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Avulsion fractures of the tibial intercondylar eminence have been well described and classified. 2,3 Most commonly, they are seen in children and adolescents.1,4 These fractures are typically the result of bicycle accidents and have a good prognosis when recognized and treated appropriately by closed or open methods.4~5 5 Most authors recommend an open approach to displaced Type III fractures of the intercondylar eminence. This injury is uncommon in adults; however, it can be expected to do well with early appropriate treatment. The ACL insufficiency associated with this injury necessitates prompt recognition and treatment for a stable knee.We report here the natural history, in an adult male, of a Type III intercondylar eminence fracture that went unrecognized and untreated for 2 years, but was still able to be successfully corrected surgically. CASE REPORTA 29-year-old male suffered a twisting injury to his knee while skiing in March 1982. The patient heard his knee snap, and experienced an immediate and painful effusion. The knee was initially splinted at the mountain where he was skiing.Thereafter, he was treated by his physician with cast immobilization and crutches for 2 weeks. The question of a possible avulsion fracture of the tibial spine was raised on radiographic evaluation at that time, but it was not pursued.The patient began to suffer symptoms of giving way, with recurring effusions. Arthrography 6 months after the injury revealed a medial meniscal tear. No treatment was rendered at that time.The patient continued to live with his symptoms until 2 years after the initial injury, when a fall from a roof resulted in a locked knee. This brought him to the senior author's attention (DMD). Arthroscopic evaluation was recommended. Preoperative radiographs revealed the presence of what appeared to be a loose body in the intercondylar notch ( Fig. 1).On arthroscopy, a posterior horizontal cleavage tear of the medial meniscus was recognized and excised. The ACL was present, but it appeared to be shortened and redundant. A bony block was present in the intercondylar area. Postoperatively, these findings were explained to the patient, and reconstruction of the ACL was planned.Two weeks later, the patient underwent arthrotomy. The ACL was noted to be intact, yet lax, although still within its synovial sleeve. It remained attached to the previously fractured tibial spine, which was avulsed into the intercondylar notch. This represented the osseous fragment that had been noted within the knee joint on preoperative radiographs. The synovial sleeve of the ligament was not opened. The bed where the osteochondral fracture had originated was curetted back to bleeding bone. The osseous surface of the osteochondral fragment was debrided of scar tissue.Three no. 2 Mersilene sutures were passed through drill holes in the osteochondral fragment, and then through drill holes in the proximal tibia. The osteochondral fragment was then reapproximated into this original bed. The ACL was restored to its normal tension and the kn...

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