Pull-out technique with footprint rivet repair of femoral-sided avulsion fracture of the anterior cruciate ligament: A case report

In children, most of the avulsion fractures of the anterior cruciate ligament occur at the tibial eminence. However, femoral-sided avulsion fracture of the anterior cruciate ligament is a very rare disease. Methods to manage such injuries remain unestablished. We have presented here the case of a 10-year-old boy with a femoral-sided avulsion fracture of the anterior cruciate ligament. X-ray and computed tomography scans revealed a free fragment in the knee cavity. Magnetic resonance imaging revealed the anterior cruciate ligament of the left knee with a dislocated fragment. With the assistance of arthroscopy, we performed a pull-out technique combined with a Footprint rivet to fix the fragment and anterior cruciate ligament in their original position. After 3 weeks of postoperative immobilization, the cast was removed. Then, the brace was fixed in the subsequent 2 months. Meanwhile, the patient was started on rehabilitation exercises under the guidance of a rehabilitation physician. After 14 months of follow-up, no deformity, laxity of the knee, or limitations of motion was recorded in this child. Femoral-side avulsion fracture of the anterior cruciate ligament is a rare injury. Pull-out repair with Footprint rivet under arthroscopy could successfully achieve bone union and a good anterior cruciate ligament function. In addition, this approach reduced the risk of thread cut.