Simultaneous Anterior Cruciate Ligament Avulsion Fracture with Bilateral Posterior Meniscal Root Tears of the Knee: A...

Anterior cruciate ligament (ACL) avulsion fractures are uncommon injuries in adults and are frequently associated with concomitant intra-articular pathology. Posterior meniscal root tears, particularly of the lateral meniscus, may coexist with ACL injuries; however, simultaneous involvement of both medial and lateral posterior meniscal roots in the setting of an ACL avulsion fracture is exceedingly rare.

A 29-year-old male presented with acute knee pain and swelling following a pivot-shift injury sustained during a low-velocity scooter accident. Radiographs and computed tomography demonstrated a displaced tibial spine avulsion fracture. Diagnostic arthroscopy revealed an ACL avulsion fracture combined with complete posterior root tears of both the medial and lateral menisci. The patient underwent single-stage arthroscopic fixation of the ACL avulsion and simultaneous transtibial pull-out repair of both meniscal roots using independent tibial tunnels. Post-operatively, a structured rehabilitation protocol was followed, resulting in restoration of the knee range of motion and stability.

This case highlights a rare but clinically significant injury pattern that may be overlooked without careful imaging and arthroscopic evaluation. Failure to recognize associated bilateral meniscal root tears in ACL avulsion injuries may result in persistent instability, meniscal extrusion, and early degenerative changes. Simultaneous anatomic repair can restore knee biomechanics and avoid the need for staged procedures. Clinicians managing ACL avulsion fractures should maintain a high index of suspicion for concomitant posterior meniscal root tears. Early diagnosis and single stage anatomic repair may optimize knee stability and functional outcomes in active patients.