Managing Tibial Eminence Fractures with ACL Involvement in Skeletally Immature Children

Corey Steinman*, George Matar*, William Duggan*, Kyle Coombes*, Kristena Abdelmalak*, Jonathan Kwok*

* American University of the Caribbean School of Medicine

An 11-year-old boy presents to the clinic with a 3-hour history of right knee pain following a fall while skating. He suffered a twisting injury to his knee as his leg internally rotated during a trip and fall over a curb. Following the fall, his right knee became erythematous, swollen, and painful, limiting his range of motion and ability to walk. Physical examination of the right knee confirmed this, as he had difficulty ambulating on the right limb. Neurovascularly, the young boy’s right lower limb was intact, sensation present, and no signs of an open fracture were noted as the overlying skin was not disrupted. The young boy’s history is unremarkable, and his only complaint is his right knee pain. He was diagnosed with a right tibial eminence fracture, Type III according to the McKeever classification, confirmed radiographically. An arthroscopic reduction and suture fixation of the right knee was recommended and performed. Prior to his operative treatment, the right knee was aspirated to remove the hematoma and decompress the joint. Following the procedure, the young boy was placed in a cast with 20 degrees of flexion for 6 weeks. Once radiographs were satisfactory, conservative treatment such as physical therapy was recommended to restore his range of motion. After three months, he was cleared to return to sports without restrictions. A fracture of this nature can be problematic given its attachment point to the anterior cruciate ligament (ACL). Complications such as ligamentous laxity, decreased range of motion, and possible growth plate involvement given this patient’s age, highlights the importance of treatment management in this case.

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