Tag Archive for: ACL avulsion fracture with tear; Paediatric sports injury; ACL reconstruction; Concomitant ACl avulsion and tear.

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,

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


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.


1. Lafosse L, Boyle S, Kordasiewicz B, Aranberri-Gutiérrez M, Fritsch B, Meller R. Arthroscopic arthrolysis for recalcitrant frozen shoulder: a lateral approach. Arthroscopy. 2012 Jul;28(7):916-23.
2. Neviaser JS. Adhesive capsulitis of the shoulder. J Bone Joint Surg Am. 1945;27:211–22.
3. Tasto JP, Elias DW.Adhesive Capsulitis. Sports Med Arthrosc Rev. 2007;15:216–21.
4. Le Lievre HMJ, Murrell GAC. Long-Term Outcomes After Arthroscopic Capsular Release for Idiopathic Adhesive Capsulitis. J Bone Joint Surg Am. 2012;94:1208-16.
5. Fernandes MR. Arthroscopic treatment of adhesive capsulitis of the shoulder with minimum follow up of six years. Acta Ortop Bras. 2015;23(2):85-9.
6. Redler LH, Dennis ER. Treatment of Adhesive Capsulitis of the Shoulder. J Am Acad Orthop Surg. 2019;27: e544-e554.
7. Berghs BM, Sole-Molins X, Bunker TD. Arthroscopic release of adhesive capsulitis. Journal of shoulder and elbow surgery.2004;13(2):180-5.
8. Cvetanovich GL, Leroux T, Hamamoto JT, Higgins JD, Romeo AA, Verma NN. Arthroscopic 360◦ Capsular Release for Adhesive Capsulitis in the Lateral Decubitus Position. Arthrosc Tech. 2016;5(5):e1033-e1038.
9. Barnes CP, Lam PH, Murrell GAC. Short-term outcomes after arthroscopic capsular release for adhesive capsulitis. J shoulder and elbow surgery; 2016 Sep;25(9):e256-264.
10. Mukherjee RN, Pandey RM, Nag HL, Mittal R. Frozen shoulder – A prospective randomized clinical trial. World J Orthop. 2017; 8(5): 394-9.
11. Gallacher S, Beazley JC, Evans J et al. A randomized controlled trial of arthroscopic capsular release versus hydrodilatation in the treatment of primary frozen shoulder. J Shoulder Elbow Surg. 2018 Aug;27(8):1401-6.
12. Walther M, Blanke F, Wehren LV, Majewski M. Frozen Shoulder – Comparison of different surgical treatment options. Acta Orthop. Belg. 2014;80:172-7.
13. De Carli A, Vadalà A, Perugia D et al. Shoulder adhesive capsulitis: manipulation and arthroscopic arthrolysis or intra-articular steroid injections. International Orthopaedics (SICOT). 2012;36:101–6.
14. Rill BK, Fleckenstein CM, Levy MS, Nagesh V, Hasan SS. Predictors of outcome after nonoperative and operative treatment of adhesive capsulitis. Am J Sports Med. 2011 Mar;39(3):567-74.
15. Massoud SN, Pearse EO, Levy O, Copeland SA. Operative management of the frozen shoulder in patients with diabetes. J Shoulder Elbow Surg. 2002;11(6):609-13.
16. Tsai MJ, Ho WP, Chen CH, Leu TH, Chuang TY. Arthroscopic extended rotator interval release for treating refractory adhesive capsulitis: A viewpoint of “mobilizing subscapularis.” Journal of Orthopaedic Surgery. 2017;25(1);1-7.
17. Mubark IM, Ragab AH, Nagi AA, Motawea BA. Evaluation of the results of management of frozen shoulder using the arthroscopic capsular release. Ortop Traumatol Rehabil. 2015;17(1):21-8.
18. Waszczykowski M, Polguj M, Fabiś J. The impact of arthroscopic capsular release in patients with primary frozen shoulder on shoulder muscular strength. Biomed Res Int. 2014;2014:834283.
19. Smith CD, Hamer P, Bunker TD. Arthroscopic capsular release for idiopathic frozen shoulder with intra-articular injection and a controlled manipulation. Ann R Coll Surg Engl. 2014;96(1):55-60.
20. Dattani R, Ramasamy V, Parker R, Patel VR. Improvement in quality of life after arthroscopic capsular release for contracture of the shoulder. Bone Joint J. 2013 Jul;95-B(7):942-6.
21. Baums MH, Spahn G, Nozaki M, Steckel H, Schultz W, Klinger HM. Functional outcome and general health status in patients after arthroscopic release in adhesive capsulitis. Knee Surg Sports Traumatol Arthrosc. 2007;15(5):638–44.
22. Klinger HM, Otte S, Baums MH, Haerer T Early arthroscopic release in refractory shoulder stiffness. Arch Orthop Trauma Surg. 2002;122:200–3.
23. Ranalletta M, Rossi LA, Zaidenberg EE et al. Midterm Outcomes After Arthroscopic Anteroinferior Capsular Release for the Treatment of Idiopathic Adhesive Capsulitis. The Journal of Arthroscopic and Related Surgery. 2017;33(3):503-8.
24. Puah KL, Salieh MS, Yeo W, Tan AHC. Outcomes of arthroscopic capsular release for the diabetic frozen shoulder in Asian patients. J Orthop Surg (Hong Kong). 2018;26(1):1-4.
25. Jerosch J. 360 degrees arthroscopic capsular release in patients with adhesive capsulitis of the glenohumeral joint–indication, surgical technique, results. Knee Surg Sports Traumatol Arthrosc. 2001;9(3):178-86.
26. Uno A, Bain G, Mehta J. Arthroscopic relationship of the axillary nerve to the shoulder joint capsule: An anatomic study.J Shoulder Elbow Surg 1999; 8: 226-30.

How to Cite this article: Swamy A, Shevate I, Nathani G, Khandalkar Y | Anterior Tibial Spine Avulsion Fracture With Concomitant Tibial Side Anterior Cruciate Ligament Tear in an Adolescent Male: A Case Report | Asian Journal of Arthroscopy | September-December 2020; 5(2): 13-16.

(Abstract)      (Text HTML)      (Download PDF)