Arthroscopic Transpatellar Cannulated Screw Fixation of Tibia Eminence Fractures in the Adult

Wang, Kook Hyun; Oh, Hyoung Keun; Yoo, Si Hoon; Chae, Dong Ju; Nam, Hyok Woo; Nha, Kyung Wook

doi:10.3928/01477447-20110124-16

Cited by 8 publications

(5 citation statements)

References 11 publications

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“…In an arthroscopic transpatellar screw fixation technique, a 7.0-mm bone tunnel is created in the patella under fluoroscopic guidance in the lateral view to enable a good visual field. 12 Nonetheless, making a large tunnel in the patella is invasive and risks patellar fracture. A proximal superomedial portal technique has been developed to visualise and treat the plica, medial and lateral gutters, and anterior compartment of the knee.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Fixation with EndoButton for Tibial Eminence Fractures Visualised through a Proximal Superomedial Portal: A Surgical Technique

Sekiya

Takatoku

Kimura

et al. 2016

J Orthop Surg (Hong Kong)

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Most tibial eminence fractures are avulsion fractures of the anterior cruciate ligament (ACL) from its tibial insertion. This study describes a new arthroscopic technique using an additional proximal superomedial portal to visualise the tibial eminence fracture and to fix the fracture with the EndoButton to avoid the risk of fragment breakage. The proximal superomedial portal enables fracture reduction without damage to the intermeniscal ligament. Fixation with the EndoButton is strong enough to allow early rehabilitation with vigorous exercise. All 5 patients achieved bone union; no young patient had growth disturbance of the tibia; all knees were stable with excellent range of motion and negative Lachman and pivot shift tests and no flexion contracture. Arthroscopic fixation with the EndoButton visualised through the proximal superomedial portal is a safe, simple, and secure method for treating tibial eminence fractures, particularly in children with small fragments.

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Section: Discussionmentioning

confidence: 99%

Arthroscopic Fixation with EndoButton for Tibial Eminence Fractures Visualised through a Proximal Superomedial Portal: A Surgical Technique

Sekiya

Takatoku

Kimura

et al. 2016

J Orthop Surg (Hong Kong)

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“…[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. Their biomechanical study suggested that the initial fixation strength of the suture anchor fixation for an ACL tibial avulsion fracture was not less than that of a screw fixation or pullout suture fixation.…”

Section: Discussionmentioning

confidence: 99%

“…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). …”

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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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“…The tibial eminence avulsion fracture has a higher incidence (3/100,000) in skeletally immature patients because the intercondylar eminence which is not fully calcified can be exposed to injuries more frequently than the ACL itsel f [1]. Because displaced fractures may cause nonunion or malunion as well as loss of knee extension or instability, types II, III, and IV are indicated for surgical intervention [2] Obviously, these modalities clearly differ from the treatment of an adult ACL injury, which is treated universally with reconstruction of the ligament as the surgical option [3] Prior studies [4][5][6][7] have demonstrated many fixation methods of the fragments of avulsion of tibial eminence, including metal hollow screws, utilizing Kirschner wires, cerclage wires, interosseus sutures, washer screws placed through the fragment, and screws and bone anchors inserted retrogradely.…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic tri-pulley Technology reduction and internal fixation of pediatric Tibial Eminence fracture: a retrospective analysis

Zhang

Jiang

et al. 2020

BMC Musculoskelet Disord

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Background Fixing a tibial eminence fracture with a tri-pulley is a new technique. The purpose of this study was to present the early clinical outcome of arthroscopic tri-pulley suture fixation for tibial eminence fractures in children. Methods Twenty-one pediatric patients with type II or type III anterior tibial eminence fractures were included in this retrospective study. All Patients underwent surgical fixation by tri-pulley technology and were followed up for at least 24 months. They were evaluated preoperatively and postoperatively by physical, X-ray, and computed tomography (CT) examination and subjectively with the International Knee Documentation Committee (IKDC), and Lysholm questionnaires. Results The patients included 12 males and 9 females; mean age, 12.5 years (range, 8 ~ 16 years). They were followed-up for a median of 27 months (range, 24 ~ 39 months). We did not find post-operative instability in any of the patients by physical examination. The KT-2000 difference of both knees decreased from 9.3 ± 1.2 mm preoperatively to 2.6 ± 0.8 mm 24 months postoperatively (P < 0.001); the IKDC subjective knee evaluation score improved from 43.1 ± 13.2 preoperatively to 83.8 ± 6.3 postoperatively (P < 0.001); and Lysholm improved from 48.3 ± 6.21 to 87.1 ± 9.8 (P < 0.001). No unhealed fractures or epiphyseal damage were reported in the postoperative X-ray and CT. Conclusions Arthroscopic tri-pulley fixation technology may provide a suitable technique for repair of tibial eminence fractures in skeletally immature patients. Level of evidence Case series; Level of evidence IV.

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Arthroscopic Transpatellar Cannulated Screw Fixation of Tibia Eminence Fractures in the Adult

Cited by 8 publications

References 11 publications

Arthroscopic Fixation with EndoButton for Tibial Eminence Fractures Visualised through a Proximal Superomedial Portal: A Surgical Technique

Arthroscopic Fixation with EndoButton for Tibial Eminence Fractures Visualised through a Proximal Superomedial Portal: A Surgical Technique

Arthroscopic Hybrid Fixation of a Tibial Eminence Fracture in Children

Arthroscopic tri-pulley Technology reduction and internal fixation of pediatric Tibial Eminence fracture: a retrospective analysis

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