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The ACL surgery where we do not replace the ACL. Most torn ACLs need a new graft. A tibial spine avulsion fracture is different. In children roughly 8-14 years old, and occasionally in adults, the ligament is stronger than the still-developing bone it anchors into. When the knee twists or hyperextends, the ACL holds and pulls a fragment of bone off the top of the tibia instead. The ligament is intact - the anchor is not. These injuries are graded by displacement. Nondisplaced fractures, and part
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