Subintermeniscal Ligament Pullout Suture Technique for Anterior Cruciate Ligament Avulsion Fracture Fixation—AIIMS Technique

Abstract

Many methods have been described, including pullout suture technique, for arthroscopic fixation of displaced tibial eminence fracture. We are describing our technique of pullout suture, which is a modification of previously described techniques. We passed two sutures arthroscopically through anterior cruciate ligament (ACL) just above the avulsed fragment and then pulled them out through medial and lateral bone tunnel in anterior aspect of crater in tibial plateau. The third suture passed through ACL was pulled out anteriorly under the transverse intermeniscal ligament through a submeniscal route. All sutures were tied under tension to a screw post placed on the anterior tibia after reducing the avulsed bone fragment. Our technique provides good reduction and even overreduction of the fragment. It also provides good initial fixation strength to work against displacing forces even in small and comminuted bony fragment. This is helpful for achieving adequate stability of knee, complete extension of knee, early rehabilitation, and quicker recovery.

Functional Outcomes and Subsequent Surgical Procedures After Arthroscopic Suture Versus Screw Fixation for ACL Tibial Avulsion Fractures: A Systematic Review and Meta-analysis

“…Despite variations in fixation methods, both high-strength sutures and suture buttons are popular implant choices. 1,8,15,21,24 The findings of the current study also supported the use of suture fixation for tibial avulsion fractures. We believe that there will be a trend toward developing fixation techniques using suture-related fixation methods in the future.…”

“…Several newly proposed techniques for tibial avulsion fracture have been developed recently. 1,8,15,21,24 It is worth noting that these newly developed methods were all suture-related fixation techniques. Despite variations in fixation methods, both high-strength sutures and suture buttons are popular implant choices.…”

Arthroscopic fixation techniques for tibial eminence fractures in pediatric patients: a review

“…In this study, two in five adolescents were found to have an affected limb that was 10 mm longer than the healthy side at final follow-up. Because pull-out sutures are easier, many other authors have taken this approach and obtained good results, with some authors knotting the sutures pulled out of the tibial tunnel at the tunnel opening outside the joint ( 20 , 21 ), or fixing them outside the joint with partially threaded cancellous bone screws (6.5 mm) ( 22 ), or by knotting the suture after passing it through a 3-hole titanium plate ( 23 ). In general, the more sutures with tibial tunnels, the better the fracture reduction, particularly in those fragmented fractures.…”