PMC4921169_01
47-year-old woman with femoral osseous avulsion of the origin of the anterior cruciate ligament. Frontal (A) and oblique (B) radiographs of the knee demonstrate a small, crescentic, ossific fragment (arrows) adjacent to the medial cortex of the lateral femoral condyle at the expected location of the anterior cruciate ligament origin.
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47-year-old woman with femoral osseous avulsion of the origin of the anterior cruciate ligament. Axial (A), coronal (B), and sagittal (C) noncontrast CT imaging with bone and soft-tissue algorithm of the knee demonstrates the avulsed osseous fragment (arrow) and the anterior cruciate ligament (open and curved arrow) arising from the fragment.
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A small avulsed fracture fragment was again noted immediately adjacent to the medial cortex of the lateral femoral condyle, with associated cortical irregularity of the adjacent femur and a grossly intact-appearing anterior cruciate ligament (ACL) attached to the minimally displaced fragment (Fig. 2).
47-year-old woman with femoral osseous avulsion of the origin of the anterior cruciate ligament. Axial proton density (A), coronal proton density (B), coronal STIR (C), sagittal proton density (D), and sagittal STIR (E) magnetic resonance images of the knee demonstrate the avulsed osseous fragment arising from the medial cortex of the femur (straight arrows) and the attached and intact anterior cruciate ligament (curved arrows).
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Notably, the ACL was intact (Fig. 3).
47-year-old woman with femoral osseous avulsion of the origin of the anterior cruciate ligament. Intra-operative image (A) demonstrates a gap separating the irregular contour of the lateral femoral condyle (open arrow) and the detached anterior cruciate ligament (asterisk), which is attached to the avulsed osseous fragment (closed arrow) prior to repair. Intra-operative image (B) demonstrates a screw (open arrow) fixing the previously avulsed anterior cruciate ligament (asterisk) to the lateral femoral condyle.
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Arthroscopy confirmed osseous femoral avulsion of the ACL origin, with an otherwise intact ACL (Fig. 4).
47-year-old woman with femoral osseous avulsion of the origin of the anterior cruciate ligament. Posteroanterior (A) and anteroposterior (B) post-operative radiographs of the knee demonstrate extensive hardware for repair of fractures and soft-tissue injuries involving the femur, tibia, and fibula. A single partially threaded screw with washer (arrows) fixes the previously avulsed anterior cruciate ligament at its femoral origin.
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The fracture fragment was reduced provisionally with a Kirschner wire and ultimately fixed with a 4-mm cancellous screw and washer (Fig. 5).