Rare ACL enthesis tears treated by suture in children. A report of 14 cases after a mean 15 years follow-up

IntroductionACL enthesis tears are rare in children and there are very few reports in the literature. Characterized by avulsion of the ligament that tears off a very thin piece of cartilage or a bone fragment at the ACL epiphyseal insertion site, we hypothesize that conservative treatment by suture could reduce the number of patients requiring later ligament reconstruction.Materials and methodsFourteen patients underwent surgery between 1986 and 2014 and were included in this retrospective study. Patients were selected according to the following criteria: suture failure requiring ligament reconstruction, reoperation-free survival for secondary injury and the subjective and objective IKDC scores by comparative laximetry.ResultsAfter almost 15 years of mean follow-up, reoperation-free survival was approximately 85%. Three patients required one or more additional surgeries; one for suture failure requiring 2 additional ligament reconstructions, one for a meniscal tear with a mechanical block requiring partial meniscectomy and one patient with secondary pain requiring arthroscopic surgery that was inconclusive.DiscussionRare and often misdiagnosed, ACL enthesis tears in children can be treated by suture with satisfactory results. Careful analysis of plain films and an X-ray centered on the intercondylar notch often provide the diagnosis. In case of doubt, MRI, which is now more accessible, can prevent missing this entity. Improved standard surgical techniques and careful patient selection could make conservative treatment an option once again while avoiding the risks associated with ligament reconstruction technique.Level of evidence4.