Defining the boundaries of surgery in pediatric ACL avulsion fractures: A Case Report in a 5-Year-Old Child

Anterior cruciate ligament (ACL) avulsion fracture is an uncommon injury in the pediatric population, typically involving a bony avulsion at the tibial insertion of the ligament. Diagnosis is usually established on plain radiographs, particularly in the lateral view, and further characterized by magnetic resonance imaging (MRI). Treatment may be conservative or surgical, depending on the degree of displacement and rotation of the bony fragment according to the Meyers and McKeever (MM) classification, as well as the presence of associated soft-tissue injuries. However, the optimal management of Type II fractures remains debated, making individual case reports valuable to guide clinical decision-making. We report the case of a five-year-old child with a Type II MM ACL avulsion fracture managed successfully with conservative treatment. The patient was immobilized in extension with a long leg cast for 30 days, and follow-up imaging demonstrated complete healing without complications. At two-year follow-up, clinical examination confirmed full recovery with a stable knee and no residual laxity. This case emphasizes that, in the absence of concomitant intra-articular lesions on MRI, conservative management can represent a safe and effective option for Type II ACL avulsion fractures in very young patients.