Arthroscopic fixation of anterior cruciate ligament tibial avulsion fractures using bioabsorbable suture anchors

In, Yong; Kim, Jung-Man; Woo, Young Kyun; Choi, Nag-Choul; Moon, Chan-Woong; Kim, Minwoo

doi:10.1007/s00167-007-0466-x

Cited by 40 publications

(43 citation statements)

References 21 publications

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“…In et al 6 described the arthroscopic suture anchor technique with good results. They used 3 or 4 suture anchors to hold the bony fragments at the edge of the ACL avulsion fragment.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] Although screw fixation has strong purchasing power and can be generally applied to a large fracture fragment, the possible disadvantages of screw fixation are the possible breakage of fracture fragment, the impingement of a screw head during knee extension, and the requirement for a secondary procedure for screw removal. 4 In et al 7 studied ACL fixation strength.…”

Section: Discussionmentioning

confidence: 99%

“…Although several fixation methods, such as the percutaneous K-wire fixation, screw fixation, and retrograde pullout sutures, are available, no single treatment can be applied to all fracture types. [1][2][3][4][5][6] The anterior impingement on terminal knee extension and, later, the operation for implant removal were the main drawbacks of the use of a metal screw and staple. Suture anchors and screw fixations have some limitations especially in small fragments or skeletally immature patients.…”

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confidence: 99%

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Arthroscopic Hybrid Fixation of a Tibial Eminence Fracture in Children

Kim

Kwon²,

Seo³

et al. 2013

Arthroscopy Techniques

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Abstract:The treatment of an anterior cruciate ligament (ACL) avulsion fracture is controversial, especially in skeletally immature patients, because of concerns about physeal damage. To reduce the risk of physeal injury, an arthroscopic technique was performed. A bioabsorbable suture anchor was inserted through anteromedial portals and fixed to a bioabsorbable suture anchor at the center of the fracture bed; it was then passed through the threads at the ACL avulsion fragment and tied with the ACL substance. After this, the avulsion fragment was repaired by an all-inside technique between the distal portion of the ACL and the transverse ligament and periosteum by a suture hook. The arthroscopic hybrid technique using a suture anchor with an all-inside repair is more rigid and safe. In addition, this physeal-sparing fixation is possible in immature patients.A nterior cruciate ligament (ACL) substance injuries are uncommon in the skeletally immature population because the strength of the ligament is greater than that of the bone and growth plate. [1][2][3] This results in more avulsion fractures in this age group than ACL ligament injuries (Fig 1A). Although several fixation methods, such as the percutaneous K-wire fixation, screw fixation, and retrograde pullout sutures, are available, no single treatment can be applied to all fracture types.1-6 The anterior impingement on terminal knee extension and, later, the operation for implant removal were the main drawbacks of the use of a metal screw and staple. Suture anchors and screw fixations have some limitations especially in small fragments or skeletally immature patients. 4 We introduce a new and effective hybrid fixation of a bioabsorbable suture anchor and an all-inside repair technique in tibial eminence fractures in skeletally immature patients, which we believe provides a more anatomic and rigid fixation (Video 1). Surgical TechniqueKnee arthroscopy was performed with an anterolateral and anteromedial (AM) portal, along with a midpatellar (MP) portal that was used for the arthroscope. After hematoma lavage, arthroscopic examination of all knee compartments was performed. The anterior and transverse horns of the menisci were probed and retracted, if they were interposed, for anatomic fracture reduction. Any clot or fibrous tissue was debrided from the fracture site. A suture hook (ConMed, Largo, FL) loaded with a shuttle relay was introduced through the AM portal; it then pierced the medial side of the ACL fibers, and the fragment was avulsed. The shuttle relay was advanced out through the hook, and the end was brought out to the MP portal (Fig 2A). The suture hook loaded with a shuttle relay was introduced again through the AM portal; by use of the same method, the suture hook pierced the lateral side of the ACL avulsion fragment, and then the end was brought out to the MP portal (Fig 2B). A 3-mm bioabsorbable suture anchor loaded with 2 strands of No. 2 FiberWire (Arthrex, Naples, FL) was placed at the center of the fracture bed from the AM portal with a 45...

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“…In et al 6 described the arthroscopic suture anchor technique with good results. They used 3 or 4 suture anchors to hold the bony fragments at the edge of the ACL avulsion fragment.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Arthroscopic Hybrid Fixation of a Tibial Eminence Fracture in Children

Kim

Kwon²,

Seo³

et al. 2013

Arthroscopy Techniques

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“…2,3,7,8 Most of the ACL tibial avulsion fractures are just a sliver of bone being held together by the fibres of the ACL. The fracture bed is of poor bone quality due to the fracture.…”

Section: Displaced Acl Tibial Avulsion Fractures (Meyers Andmentioning

confidence: 99%

“…9 There is risk of screws backing out into the joint, posterior neurovascular injury, extension block by the screw head or washer during the postoperative period and need for hardware removal after 8 to 10 weeks. 4,8 Use of single or multiple staples have the same disadvantage as that of screws and they are placed in the fractured bone bed which has poor hold for implants. Sundararajan et al reported backing out of a staple in one out of twenty two patients in their study.…”

Section: Displaced Acl Tibial Avulsion Fractures (Meyers Andmentioning

confidence: 99%

Arthroscopic fixation of anterior cruciate ligament tibial avulsion fractures: the suture “bridge” pull out technique and evaluation of results

et al. 2017

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INTRODUCTIONTibial anterior cruciate ligament (ACL) avulsion fractures are a common injury in children and adolescents. In adults they account for 1% to 5% of ACL injuries.1 They are caused by a hyperextension injury of the knee or by a direct force over the distal femur with the knee in flexion. Meyers and McKeever have classified these injuries depending on the amount of displacement of the ACL tibial fragment as follows: type 1-minimal or undisplaced fracture fragment; type 2-elevation of only the anterior half of the fragment; type 3-complete displacement of the ABSTRACT Background: Tibial anterior cruciate ligament (ACL) avulsion fractures are a common injury in children and adolescents. Operative treatment is indicated for type 2, 3 and 4 fractures. Arthroscopic fixation is the preferred method and numerous fixation options are described. The purpose of this study is to evaluate the results of a new technique of arthroscopic fixation. Methods: A retrospective study was done involving twelve patients having displaced ACL tibial avulsion fractures. The arthroscopic suture "bridge" pull out technique was used to fix these fractures. Patient symptoms like knee pain, locking, clicking, sensation of giving way and clinical signs like tenderness, range of motion, Mc Murray's test, stability test and Lysholm knee scores were evaluated pre operatively and post operatively at 3 months and 6 months. Patient satisfaction was noted at latest follow up. Results: One patient had type 2, 7 patients had type 3 and 4 patients had type 4 tibial ACL avulsion fractures. All the fractures united and all patients achieved full knee range of motion by 2 months post-operative. The clinical symptoms and signs improved post operatively. The mean Lysholm knee score at 3 months follow up was 88.8 and at 6 months follow up were 98.8. At latest follow up, all the patients were satisfied with their knee function. Conclusions: The arthroscopic suture "bridge" pull out technique is an effective method for fixation of ACL tibial avulsion fractures with respect to knee stability, range of motion and resumption of pre injury activity level.

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