Chotel et al identified findings associated with fracture of the cartilaginous tibial eminence in a young child. These can help to identify a child who may require surgery to refix the avulsed fragment. The authors are from Lyon University Hospital for Mother and Children and Universite Clause Bernard in France.


In a young child with open physes a purely cartilaginous avulsion of the tibial ACL insertion can occur.


Clinical features of a patient with a fracture of the cartilaginous tibial eminence:

(1) The patient is <= 9 years old.

(2) The patient has a history of knee trauma. This may be a low-energy injury and may be sport or play related.

(3) The patient has an effusion of the knee joint.


An X-ray at the time of injury is typically normal and an MRI looking for ACL injuries is often negative.


Diagnosis is made on MRI studies, which may have to be repeated on follow-up:

(1) A "double PCL" sign may be seen on MRI.

(2) An epiphyseal fluid sign can be seen on T2 images


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