A simple, modified arthroscopic suture fixation of avulsion fracture of the tibial intercondylar eminence in children

Abstract

The purpose of this study was to describe a simple and modified technique for arthroscopic suture fixation in a 12-year-old boy who sustained a displaced type III intercondylar eminence of the tibial. The arthroscopic fixation was modified by using the Arthrex suture lasso device to place two nonabsorbable sutures into the anterior cruciate ligament (ACL). However, the procedure became simple with the help of the Acufex ACL guide to reduce the avulsed tibial spine fragment and to place an appropriate tibial tunnel. Sutures were then passed through the tibial tunnel and secured over a bony bridge with the knee at 20° of flexion. At 6 months, the patient had a full range of motion with normal Lachman and anterior drawer testing, and he had returned to his daily activities. Radiographs showed complete fracture healing. Repair using the Arthrex suture lasso device provides a significant advantage in the treatment of type III and IV fractures of the tibial eminence by obtaining arthroscopic fixation with the substance of the ACL, thus eliminating the risks of comminution of the fracture fragment and hardware removal. This arthroscopic technique restores the length and integrity of the ACL, and provides a simplified, reproducible method of treatment for this injury.

Treatment of Posterior Cruciate Ligament Injuries in Pediatric and Adolescent Patients

“…Similar to the evolution of treatment of ACL avulsion injuries in children involving tibial spine fractures, for which some authors have begun to favor suture fixation over screw fixation, suture-based repairs of PCL avulsion injuries may more easily avoid issues with permanent hardware causing impingement, imposition of rigid forces by hardware on physeal growth, or a required additional future procedure, in the form of removal of implants, which creates cost and risk for the patient. [39][40][41] However, because of the rarity of PCL injuries, no studies have compared these techniques directly.…”

Biomechanical comparison of three techniques for fixation of tibial avulsion fractures of the anterior cruciate ligament

“…Although many successful arthroscopic reduction and internal fixation (ARIF) techniques using a variety of fixation methods have been described in the literature, fixation is most commonly achieved with pull-out sutures or with screws [2,8,12,13,16,17,19,27,28,31,36,44]. However, the screw fixation and the pull-out suture fixation with nonabsorbable sutures have several limitations [7,14,21,42,44,45].…”

Physeal fractures about the knee

“…An ACL guide can assist with reduction of the fragment, and to drill one or two 2 mm holes, similar to an ACL tunnel. The sutures can be pulled out the tibia through the transosseous tunnels and tied over a button or bony bridge, respectively [45].…”