Early effectiveness of arthroscopic three-point suture technique in treatment of anterior cruciate ligament tibial eminence avulsion fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Wenhuai , FANG Kaibin , LIN Sanfu , WU Guozhong ,  CHEN Shoubo

Department of Orthopedics, the Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000, P.R.China;

Corresponding author：

CHEN Shoubo, Email: 12275105@qq.com

Keywords：

Anterior cruciate ligament; tibial insertion; avulsion fracture; arthroscopy; suture fixation

DOI：

10.7507/1002-1892.201902007

Video：

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Objective To investigate the early effectiveness of three-point suture technique in treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture by arthroscopy. Methods Between January 2016 and December 2017, 12 patients with ACL tibial eminence avulsion fractures underwent arthroscopic fixation of avulsion fractures with Ethibon suture using three-point suture technique. There were 9 males and 3 females, with an average of 36.4 years (range, 18-50 years). The fracture caused by traffic accident in 10 cases and sports in 2 cases. Among them, 1 patient was old fracture and 11 was fresh fracture. According to the modified Meyers-McKeever classification criteria, the fractures were rated as type Ⅲ in 7 cases and type Ⅳ in 5 cases. There were 2 cases of medial collateral ligament injury and medial meniscus injury. The preoperative International Knee Documentation Committee (IKDC) score was 37.9±4.7 and Lysholm score was 46.0±3.7. Results All operations completed smoothly. The operation time was 45-70 minutes (mean, 61.3 minutes). The incisions healed by first intention in all patients. The hospitalization stays ranged from 4 to 9 days (mean, 5 days). All patients were followed up 3-20 months (mean, 9.3 months). The anterior drawer test, Lachman test, and axis shift test in all patients were negative after operation. At last follow-up, the IKDC score was 89.7±2.5 and Lysholm score was 90.2±1.9, which were significantly higher than those before operation (t=–30.94, P=0.00; t=–33.03, P=0.00). At last follow-up, the X-ray films showed 9 cases of fracture anatomical reduction and 3 cases of almost anatomical reduction, and 12 cases of fracture healing. Conclusion For ACL tibial eminence avulsion fracture, arthroscopic three-point suture technique can effectively restore the stability of knee joint and obtain satisfactory early effectiveness.

Citation： WANG Wenhuai, FANG Kaibin, LIN Sanfu, WU Guozhong, CHEN Shoubo. Early effectiveness of arthroscopic three-point suture technique in treatment of anterior cruciate ligament tibial eminence avulsion fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(7): 860-864. doi: 10.7507/1002-1892.201902007 Copy

1.	Zaricznyj B. Avulsion fracture of the tibial eminence: treatment by open reduction and pinning. J Bone Joint Surg (Am), 1977, 59(8): 1111-1114.
2.	姚俊娜, 王洪刚, 权松涛, 等. 关节镜下缝合线桥内固定技术治疗青少年前交叉韧带胫骨止点撕脱骨折. 中国修复重建外科杂志, 2018, 32(11): 1402-1405.
3.	刘俊才, 岳永川, 李忠. 关节镜下双头加压空心螺钉固定治疗青少年前交叉韧带胫骨止点撕脱骨折. 中国修复重建外科杂志, 2018, 32(9): 1172-1176.
4.	Ebrahimzadeh MH, Makhmalbaf H, Golhasani-Keshtan F, et al. The International Knee Documentation Committee (IKDC) Subjective Short Form: a validity and reliability study. Knee Surgery Sports Traumatol Arthrosc, 2015, 23(11): 3163-3167.
5.	Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med, 1982, 10(3): 150-154.
6.	Zacharias I, Hull ML, Howell SM. Static and fatigue strength of a fixation device transducer for measuring anterior cruciate ligament graft tension. J Biomech Eng, 2000, 122(6): 600-603.
7.	Lansdown D, Ma CB. The influence of tibial and femoral bone morphology on knee kinematics in the anterior cruciate ligament injured knee. Clin Sports Med, 2018, 37(1): 127-136.
8.	韩亮, 黄长明, 范华强, 等. 前交叉韧带胫骨髁间棘撕脱骨折三种内固定生物力学研究. 中国骨与关节损伤杂志, 2012, 27(10): 893-895.
9.	Tsukada H, Ishibashi Y, Tsuda E. A biomechanical comparison of repair techniques for anterior cruciate ligament tibial avulsion fracture under cyclic loading. Arthroscopy, 2005, 21(10): 1197-1201.
10.	王琪, 李众利, 刘玉杰, 等. 关节镜下带线可吸收双锚钉治疗胫骨髁间嵴撕脱骨折. 中国修复重建外科杂志, 2011, 25(2): 220-224.
11.	Binnet MS, Gürkan I, Yilmaz C, et al. Arthroscopic fixation of intercondylar eminence fractures using a 4-portal technique. Arthroscopy, 2001, 17(5): 450-460.
12.	Ahn JH, Yoo JC. Clinical outcome of arthroscopic reduction and suture for displaced acute and chronic tibial spine fractures. Knee Surg Sports Traumatol Arthrosc, 2005, 13(2): 116-121.
13.	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.
14.	Koukoulias NE, Germanou E, Lola D, et al. Clinical outcome of arthroscopic suture fixation for tibial eminence fractures in adults. Arthroscopy, 2012, 28(10): 1472-1480.
15.	Jang KM, Bae JH, Kim JG, et al. Novel arthroscopic fixation method for anterior cruciate ligament tibial avulsion fracture with accompanying detachment of the anterior horn of the lateral meniscus: three-point suture fixation. Injury, 2013, 44(8): 1028-1032.
16.	刘阳, 孙学斌, 张克远, 等. 关节镜治疗骨骺未闭青少年前交叉韧带撕脱骨折的疗效观察. 中国修复重建外科杂志, 2015, 29(6): 725-729.
17.	陆振飞, 赵金忠, 皇甫小桥. 关节镜下跨骺板 8 字缝线固定法治疗前交叉韧带胫骨止点撕脱骨折后的随访研究. 中华小儿外科杂志, 2007, 28(12): 639-643.

1. Zaricznyj B. Avulsion fracture of the tibial eminence: treatment by open reduction and pinning. J Bone Joint Surg (Am), 1977, 59(8): 1111-1114.
2. 姚俊娜, 王洪刚, 权松涛, 等. 关节镜下缝合线桥内固定技术治疗青少年前交叉韧带胫骨止点撕脱骨折. 中国修复重建外科杂志, 2018, 32(11): 1402-1405.
3. 刘俊才, 岳永川, 李忠. 关节镜下双头加压空心螺钉固定治疗青少年前交叉韧带胫骨止点撕脱骨折. 中国修复重建外科杂志, 2018, 32(9): 1172-1176.
4. Ebrahimzadeh MH, Makhmalbaf H, Golhasani-Keshtan F, et al. The International Knee Documentation Committee (IKDC) Subjective Short Form: a validity and reliability study. Knee Surgery Sports Traumatol Arthrosc, 2015, 23(11): 3163-3167.
5. Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med, 1982, 10(3): 150-154.
6. Zacharias I, Hull ML, Howell SM. Static and fatigue strength of a fixation device transducer for measuring anterior cruciate ligament graft tension. J Biomech Eng, 2000, 122(6): 600-603.
7. Lansdown D, Ma CB. The influence of tibial and femoral bone morphology on knee kinematics in the anterior cruciate ligament injured knee. Clin Sports Med, 2018, 37(1): 127-136.
8. 韩亮, 黄长明, 范华强, 等. 前交叉韧带胫骨髁间棘撕脱骨折三种内固定生物力学研究. 中国骨与关节损伤杂志, 2012, 27(10): 893-895.
9. Tsukada H, Ishibashi Y, Tsuda E. A biomechanical comparison of repair techniques for anterior cruciate ligament tibial avulsion fracture under cyclic loading. Arthroscopy, 2005, 21(10): 1197-1201.
10. 王琪, 李众利, 刘玉杰, 等. 关节镜下带线可吸收双锚钉治疗胫骨髁间嵴撕脱骨折. 中国修复重建外科杂志, 2011, 25(2): 220-224.
11. Binnet MS, Gürkan I, Yilmaz C, et al. Arthroscopic fixation of intercondylar eminence fractures using a 4-portal technique. Arthroscopy, 2001, 17(5): 450-460.
12. Ahn JH, Yoo JC. Clinical outcome of arthroscopic reduction and suture for displaced acute and chronic tibial spine fractures. Knee Surg Sports Traumatol Arthrosc, 2005, 13(2): 116-121.
13. 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.
14. Koukoulias NE, Germanou E, Lola D, et al. Clinical outcome of arthroscopic suture fixation for tibial eminence fractures in adults. Arthroscopy, 2012, 28(10): 1472-1480.
15. Jang KM, Bae JH, Kim JG, et al. Novel arthroscopic fixation method for anterior cruciate ligament tibial avulsion fracture with accompanying detachment of the anterior horn of the lateral meniscus: three-point suture fixation. Injury, 2013, 44(8): 1028-1032.
16. 刘阳, 孙学斌, 张克远, 等. 关节镜治疗骨骺未闭青少年前交叉韧带撕脱骨折的疗效观察. 中国修复重建外科杂志, 2015, 29(6): 725-729.
17. 陆振飞, 赵金忠, 皇甫小桥. 关节镜下跨骺板 8 字缝线固定法治疗前交叉韧带胫骨止点撕脱骨折后的随访研究. 中华小儿外科杂志, 2007, 28(12): 639-643.

Chinese Journal of Reparative and Reconstructive Surgery

Early effectiveness of arthroscopic three-point suture technique in treatment of anterior cruciate ligament tibial eminence avulsion fracture

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