Avulsion fractures involving the cruciate ligaments

The evaluation of a child with an acute knee injury is difficult. The injury may be an avulsion fracture involving either of the cruciate ligaments; a common cause is a cycling accident. The amount of fragment displacement dictates the management. Minimal displacement can be treated with immobilization in flexion. Larger displacement requires internal fixation, which can be accomplished arthroscopically. Rehabilitation must be early and aggressive.