Lesser Tuberosity Avulsion Fracture Repair Using Knotless Arthroscopic Fixation

Abstract

Although some literature may suggest that acute nondisplaced lesser tuberosity fractures should undergo nonoperative management, there is a body of evidence that supports surgical stabilization of these injuries due to concern for fracture displacement, nonunion and malunion, anteromedial impingement, and possible biceps tendon subluxation or dislocation. In this Technical Note, we introduce a novel technique for arthroscopic fixation of lesser tuberosity avulsion fractures using a knotless repair. In the lateral decubitus position using standard arthroscopic portals, with the addition of the biceps accessory portal, 2 ULTRATAPE sutures are fixed to the avulsed fragment in luggage-tag fashion to create a secure, knotless fixation. These are used to mobilize and anatomically approximate the lesser tuberosity to the avulsion bed and are held in place with suture anchors placed immediately adjacent to the fracture bed. This technique provides good anatomic reduction with maximal surface area for bone-to-bone healing.

Knotless Arthroscopic Repair of Subscapularis Avulsion Fracture Using a Single Anterior Portal

“…This technique uses previous advancements of knotless technique to create a low profile construct and anchors outside of the fracture site to maximize bone-to-bone healing potential. 16 It goes beyond prior techniques to use only 1 anterior working portal for a more efficient surgical technique and uses the beach chair position ( Table 2 ). The surgery is accomplished through only 2 total portals through a wide rotator interval debridement and use of a 70° camera to visualize the anterior humerus from a posterior portal ( Table 3 ).…”

“… 15 Cregar et al. 16 Barlow et al. Position Beach chair Not specified Lateral Beach chair Knots Mattress stich, single stitch Horizontal mattress Luggage loop, knotless Knotless Anchor position Inside fracture Inside fracture Outside fracture Outside fracture No.…”

“…Cregar et al. 16 previously described a similar all arthroscopic technique. The authors described using primarily a lateral viewing portal along with a subacromial bursectomy.…”

“…Classically, these injuries were managed by open reduction and internal fixation, which has fallen out of favor with the demonstrated success and decreased morbidity of arthroscopic techniques. There are currently 3 all-arthroscopic techniques described by Scheibel et al., 12 Heyworth et al., 15 and Cregar et al., 16 which have built upon one another to achieve maximum fracture healing area and secure fixation. The following technique is a natural advancement of these prior descriptions to achieve secure fixation in a streamlined fashion.…”

Arthroscopic Fixation of Avulsion Fractures of the Lesser Tuberosity of the Humerus: Clinical Outcomes With a Mean 3.5-Year Follow-up

“…10,14,16,18,23 To our knowledge, only 3 studies (technique note and case report) about arthroscopic reduction and fixation for AFLT have been reported. 4,8,19 There is a paucity of information in the literature regarding the outcomes of arthroscopic fixation of AFLT.…”