Femoral-Sided Avulsion Fracture Treated with a Novel Arthroscopic Physeal-Sparing Method in a Skeletally Immature Patient

Introduction: Femoral-sided avulsion fractures of the anterior cruciate ligament (ACL) are exceedingly rare, particularly in skeletally immature patients. Because only isolated case reports exist, no standardized diagnostic or operative treatment guidelines have been established. Case Report: A 13-year-old girl sustained a femoral-sided ACL avulsion during a skiing accident. Initial radiographs suggested a tibial eminence fracture, but computed tomography (CT) confirmed a femoral-sided avulsion. Magnetic resource imaging was not performed, as CT is the standard first-line imaging modality in Denmark for suspected osteochondral avulsion injuries and provided sufficient anatomical detail for surgical planning. Sixteen days post-injury, arthroscopic fixation was performed using a physeal-sparing technique. At 6-month follow-up with a private practitioner, the patient demonstrated a full symmetric range of motion and negative Lachman and pivot shift tests; however, no radiographic imaging was obtained. Conclusion: Arthroscopic physeal-sparing fixation enabled stable anatomical reduction and bone-to-bone healing while minimizing the risk of growth disturbance in this skeletally immature patient.