Arthroscopic suture fixation of tibial eminence avulsion fractures.

Abstract

PURPOSE:

This study presents the clinical results of a procedure for treating tibial eminence fractures of the anterior cruciate ligament (ACL) using arthroscopic reduction and No. 5 Ethibond sutures (Ethicon, Somerville, NJ).

METHODS:

This prospective study analyzed 36 patients who underwent arthroscopic reduction and suture fixation for image-proven ACL avulsion fractures of the tibial eminence. The classification of Meyers and McKeever identified 6 type II, 16 type III, and 14 type IV fractures. The mean follow-up period was 34.4 months (range, 24 to 91 months). Follow-up assessment included Lysholm knee score, Tegner activity score, International Knee Documentation Committee (IKDC) score, and KT-1000 arthrometer (MEDmetric, San Diego, CA) and radiographic evaluation.

RESULTS:

The mean preoperative Lysholm score in the 36 knees was 38 (range, 28 to 54); the mean postoperative Lysholm score was 98 (range, 83 to 100). The mean preinjury and preoperative Tegner scores in the 36 knees were 7.5 +/- 1.5 (range, 5 to 9) and 3 +/- 1.7 (range, 2 to 5), respectively. The mean postoperative Tegner score was 7.3 +/- 1.7 (range, 5 to 9). At final follow-up, 34 patients (94.5%) were classified by IKDC score as normal or nearly normal (grade A or B). The IKDC classification was abnormal (grade C) in 2 patients (5.5%). All 36 fractures achieved union within 3 months. No significant complications, such as arthrofibrosis, loss of initial fixation, or wound infection, were noted.

CONCLUSIONS:

Treating ACL avulsion fracture by arthroscopic suture fixation by use of 4 No. 5 Ethibond sutures can restore ACL length, stabilize fragments, promote early motion, and minimize morbidity.

LEVEL OF EVIDENCE:

Level IV, therapeutic case series.

• Authors: Tsan-Wen Huang, Kuo-Yao Hsu, Chun-Ying Cheng, Lih-Huei Chen, Ching-Jen Wang, Yi-Sheng Chan, Wen-Jer Chen
• Journal: Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association (Arthroscopy) Vol. 24 Issue 11 Pg. 1232-8 (Nov 2008) ISSN: 1526-3231 [Electronic] United States
• PMID: 18971052 (Publication Type: Journal Article)

Topics

• Adult
• Anterior Cruciate Ligament (physiopathology)
• Arthroscopy (methods)
• Follow-Up Studies
• Humans
• Knee Joint (physiopathology, surgery)
• Longitudinal Ligaments (physiopathology)
• Middle Aged
• Orthopedic Fixation Devices
• Pain Measurement
• Pain, Postoperative (physiopathology)
• Posterior Cruciate Ligament (physiopathology)
• Prospective Studies
• Range of Motion, Articular
• Suture Techniques
• Tibia (surgery)
• Tibial Fractures (rehabilitation, surgery)