postero-lateral bundle.
Case Report: An adolescent male child presented with twisting injury to right knee while playing football. Local examination revealed positive patellar tap, Lachman test and anterior drawer test were grade 2 positive. Radiographs showed type 3 tibial spine avulsion fracture. Magnetic Resonance Imaging(MRI) and arthroscopy confirmed the diagnosis of avulsion with complete ACL tear. We decided to do transphyseal ACL reconstruction using hamstring autograft and excision of the avulsed fragment. Post operatively physiotherapy and weight bearing were started as per pain tolerance. Patient achieved full range of motion and returned to pre injury activity and sports 1 year post operatively.
Discussion: After reviewing the literature we found that anterior tibial spine fractures along with ACL tear are most uncommon reported in paediatric age group. In nearly 30-60% cases of displaced tibial eminence fracture, concomitant injury either to the meniscus, ligaments or the articular cartilage were diagnosed on MRI. Reported literature shows no difference in percentage of growth abnormalities in transphyseal verses physeal sparing techniques.
Conclusion: A thorough preoperative evaluation with radiographs and MRI is important to detect these injuries and planning the treatment accordingly. Primary ACL reconstruction gives good results in these cases.
Keywords: ACL avulsion fracture with tear; Paediatric sports injury; ACL reconstruction; Concomitant ACl avulsion and tear.

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