Early effectiveness of arthroscopic three-point suture technique in treatment of anterior cruciate ligament tibial eminence avulsion fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Wenhuai , FANG Kaibin , LIN Sanfu , WU Guozhong ,  CHEN Shoubo

Department of Orthopedics, the Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000, P.R.China;

Corresponding?author：

CHEN Shoubo, Email: 12275105@qq.com

Keywords：

Anterior cruciate ligament; tibial insertion; avulsion fracture; arthroscopy; suture fixation

DOI：

10.7507/1002-1892.201902007

Video：

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Objective To investigate the early effectiveness of three-point suture technique in treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture by arthroscopy. Methods Between January 2016 and December 2017, 12 patients with ACL tibial eminence avulsion fractures underwent arthroscopic fixation of avulsion fractures with Ethibon suture using three-point suture technique. There were 9 males and 3 females, with an average of 36.4 years (range, 18-50 years). The fracture caused by traffic accident in 10 cases and sports in 2 cases. Among them, 1 patient was old fracture and 11 was fresh fracture. According to the modified Meyers-McKeever classification criteria, the fractures were rated as type Ⅲ in 7 cases and type Ⅳ in 5 cases. There were 2 cases of medial collateral ligament injury and medial meniscus injury. The preoperative International Knee Documentation Committee (IKDC) score was 37.9±4.7 and Lysholm score was 46.0±3.7. Results All operations completed smoothly. The operation time was 45-70 minutes (mean, 61.3 minutes). The incisions healed by first intention in all patients. The hospitalization stays ranged from 4 to 9 days (mean, 5 days). All patients were followed up 3-20 months (mean, 9.3 months). The anterior drawer test, Lachman test, and axis shift test in all patients were negative after operation. At last follow-up, the IKDC score was 89.7±2.5 and Lysholm score was 90.2±1.9, which were significantly higher than those before operation (t=–30.94, P=0.00; t=–33.03, P=0.00). At last follow-up, the X-ray films showed 9 cases of fracture anatomical reduction and 3 cases of almost anatomical reduction, and 12 cases of fracture healing. Conclusion For ACL tibial eminence avulsion fracture, arthroscopic three-point suture technique can effectively restore the stability of knee joint and obtain satisfactory early effectiveness.

Citation： WANG Wenhuai, FANG Kaibin, LIN Sanfu, WU Guozhong, CHEN Shoubo. Early effectiveness of arthroscopic three-point suture technique in treatment of anterior cruciate ligament tibial eminence avulsion fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(7): 860-864. doi: 10.7507/1002-1892.201902007 Copy

1.	Zaricznyj B. Avulsion fracture of the tibial eminence: treatment by open reduction and pinning. J Bone Joint Surg (Am), 1977, 59(8): 1111-1114.
2.	姚俊娜, 王洪剛, 權松濤, 等. 關節鏡下縫合線橋內固定技術治療青少年前交叉韌帶脛骨止點撕脫骨折. 中國修復重建外科雜志, 2018, 32(11): 1402-1405.
3.	劉俊才, 岳永川, 李忠. 關節鏡下雙頭加壓空心螺釘固定治療青少年前交叉韌帶脛骨止點撕脫骨折. 中國修復重建外科雜志, 2018, 32(9): 1172-1176.
4.	Ebrahimzadeh MH, Makhmalbaf H, Golhasani-Keshtan F, et al. The International Knee Documentation Committee (IKDC) Subjective Short Form: a validity and reliability study. Knee Surgery Sports Traumatol Arthrosc, 2015, 23(11): 3163-3167.
5.	Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med, 1982, 10(3): 150-154.
6.	Zacharias I, Hull ML, Howell SM. Static and fatigue strength of a fixation device transducer for measuring anterior cruciate ligament graft tension. J Biomech Eng, 2000, 122(6): 600-603.
7.	Lansdown D, Ma CB. The influence of tibial and femoral bone morphology on knee kinematics in the anterior cruciate ligament injured knee. Clin Sports Med, 2018, 37(1): 127-136.
8.	韓亮, 黃長明, 范華強, 等. 前交叉韌帶脛骨髁間棘撕脫骨折三種內固定生物力學研究. 中國骨與關節損傷雜志, 2012, 27(10): 893-895.
9.	Tsukada H, Ishibashi Y, Tsuda E. A biomechanical comparison of repair techniques for anterior cruciate ligament tibial avulsion fracture under cyclic loading. Arthroscopy, 2005, 21(10): 1197-1201.
10.	王琪, 李眾利, 劉玉杰, 等. 關節鏡下帶線可吸收雙錨釘治療脛骨髁間嵴撕脫骨折. 中國修復重建外科雜志, 2011, 25(2): 220-224.
11.	Binnet MS, Gürkan I, Yilmaz C, et al. Arthroscopic fixation of intercondylar eminence fractures using a 4-portal technique. Arthroscopy, 2001, 17(5): 450-460.
12.	Ahn JH, Yoo JC. Clinical outcome of arthroscopic reduction and suture for displaced acute and chronic tibial spine fractures. Knee Surg Sports Traumatol Arthrosc, 2005, 13(2): 116-121.
13.	Lafrance RM, Giordano B, Goldblatt J, et al. Pediatric tibial eminence fractures: evaluation and management. J Am Acad Orthop Surg, 2010, 18(7): 395-405.
14.	Koukoulias NE, Germanou E, Lola D, et al. Clinical outcome of arthroscopic suture fixation for tibial eminence fractures in adults. Arthroscopy, 2012, 28(10): 1472-1480.
15.	Jang KM, Bae JH, Kim JG, et al. Novel arthroscopic fixation method for anterior cruciate ligament tibial avulsion fracture with accompanying detachment of the anterior horn of the lateral meniscus: three-point suture fixation. Injury, 2013, 44(8): 1028-1032.
16.	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.
17.	陸振飛, 趙金忠, 皇甫小橋. 關節鏡下跨骺板 8 字縫線固定法治療前交叉韌帶脛骨止點撕脫骨折后的隨訪研究. 中華小兒外科雜志, 2007, 28(12): 639-643.

1. Zaricznyj B. Avulsion fracture of the tibial eminence: treatment by open reduction and pinning. J Bone Joint Surg (Am), 1977, 59(8): 1111-1114.
2. 姚俊娜, 王洪剛, 權松濤, 等. 關節鏡下縫合線橋內固定技術治療青少年前交叉韌帶脛骨止點撕脫骨折. 中國修復重建外科雜志, 2018, 32(11): 1402-1405.
3. 劉俊才, 岳永川, 李忠. 關節鏡下雙頭加壓空心螺釘固定治療青少年前交叉韌帶脛骨止點撕脫骨折. 中國修復重建外科雜志, 2018, 32(9): 1172-1176.
4. Ebrahimzadeh MH, Makhmalbaf H, Golhasani-Keshtan F, et al. The International Knee Documentation Committee (IKDC) Subjective Short Form: a validity and reliability study. Knee Surgery Sports Traumatol Arthrosc, 2015, 23(11): 3163-3167.
5. Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med, 1982, 10(3): 150-154.
6. Zacharias I, Hull ML, Howell SM. Static and fatigue strength of a fixation device transducer for measuring anterior cruciate ligament graft tension. J Biomech Eng, 2000, 122(6): 600-603.
7. Lansdown D, Ma CB. The influence of tibial and femoral bone morphology on knee kinematics in the anterior cruciate ligament injured knee. Clin Sports Med, 2018, 37(1): 127-136.
8. 韓亮, 黃長明, 范華強, 等. 前交叉韌帶脛骨髁間棘撕脫骨折三種內固定生物力學研究. 中國骨與關節損傷雜志, 2012, 27(10): 893-895.
9. Tsukada H, Ishibashi Y, Tsuda E. A biomechanical comparison of repair techniques for anterior cruciate ligament tibial avulsion fracture under cyclic loading. Arthroscopy, 2005, 21(10): 1197-1201.
10. 王琪, 李眾利, 劉玉杰, 等. 關節鏡下帶線可吸收雙錨釘治療脛骨髁間嵴撕脫骨折. 中國修復重建外科雜志, 2011, 25(2): 220-224.
11. Binnet MS, Gürkan I, Yilmaz C, et al. Arthroscopic fixation of intercondylar eminence fractures using a 4-portal technique. Arthroscopy, 2001, 17(5): 450-460.
12. Ahn JH, Yoo JC. Clinical outcome of arthroscopic reduction and suture for displaced acute and chronic tibial spine fractures. Knee Surg Sports Traumatol Arthrosc, 2005, 13(2): 116-121.
13. Lafrance RM, Giordano B, Goldblatt J, et al. Pediatric tibial eminence fractures: evaluation and management. J Am Acad Orthop Surg, 2010, 18(7): 395-405.
14. Koukoulias NE, Germanou E, Lola D, et al. Clinical outcome of arthroscopic suture fixation for tibial eminence fractures in adults. Arthroscopy, 2012, 28(10): 1472-1480.
15. Jang KM, Bae JH, Kim JG, et al. Novel arthroscopic fixation method for anterior cruciate ligament tibial avulsion fracture with accompanying detachment of the anterior horn of the lateral meniscus: three-point suture fixation. Injury, 2013, 44(8): 1028-1032.
16. 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.
17. 陸振飛, 趙金忠, 皇甫小橋. 關節鏡下跨骺板 8 字縫線固定法治療前交叉韌帶脛骨止點撕脫骨折后的隨訪研究. 中華小兒外科雜志, 2007, 28(12): 639-643.

Chinese Journal of Reparative and Reconstructive Surgery

Early effectiveness of arthroscopic three-point suture technique in treatment of anterior cruciate ligament tibial eminence avulsion fracture

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