EFFECTIVENESS OF ARTHROSCOPIC ULTRA-Braid SUTURE PLANE FIXATION FOR ANTERIOR CRUCIATE LIGAMENT TIBIAL EMINENCE AVULSION FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANGJing , WENGXiaoJun , LIJing , CHENXintong

Department of Joint Surgery, Orthopaedic Center, Hunan Provincial People's Hospital, Changsha Hunan, 410005, P. R. China;

Corresponding author：

WANGJing, Email: wangj0405@163.com

Keywords：

Anterior cruciate ligament; Tibial eminence avulsion fracture; Arthroscopy; Suture; Internal fixation

DOI：

10.7507/1002-1892.20150292

Video：

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Objective To investigate the surgical technique and effectiveness of arthroscopic ULTRA-Braid suture plane fixation for anterior cruciate ligament (ACL) tibial eminence avulsion fractures. Methods Between June 2012 and October 2014, 16 cases of ACL tibial eminence avulsion fracture were treated with ULTRA-Braid suture plane fixation under arthroscopy. There were 10 males and 6 females, aged from 17 to 38 years (mean, 25.8 years). The left knee was involved in 5 cases and the right knee in 11 cases. The causes were traffic accident injury in 9 cases, falling from height injury in 4 cases, and sports injury in 3 cases. The average interval from injury to operation was 7 days (range, 5-10 days) except 1 patient who received operation at 6 weeks after injury. The knee joint swelling was obvious; the result of Lachman test was positive; and the knee joint Lysholm score was 45.38±9.87. According to classification standard introduced by Meyers-McKeever-Zaricznyj, 7 cases were rated as type Ⅱ, 8 cases as type Ⅲ, and 1 case as type Ⅳ, excluding ligament and meniscus injury. Results All the incisions healed by first intention. The patients received follow-up of 6-18 months (mean, 10 months). The postoperative X-ray and CT showed anatomic reduction (12 cases) or near anatomic reduction (4 cases); all fractures healed at 6 months after operation. The result of Lachman test was negative in the other 15 patients except 1 patient (Ⅱ degree). One patient had slight knee pain at 6 months postoperatively, and pain symptom disappeared after 1 year; the other cases resumed daily activities. Lysholm score at last follow-up was 98.13±2.34, showing significant difference when compared with preoperative score (t=-20.801, P=0.000). Conclusion Arthroscopic ULTRA-Braid suture plane fixation for ACL tibial eminence avulsion fractures is an effective procedure with the advantages of minimal trauma, reliable fixation, satisfactory functional recovery, and simultaneously avoiding the second surgery.

Citation： WANGJing, WENGXiaoJun, LIJing, CHENXintong. EFFECTIVENESS OF ARTHROSCOPIC ULTRA-Braid SUTURE PLANE FIXATION FOR ANTERIOR CRUCIATE LIGAMENT TIBIAL EMINENCE AVULSION FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(11): 1353-1357. doi: 10.7507/1002-1892.20150292 Copy

1.	Accousti WK, Willis RB. Tibial eminence fractures. Orthop Clin North Am, 2003, 34(3):365-375.
2.	Salehoun R, Pardisnia N. Rehabilitation of tibial eminence fracture. J Can Chiropr Assoc, 2007, 51(2):99-105.
3.	Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg (Am), 1970, 52(8):1677-1684.
4.	Zaricznyj B. Avulsion fracture of the tibial eminence:treatment by open reduction and pinning. J Bone Joint Surg (Am), 1977, 59(8):1111-1114.
5.	Lu XW, Hu XP, Jin C, et al. Reduction and fixation of the avulsion fracture of the tibial eminence using mini-open technique. Knee Surg Sports Traumatol Arthrosc, 2010, 18(11):1476-1480.
6.	Sang W, Zhu L, Ma J, et al. A comparative study of two methods for treating type Ⅲ tibial eminence avulsion fracture in adults. Knee Surg Sports Traumatol Arthrosc, 2012, 20(8):1560-1564.
7.	Anderson CN, Nyman JS, McCullough KA, et al. Biomechanical evaluation of physeal-sparing fixation methods in tibial eminence fractures. Am J Sports Med, 2013, 41(7):1586-1594.
8.	Hunter RE, Willis JA. Arthroscopic fixation of avulsion fractures of the tibial eminence:technique and outcome. Arthroscopy, 2004, 20(2):113-121.
9.	Tsukada H, Ishibashi Y, Tsuda E, et al. A biomechanical comparison of repair techniques for anterior cruciate ligament tibial avulsion fracture under cyclic loading. Arthroscopy, 2005, 21(10):1197-1201.
10.	Mahar AT, Duncan D, Oka R, et al. Biomechanical comparison of four different fixation techniques for pediatric tibial eminence avulsion fractures. J Pediatr Orthop, 2008, 28(2):159-162.
11.	Verdano MA, Pellegrini A, Lunini E, et al. Arthroscopic absorbable suture fixation for tibial spine fractures. Arthrosc Tech, 2013, 3(1):e45-48.
12.	Patel NM, Park MJ, Sampson NR, et al. Tibial eminence fractures in children:earlier posttreatment mobilization results in improved outcomes. J Pediatr Orthop, 2012, 32(2):139-144.
13.	Senekovic V, Veselko M. Anterograde arthroscopic fixation of avulsion fractures of the tibial eminence with a cannulated screw:five-year results. Arthroscopy, 2003, 19(1):54-61.
14.	Bong MR, Romero A, Kubiak E, et al. Suture versus screw fixation of displaced tibial eminence fractures:a biomechanical comparison. Arthroscopy, 2005, 21(10):1172-1176.
15.	Huang TW, Hsu KY, Cheng CY, et al. Arthroscopic suture fixation of tibial eminence avulsion fractures. Arthroscopy, 2008, 24(11):1232-1238.
16.	Lafrance RM, Giordano B, Goldblatt J, et al. Pediatric tibial eminence fractures:evaluation and management. J Am Acad Orthop Surg, 2010, 18(7):395-405.
17.	赵金忠, 蒋垚, 沈灏, 等. 关节镜下8字法缝线固定治疗成人胫骨髁间隆突骨折. 中国修复重建外科杂志, 2003, 17(3):205-208.
18.	Boutsiadis A, Karataglis D, Agathangelidis F, et al. Arthroscopic 4-point suture fixation of anterior cruciate ligament tibial avulsion fractures. Arthrosc Tech, 2014, 3(6):e683-687.
19.	Nelson EW, LaPrade RF. The anterior intermeniscal ligament of the knee. An anatomic study. Am J Sports Med, 2000, 28(1):74-76.

1. Accousti WK, Willis RB. Tibial eminence fractures. Orthop Clin North Am, 2003, 34(3):365-375.
2. Salehoun R, Pardisnia N. Rehabilitation of tibial eminence fracture. J Can Chiropr Assoc, 2007, 51(2):99-105.
3. Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg (Am), 1970, 52(8):1677-1684.
4. Zaricznyj B. Avulsion fracture of the tibial eminence:treatment by open reduction and pinning. J Bone Joint Surg (Am), 1977, 59(8):1111-1114.
5. Lu XW, Hu XP, Jin C, et al. Reduction and fixation of the avulsion fracture of the tibial eminence using mini-open technique. Knee Surg Sports Traumatol Arthrosc, 2010, 18(11):1476-1480.
6. Sang W, Zhu L, Ma J, et al. A comparative study of two methods for treating type Ⅲ tibial eminence avulsion fracture in adults. Knee Surg Sports Traumatol Arthrosc, 2012, 20(8):1560-1564.
7. Anderson CN, Nyman JS, McCullough KA, et al. Biomechanical evaluation of physeal-sparing fixation methods in tibial eminence fractures. Am J Sports Med, 2013, 41(7):1586-1594.
8. Hunter RE, Willis JA. Arthroscopic fixation of avulsion fractures of the tibial eminence:technique and outcome. Arthroscopy, 2004, 20(2):113-121.
9. Tsukada H, Ishibashi Y, Tsuda E, et al. A biomechanical comparison of repair techniques for anterior cruciate ligament tibial avulsion fracture under cyclic loading. Arthroscopy, 2005, 21(10):1197-1201.
10. Mahar AT, Duncan D, Oka R, et al. Biomechanical comparison of four different fixation techniques for pediatric tibial eminence avulsion fractures. J Pediatr Orthop, 2008, 28(2):159-162.
11. Verdano MA, Pellegrini A, Lunini E, et al. Arthroscopic absorbable suture fixation for tibial spine fractures. Arthrosc Tech, 2013, 3(1):e45-48.
12. Patel NM, Park MJ, Sampson NR, et al. Tibial eminence fractures in children:earlier posttreatment mobilization results in improved outcomes. J Pediatr Orthop, 2012, 32(2):139-144.
13. Senekovic V, Veselko M. Anterograde arthroscopic fixation of avulsion fractures of the tibial eminence with a cannulated screw:five-year results. Arthroscopy, 2003, 19(1):54-61.
14. Bong MR, Romero A, Kubiak E, et al. Suture versus screw fixation of displaced tibial eminence fractures:a biomechanical comparison. Arthroscopy, 2005, 21(10):1172-1176.
15. Huang TW, Hsu KY, Cheng CY, et al. Arthroscopic suture fixation of tibial eminence avulsion fractures. Arthroscopy, 2008, 24(11):1232-1238.
16. Lafrance RM, Giordano B, Goldblatt J, et al. Pediatric tibial eminence fractures:evaluation and management. J Am Acad Orthop Surg, 2010, 18(7):395-405.
17. 赵金忠, 蒋垚, 沈灏, 等. 关节镜下8字法缝线固定治疗成人胫骨髁间隆突骨折. 中国修复重建外科杂志, 2003, 17(3):205-208.
18. Boutsiadis A, Karataglis D, Agathangelidis F, et al. Arthroscopic 4-point suture fixation of anterior cruciate ligament tibial avulsion fractures. Arthrosc Tech, 2014, 3(6):e683-687.
19. Nelson EW, LaPrade RF. The anterior intermeniscal ligament of the knee. An anatomic study. Am J Sports Med, 2000, 28(1):74-76.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF ARTHROSCOPIC ULTRA-Braid SUTURE PLANE FIXATION FOR ANTERIOR CRUCIATE LIGAMENT TIBIAL EMINENCE AVULSION FRACTURES

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