title: Cruciate ligament avulsion fractures: anatomy, biomechanics, injury patterns, and approach to management.
abstract: Injury to the ACL or PCL of the knee most commonly involves a tear of the collagenous fibers of the ligament. Less frequently, a cruciate ligament injury involves an avulsion fracture at the origin or insertion of the ligament, usually from the insertion site on the tibial surface. Avulsion fractures of the cruciate ligaments are important, as they can be identified on radiographs, allowing a specific diagnosis. Although more common in children, when they occur in adults, they are more commonly associated with other injuries. The treatment of cruciate ligament avulsion fractures is different than the treatment of intrasubstance tears of the cruciate ligaments. These injuries can be treated conservatively or surgically with good outcomes. Recently arthroscopic fixation of these injuries with various fixation devices has become more frequent. Treatment largely depends on the type of fracture, particularly, the size, displacement, comminution, and orientation of the avulsed fracture fragment, in addition to the integrity of the attached cruciate ligament. This review article covers the anatomy and biomechanics of the cruciate ligaments, their injury patterns, and approach to management.
authors.affiliation: Department of Radiology, 1500 San Pablo Street, Second Floor Imaging, Los Angeles, CA, 90033, USA, ericwhiteusc@gmail.com.
authors.forename: Eric A
authors.initials: EA
authors.lastname: White
authors.forename: Dakshesh B
authors.initials: DB
authors.lastname: Patel
authors.forename: George R
authors.initials: GR
authors.lastname: Matcuk
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Forrester
authors.forename: Ryan B
authors.initials: RB
authors.lastname: Lundquist
authors.forename: George F Rick
authors.initials: GF
authors.lastname: Hatch
authors.forename: C Thomas
authors.initials: CT
authors.lastname: Vangsness
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Gottsegen
mesh_terms: D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy; D001696:Biomechanical Phenomena; D003952:Diagnostic Imaging; D005592:Fracture Fixation / Q000379:methods*; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D016119:Posterior Cruciate Ligament / Q000293:injuries*; D013978:Tibial Fractures / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*