Arthroscopic treatment of anterior cruciate ligament tibial eminence avulsion fracture with double heads compressive cannulated screw fixation in adolescents_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Juncai ¹ , YUE Yongchuan ² ,  LI Zhong ¹

1. Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;
2. Department of Orthopedics, the Second People’s Hospital of Neijiang, Neijiang Sichuan, 641000, P.R.China;

Corresponding?author：

LI Zhong, Email: 545890312@qq.com

Keywords：

Double heads compressive cannulated screw; anterior cruciate ligament; avulsion fracture; arthroscope; adolescents

DOI：

10.7507/1002-1892.201803012

Video：

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ObjectiveTo discuss the effectiveness of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture in adolescents by using double heads compressive cannulated screw fixation.MethodsTwenty-four patients with ACL tibial eminence avulsion fractures were treated by arthroscopic reduction and internal fixation with double heads compressive cannulated screw fixation between June 2014 and June 2017. There were 15 males and 9 females with an average age of 12.3 years (range, 5-18 years). The body mass index was 19.3-26.4 kg/m² (mean, 23.3 kg/m²). The injury causes included traffic accident injury in 10 cases, sports injury in 8 cases, and falling injury in 6 cases. According to the Meyers-McKeever classification, there were 19 cases of type Ⅱ and 5 cases of type Ⅲa. All patients’ drawer test and pivot shift test were positive. The interval between injury and operation was 3-14 days (mean, 6.2 days). During the follow-up period, the fracture healing condition of patients were determined by X-ray examination; Lysholm score, International Knee literature Committee (IKDC) score, and Tegner score were used to evaluate the knee function.ResultsPrimary healing of incision was obtained in all patients after operation. All the 24 patients were followed up 6-32 months (mean, 16.4 months). At 6 weeks after operation, 3 patients had difficulty in knee flexion. After the release of the knee joint by manipulation, the knee joint function recovered normally at 6 months after operation. At last follow-up, the X-ray films showed that all the fractures healed and no epiphyseal dysplasia, knee joint deformity, or leg length discrepancy occurred. The Lysholm score, IKDC score, and Tegner score were improved from preoperative 44.3±5.4, 43.7±4.4, and 3.0±1.3 to postoperative 93.1±4.3, 94.6±3.3, and 8.1±1.2, the differences were all significant (t=25.152, P=0.000; t=28.634, P=0.000; t=13.226, P=0.000).ConclusionThe arthroscopic reduction and internal fixation with double heads compressive cannulated screw in treatment of ACL tibial avulsion fracture (Meyers-McKeever type Ⅱ and Ⅲ) in adolescents has so many advantages, such as minimal trauma, simple operation, firm fixation, little effect on the epiphyseal plate, and has a good joint function recovery.

Citation： LIU Juncai, YUE Yongchuan, LI Zhong. Arthroscopic treatment of anterior cruciate ligament tibial eminence avulsion fracture with double heads compressive cannulated screw fixation in adolescents. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(9): 1172-1176. doi: 10.7507/1002-1892.201803012 Copy

1.	Luhmann SJ. Acute traumatic knee effusions in children and adolescents. J Pediatr Orthop, 2003, 23(2): 199-202.
2.	Leeberg V, Lekdorf J, Wong C, et al. Tibial eminentia avulsion fracture in children-a systematic review of the current literature. Dan Med J, 2014, 61(3): A4792.
3.	Estes AR, Oladeji LO. Arthroscopic treatment of tibial spine malunion with resorbable screws. Am J Orthop (Belle Mead NJ), 2015, 44(5): E160-E164.
4.	牛金龍, 黃遠章, 王晉豫, 等. 關節鏡下空心螺釘和鋼絲治療前交叉韌帶脛骨止點撕脫骨折對比療效分析. 實用骨科雜志, 2016, 22(7): 598-602.
5.	Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg (Am), 1959, 41-A(2): 209-220.
6.	Zaricznyj B. Avulsion fracture of the tibial eminence: treatment by open reduction and pinning. J Bone Joint Surg (Am), 1977, 59(8): 1111-1114.
7.	Hsu SY. An easy and effective method for reattaching an anterior cruciate ligament avulsion fracture from the tibial eminence. Arthroscopy, 2004, 20(1): 96-100.
8.	張志偉, 李忠. 前交叉韌帶脛骨止點撕脫骨折的治療進展. 西南軍醫, 2016, 18(5): 457-460.
9.	陳巍, 李彬, 鄭磊, 等. 關節鏡下空心螺釘治療前交叉韌帶脛骨止點撕脫性骨折 18 例. 中國中醫骨傷科雜志, 2016, 24(7): 58-59.
10.	Lubowitz JH, Elson WS, Guttmann D. Part II: arthroscopic treatment of tibial plateau fractures: intercondylar eminence avulsion fractures. Arthroscopy, 2005, 21(1): 86-92.
11.	孫偉, 張鵬, 劉澤淼, 等. 關節鏡下經髕內側入路空心釘固定治療前交叉韌帶脛骨止點撕脫骨折. 中國運動醫學雜志, 2013, 32(2): 108-111, 141.
12.	May JH, Levy BA, Guse D, et al. ACL tibial spine avulsion: mid-term outcomes and rehabilitation. Orthopedics, 2011, 34(2): 89.
13.	杜興升, 喻長純. 前交叉韌帶脛骨止點撕脫骨折的臨床治療. 實用中西醫結合臨床, 2017, 17(5): 79, 93.
14.	劉陽, 孫學斌, 張克遠, 等. 關節鏡治療骨骺未閉青少年前交叉韌帶撕脫骨折的療效觀察. 中國修復重建外科雜志, 2015, 29(6): 725-729.
15.	段鑫, 陳志超, 李志力, 等. 關節鏡下雙帶線錨釘治療前交叉韌帶脛骨止點撕脫骨折. 廣東醫學, 2016, 37(增刊): 133-135.
16.	Su WR, Wang PH, Wang HN, et al. A simple, modified arthroscopic suture fixation of avulsion fracture of the tibial intercondylar eminence in children. J Pediatr Orthop B, 2011, 20(1): 17-21.
17.	盧華定, 史德海, 董云旭, 等. 關節鏡下鋼絲固定治療前交叉韌帶脛骨止點撕脫骨折. 中國骨與關節損傷雜志, 2011, 26(2): 112-114.
18.	呂宏升, 林洪光, 鄭佳鵬, 等. 關節鏡下掌骨鋼板結合不可吸收縫線固定治療前交叉韌帶止點撕脫骨折. 中國骨與關節損傷雜志, 2014, 29(4): 353-355.
19.	Siegel L, Vandenakker-Albanese C, Siegel D. Anterior cruciate ligament injuries: anatomy, physiology, biomechanics, and management. Clin J Sport Med, 2012, 22(4): 349-355.
20.	錢平康, 徐鋒, 孫斌峰, 等. 關節鏡下空心加壓螺釘內固定治療前交叉韌帶脛骨止點撕脫骨折 27 例分析. 中外醫療, 2015, (35): 74-76, 87.
21.	王慶, 黃華揚, 張濤, 等. 關節鏡下螺釘與縫線固定前交叉韌帶脛骨止點撕脫骨折的療效比較. 中華創傷骨科雜志, 2015, 17(4): 309-313.
22.	牛金龍. 不同手術方式治療前交叉韌帶脛骨止點撕脫骨折的臨床療效分析. 太原: 山西醫科大學, 2016.
23.	王海生, 李長江, 張國文, 等. 應用 AOΦ3.0 mm 雙頭空心加壓螺釘經皮內固定治療腕舟骨骨折. 臨床骨科雜志, 2012, 15(6): 647-648.

1. Luhmann SJ. Acute traumatic knee effusions in children and adolescents. J Pediatr Orthop, 2003, 23(2): 199-202.
2. Leeberg V, Lekdorf J, Wong C, et al. Tibial eminentia avulsion fracture in children-a systematic review of the current literature. Dan Med J, 2014, 61(3): A4792.
3. Estes AR, Oladeji LO. Arthroscopic treatment of tibial spine malunion with resorbable screws. Am J Orthop (Belle Mead NJ), 2015, 44(5): E160-E164.
4. 牛金龍, 黃遠章, 王晉豫, 等. 關節鏡下空心螺釘和鋼絲治療前交叉韌帶脛骨止點撕脫骨折對比療效分析. 實用骨科雜志, 2016, 22(7): 598-602.
5. Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg (Am), 1959, 41-A(2): 209-220.
6. Zaricznyj B. Avulsion fracture of the tibial eminence: treatment by open reduction and pinning. J Bone Joint Surg (Am), 1977, 59(8): 1111-1114.
7. Hsu SY. An easy and effective method for reattaching an anterior cruciate ligament avulsion fracture from the tibial eminence. Arthroscopy, 2004, 20(1): 96-100.
8. 張志偉, 李忠. 前交叉韌帶脛骨止點撕脫骨折的治療進展. 西南軍醫, 2016, 18(5): 457-460.
9. 陳巍, 李彬, 鄭磊, 等. 關節鏡下空心螺釘治療前交叉韌帶脛骨止點撕脫性骨折 18 例. 中國中醫骨傷科雜志, 2016, 24(7): 58-59.
10. Lubowitz JH, Elson WS, Guttmann D. Part II: arthroscopic treatment of tibial plateau fractures: intercondylar eminence avulsion fractures. Arthroscopy, 2005, 21(1): 86-92.
11. 孫偉, 張鵬, 劉澤淼, 等. 關節鏡下經髕內側入路空心釘固定治療前交叉韌帶脛骨止點撕脫骨折. 中國運動醫學雜志, 2013, 32(2): 108-111, 141.
12. May JH, Levy BA, Guse D, et al. ACL tibial spine avulsion: mid-term outcomes and rehabilitation. Orthopedics, 2011, 34(2): 89.
13. 杜興升, 喻長純. 前交叉韌帶脛骨止點撕脫骨折的臨床治療. 實用中西醫結合臨床, 2017, 17(5): 79, 93.
14. 劉陽, 孫學斌, 張克遠, 等. 關節鏡治療骨骺未閉青少年前交叉韌帶撕脫骨折的療效觀察. 中國修復重建外科雜志, 2015, 29(6): 725-729.
15. 段鑫, 陳志超, 李志力, 等. 關節鏡下雙帶線錨釘治療前交叉韌帶脛骨止點撕脫骨折. 廣東醫學, 2016, 37(增刊): 133-135.
16. Su WR, Wang PH, Wang HN, et al. A simple, modified arthroscopic suture fixation of avulsion fracture of the tibial intercondylar eminence in children. J Pediatr Orthop B, 2011, 20(1): 17-21.
17. 盧華定, 史德海, 董云旭, 等. 關節鏡下鋼絲固定治療前交叉韌帶脛骨止點撕脫骨折. 中國骨與關節損傷雜志, 2011, 26(2): 112-114.
18. 呂宏升, 林洪光, 鄭佳鵬, 等. 關節鏡下掌骨鋼板結合不可吸收縫線固定治療前交叉韌帶止點撕脫骨折. 中國骨與關節損傷雜志, 2014, 29(4): 353-355.
19. Siegel L, Vandenakker-Albanese C, Siegel D. Anterior cruciate ligament injuries: anatomy, physiology, biomechanics, and management. Clin J Sport Med, 2012, 22(4): 349-355.
20. 錢平康, 徐鋒, 孫斌峰, 等. 關節鏡下空心加壓螺釘內固定治療前交叉韌帶脛骨止點撕脫骨折 27 例分析. 中外醫療, 2015, (35): 74-76, 87.
21. 王慶, 黃華揚, 張濤, 等. 關節鏡下螺釘與縫線固定前交叉韌帶脛骨止點撕脫骨折的療效比較. 中華創傷骨科雜志, 2015, 17(4): 309-313.
22. 牛金龍. 不同手術方式治療前交叉韌帶脛骨止點撕脫骨折的臨床療效分析. 太原: 山西醫科大學, 2016.
23. 王海生, 李長江, 張國文, 等. 應用 AOΦ3.0 mm 雙頭空心加壓螺釘經皮內固定治療腕舟骨骨折. 臨床骨科雜志, 2012, 15(6): 647-648.

Chinese Journal of Reparative and Reconstructive Surgery

Arthroscopic treatment of anterior cruciate ligament tibial eminence avulsion fracture with double heads compressive cannulated screw fixation in adolescents

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