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

In, Yong; Kwak, Dai-Soon; Moon, Chan-Woong; Han, Seung‐Ho; Choi, Nag-Choul

doi:10.1007/s00167-011-1694-7

Cited by 15 publications

(13 citation statements)

References 43 publications

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“…4 There was no difference in the proportion of men with revision ACL reconstruction regardless of whether it was a primary revision or multiple revision. These results are similar to the proportion of men (57%) undergoing primary ACL reconstruction as reported by the Multicenter Orthopaedic Outcomes Network (MOON) 5,10 and those undergoing revision ACL reconstruction in a recent meta-analysis (66%). 22 The high proportion of primary and revision ACL reconstructions among men has not been clearly addressed in the literature.…”

Section: Discussionsupporting

confidence: 83%

Differences in Mechanisms of Failure, Intraoperative Findings, and Surgical Characteristics Between Single- and Multiple-Revision ACL Reconstructions

et al. 2013

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Background The factors that lead to patients failing multiple anterior cruciate ligament (ACL) reconstructions are not well understood. Hypothesis Multiple-revision ACL reconstruction will have different characteristics than first-time revision in terms of previous and current graft selection, mode of failure, chondral/meniscal injuries, and surgical charactieristics. Study Design Case-control study; Level of evidence, 3. Methods A prospective multicenter ACL revision database was utilized for the time period from March 2006 to June 2011. Patients were divided into those who underwent a single-revision ACL reconstruction and those who underwent multiple-revision ACL reconstructions. The primary outcome variable was Marx activity level. Primary data analyses between the groups included a comparison of graft type, perceived mechanism of failure, associated injury (meniscus, ligament, and cartilage), reconstruction type, and tunnel position. Data were compared by analysis of variance with a post hoc Tukey test. Results A total of 1200 patients (58% men; median age, 26 years) were enrolled, with 1049 (87%) patients having a primary revision and 151 (13%) patients having a second or subsequent revision. Marx activity levels were significantly higher (9.77) in the primary-revision group than in those patients with multiple revisions (6.74). The most common cause of reruptures was a traumatic, noncontact ACL graft injury in 55% of primary-revision patients; 25% of patients had a nontraumatic, gradual-onset recurrent injury, and 11% had a traumatic, contact injury. In the multiple-revision group, a nontraumatic, gradual-onset injury was the most common cause of recurrence (47%), followed by traumatic noncontact (35%) and nontraumatic sudden onset (11%) (P < .01 between groups). Chondral injuries in the medial compartment were significantly more common in the multiple-revision group than in the single-revision group, as were chondral injuries in the patellofemoral compartment. Conclusion Patients with multiple-revision ACL reconstructions had lower activity levels, were more likely to have chondral injuries in the medial and patellofemoral compartments, and had a high rate of a nontraumatic, recurrent injury of their graft.

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Section: Discussionsupporting

confidence: 83%

Differences in Mechanisms of Failure, Intraoperative Findings, and Surgical Characteristics Between Single- and Multiple-Revision ACL Reconstructions

et al. 2013

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“…To the best of our knowledge, this is the first study presenting the biomechanical properties of the TightRope® fixation system in ACL avulsion fractures. Other authors have focused on the biomechanical properties of different suture anchors [12,13], screw fixations [11], suture techniques and materials [11][12][13][14] or fixation devices such as the EndoButton® [12].…”

Section: Discussionmentioning

confidence: 99%

“…A variety of testing protocols for simulated tibial avulsion fractures have been published recently. In et al [13] applied a series of ten cycles between 0 and 30 N and a strain rate of 200 mm/min in human cadaver knees with an average age around 60 years. Hapa et al [12] applied a series of 500 cycles between 0 and 100 N with a strain rate of 100 mm/min in ovine knees and Mahar et al [14] applied 200 cycles between 0 and 150 N with a strain rate of 0.5 mm/s in porcine knees.…”

Section: Discussionmentioning

confidence: 99%

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

Ezechieli

Schäfer

Dratzidis

et al. 2013

International Orthopaedics (SICOT)

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“…Steel wires offer poor toughness and non-elastic xation; hence, breakage can occur easily during knee exion and extension. 9,10 Kirschner wire xation causes minimal damage, but it does not offer su cient holding power, which can easily lead to the loosening or detachment of internal xation, thereby resulting in fracture re-displacement and affecting the function of the affected limb. 11 Currently, the most commonly used method in clinical settings is the technique of using cannulated screws, which generally involves utilizing two screws to x the fractured bone.…”

Section: E Cacy Evaluationmentioning

confidence: 99%

Treatment of Anterior Cruciate Ligament Tibial Avulsion Fracture in Children with Suture Anchor Fixation Outside The Tunnel: A Retrospective study

Chen

Xiao

Wang

2020

Preprint

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Background: Anterior cruciate ligament (ACL) tibial avulsion fractures are a special ACL injury type, classified as intra-articular fractures. Presently, the main treatment method is arthroscopic surgery, and various fixation methods are available, including use of steel wires, high-strength sutures, cannulated screws, anchors, Kirschner wires, etc. Joint fixation using wire binding could cut through the bone tunnel. We aimed to evaluate the clinical efficacy of a novel method involving suture anchor fixation outside the tunnel to treat anterior cruciate ligament (ACL) tibial avulsion fractures in children.Methods: This retrospective study analyzed the data of 42 pediatric patients (26 boys and 16 girls; age: 7–13 years) with ACL tibial avulsion fractures. Based on the Meyers–McKeever–Zaricznyj classification of fractures, 22, 14, and 6 patients had types II, III, and IV fractures, respectively. All patients underwent arthroscopic surgery for ACL tibial avulsion fracture; during surgery, double tibial tunnels were established, and high-strength sutures were passed through the tunnels and fixed externally with an anchor. The clinical outcome was evaluated by assessing the pre- and post-operative knee joint range of motion (ROM) and by using the Lysholm knee function score and International Knee Documentation Committee (IKDC) score. Post-operative computed tomography and magnetic resonance images were reviewed to determine the status of fracture displacement, healing, and epiphyseal damage.Results: All 42 patients were followed up for 20–36 months (average of 27.8 months). Knee ROM increased from 48.2°±21.7° pre-operatively to 131.6°±8.7° at the final follow-up (t=23.119, P=0.000). The Lysholm knee function score increased from 37.6±5.2 points pre-operatively to 90.1±6.3 points post-operatively, representing a significant improvement (t=41.651, P=0.000). The IKDC score improved from 43.3±7.5 points pre-operatively to 91.3±5.7 points post-operatively (t=45.521, P=0.000). The imaging findings indicated that the fractures healed with displacement and there was no significant epiphyseal damage.Conclusions: Suture anchor fixation outside the tunnel to treat ACL tibial avulsion fracture in children reduces the cutting action of the sutures on the tunnel, minimizes epiphyseal damage, involves a simple procedure, offers firm fixation, and effectively improves knee function. This approach can enable early functional rehabilitation and achieve satisfactory clinical efficacy.

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

Cited by 15 publications

References 43 publications

Differences in Mechanisms of Failure, Intraoperative Findings, and Surgical Characteristics Between Single- and Multiple-Revision ACL Reconstructions

Differences in Mechanisms of Failure, Intraoperative Findings, and Surgical Characteristics Between Single- and Multiple-Revision ACL Reconstructions

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

Treatment of Anterior Cruciate Ligament Tibial Avulsion Fracture in Children with Suture Anchor Fixation Outside The Tunnel: A Retrospective study

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