title: Rare ACL enthesis tears treated by suture in children. A report of 14 cases after a mean 15 years follow-up.
abstract: ACL enthesis tears are rare in children and there are very few reports in the literature. Characterized by avulsion of the ligament that tears off a very thin piece of cartilage or a bone fragment at the ACL epiphyseal insertion site, we hypothesize that conservative treatment by suture could reduce the number of patients requiring later ligament reconstruction.
  
  
  
  Fourteen patients underwent surgery between 1986 and 2014 and were included in this retrospective study. Patients were selected according to the following criteria: suture failure requiring ligament reconstruction, reoperation-free survival for secondary injury and the subjective and objective IKDC scores by comparative laximetry.
  
  
  
  After almost 15 years of mean follow-up, reoperation-free survival was approximately 85%. Three patients required one or more additional surgeries; one for suture failure requiring 2 additional ligament reconstructions, one for a meniscal tear with a mechanical block requiring partial meniscectomy and one patient with secondary pain requiring arthroscopic surgery that was inconclusive.
  
  
  
  Rare and often misdiagnosed, ACL enthesis tears in children can be treated by suture with satisfactory results. Careful analysis of plain films and an X-ray centered on the intercondylar notch often provide the diagnosis. In case of doubt, MRI, which is now more accessible, can prevent missing this entity. Improved standard surgical techniques and careful patient selection could make conservative treatment an option once again while avoiding the risks associated with ligament reconstruction technique.
  
  
  
  4.
authors.affiliation: Service de chirurgie orthopédique et traumatologie, CHU de Nantes, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France. Electronic address: xavierpierremarc@gmail.com.
authors.forename: P-M
authors.initials: PM
authors.lastname: Xavier
authors.affiliation: Service de chirurgie orthopédique et traumatologie pédiatrique, PRES centre Val-de-Loire université, université François-Rabelais de Tours, CHRU de Tours, 49, boulevard Béranger, 37044 Tours, France.
authors.forename: J
authors.initials: J
authors.lastname: Fournier
authors.affiliation: Service de chirurgie orthopédique et traumatologie pédiatrique, PRES centre Val-de-Loire université, université François-Rabelais de Tours, CHRU de Tours, 49, boulevard Béranger, 37044 Tours, France.
authors.forename: B
authors.initials: B
authors.lastname: de Courtivron
authors.affiliation: Service de chirurgie orthopédique et traumatologie pédiatrique, PRES centre Val-de-Loire université, université François-Rabelais de Tours, CHRU de Tours, 49, boulevard Béranger, 37044 Tours, France.
authors.forename: F
authors.initials: F
authors.lastname: Bergerault
authors.affiliation: Service de chirurgie orthopédique et traumatologie pédiatrique, PRES centre Val-de-Loire université, université François-Rabelais de Tours, CHRU de Tours, 49, boulevard Béranger, 37044 Tours, France.
authors.forename: C
authors.initials: C
authors.lastname: Bonnard
mesh_terms: D020341:Absorbable Implants; D000293:Adolescent; D000070598:Anterior Cruciate Ligament Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D002648:Child; D004838:Epiphyses / Q000293:injuries* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D013537:Sutures
keywords: Anterior cruciate ligament; Avulsion; Enthesis; Intercondylar eminence; Paediatric