Arthroscopic Avulsion Repair of a Pediatric ACL with an Anomalous Primary Insertion into the Lateral Meniscus

Jason O. Toy, BA
School of Medicine, Case Western Reserve University

Brian T. Feeley, MD
Department of Orthopedic Surgery, Hospital for Special Surgery
Department of Orthopaedic Surgery, University of California

Lawrence V. Gulotta, MD
Lawrence V. Gulotta, MD
Assistant Attending Orthopaedic Surgeon, Hospital for Special Surgery
Assistant Professor of Orthopaedic Surgery, Weill Cornell Medical College
Russell F. Warren, MD
Russell F. Warren, MD
Attending Orthopaedic Surgeon, Hospital for Special Surgery
Surgeon-in-Chief Emeritus, Hospital for Special Surgery
Professor of Orthopaedic Surgery, Weill Cornell Medical College


Injury to the anterior cruciate ligament (ACL) in the pediatric population is becoming more common, with the majority of ruptures occurring at the tibial insertion site. However, to our knowledge, there are no reports of avulsion in which the primary ACL insertion site is the anterior lateral meniscal root.

We report a rare case of a pediatric ACL/anterior horn of the lateral meniscus avulsion, which was successfully repaired arthroscopically.


In this patient, neither a mid-substance tear, nor a tibial eminence fracture was noted. Instead, the patient avulsed the tibial insertion of the ACL from its small footprint, which included an extensive attachment to the lateral meniscus.


We believe this developmental anomaly may provide further support of the shared embryological origin between the ACL and menisci. In this case report, we review the literature on anterior cruciate ligament injury and repair in the pediatric population.

This article appears in HSS Journal: Volume 7, Number 2.
View the full article at

About the HSS Journal
HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.

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