Kindliche kniegelenknahe Avulsionen

Background

Avulsion fractures around the knee in children and adolescents are rare injuries and usually occur during sport activities. This article describes the epidemiology, classification and current treatment strategies for these injuries.

Objective

This article gives an overview of the epidemiology, classification and current treatment concepts of pediatric avulsion fractures around the knee.

Results

The most frequent pediatric avulsion fractures around the knee affect the tibial tuberosity and both the anterior and posterior cruciate ligaments. Bony avulsion of the cruciate ligaments can be classified according to Meyers and McKeever. In many cases there are indications for surgical treatment but non-dislocated fractures can be conservatively treated. Apophyseal fractures of the tibial tuberosity are as a rule repositioned by an open procedure followed by fixation with screws. The options for surgical treatment of bony avulsion of the cruciate ligaments are manifold, ranging from direct open screw fixation to bone anchoring and arthroscopic repositioning with suture cerclage. The advantages of arthroscopic procedures are the possibility to simultaneously treat unilateral accompanying injuries, such as meniscus ruptures.

Conclusion

Non-dislocated pediatric avulsion injuries near the knee can be treated conservatively under regular clinical and radiological follow-up control. Dislocated avulsions and non-dislocated avulsions with accompanying injuries are surgically treated. Arthroscopic procedures should be a standard procedure with respect to bony avulsion of the anterior cruciate ligament. In contrast, bony avulsion of the posterior cruciate ligament and injuries of the tibial tuberosity must be addressed rapidly and effectively with direct open repositioning.