Objective To investigate the effectiveness of percutaneous reduction by leverage and fixation using nonabsorbable suture with neckwear knot loop l igature to treat tibial intercondylar eminence avulsion fractures under the arthroscope. Methods Between February 2003 and December 2008, 28 patients with tibial intercondylar eminence avulsion fractures were treated, including 16 left knees and 12 right knees. There were 15 males and 13 females with an average age of19.5 years (range, 14-45 years). The injury causes included traffic accident injury in 11 cases, sport injury in 10 cases, and sprain injury in 7 cases. Based on Meyers-McKeever classification, there were 18 cases of type III and 10 cases of type IV. The X-ray films showed the tibial intercondylar eminence displaced fracture. The mean time between trauma and operation was 7 days (range, 4-12 days). All patients were treated surgically with an arthroscopically assisted reduction by leverage and fixation using 5-0 Ethibond suture with neckwear knot loop l igature. Results All incisions healed by first intention without infection or injuries of nerves and vessels. Twenty-eight patients were followed up 26 months on average (range, 12-66 months). The X-ray films showed fracture heal ing within 9-13 weeks (mean, 11 weeks). At last follow-up, all patients were able to return to their pre-injury activity and daily l ife. The knee joint was stable with no l imp or impingement of intercondylar fossa. The knee joint range of motion was 0-130°. The results of Lachman and anterior drawer tests were negative in all patients. At last follow-up, the Lysholm score was 93.5 ± 2.5, showing significant difference when compared with the preoperative one (29.0±2.2, t=53.000, P=0.000). Conclusion Percutaneous reduction by leverage and fixation using nonabsorbable suture with neckwear knot loop l igature is minimally invasive and satisfied reduction and fixation in treating the tibial intercondylar eminence avulsion fracture under the arthroscope, so it is benefit for early functional exercises, and can achieve excellent results.
Objective
To investigate the effectiveness of arthroscopically assisted treatment of acute tibial insertion avulsion fracture of the posterior cruciate ligament (PCL) via posteromedial incision.
Methods
Between January 2010 and January 2012, 22 patients with acute tibial insertion avulsion of the PCL underwent arthroscopic reduction and fixation via posteromedial incision. There were 14 males and 8 females with an average age of 32 years (range, 18-48 years). The injury causes included traffic accident injury in 14 cases, sport injury in 4 cases, and falling injury in 4 cases. The disease duration ranged from 7 to 16 days (mean, 10 days). Of 22 patient, 14 had simple PCL injury, 6 had PCL injury with meniscus injury, and 2 with cartilage injury. The results of posterior drawer test were positive in all patients. The preoperative Lysholm score was 51.1 ± 3.4.
Results
All incisions healed by first intention without infection, deep venous thrombosis of lower limbs, or vessel and nerve injuries. All patients were followed up 12-24 months (mean, 18.4 months). X-ray films showed that all fractures healed with the healing time of 2-4 months (mean, 3 months). The Lysholm score was improved to 96.0 ± 2.2 at 6 months after operation, showing significant difference when compared with preoperative score (t=43.020, P=0.000).
Conclusion
Arthroscopically assisted treatment of acute tibial insertion avulsion fracture of the PCL via posteromedial incision is a safe, easy, and effective method.
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.
Objective
To evaluate the surgical techniques and effectiveness of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture with non-absorbable suture fixation combined with the mini-plate.
Methods
Between January 2009 and March 2012, 32 patients with ACL tibial eminence avulsion fractures were treated. There were 18 males and 14 females, aged 12-40 years (mean, 17.5 years). The injury causes included traffic accident injury in 15 cases, sport injury in 6 cases, and falling injury in 11 cases. The time from injury to operation ranged 7-18 days with an average of 9.5 days. Before operation, the results of Lachman test were all positive; the Lysholm score was 52.13 ± 4.22 and the International Knee Documentation Committee (IKDC) score was 44.82 ± 2.44. According to Meyers-McKeever classification criteria, there were 12 cases of type II and 20 cases of type III. After arthroscopic poking reduction of fracture, tibial eminence avulsion fractures were fixed with the Ethibond non-absorbable sutures bypass figure-of-eight tibial tunnel combined with the metacarpal and phalangeal mini-plate.
Results
Primary healing was obtained in all incisions; no joint infection or skin necrosis occurred after operation. All patients were followed up with an average time of 22.4 months (range, 12-50 months). The patients showed negative Lachman test at 12 weeks after operation. Except 3 patients having knee extension limitation at last follow-up, the knee extension range of motion (ROM) was normal in the other patients; the knee flexion ROM was normal in all patients. The Lysholm score and IKDC score were significantly improved to 94.19 ± 0.93 and 94.35 ± 1.22 at last follow-up, showing significant differences when compared with preoperative values (t=55.080, P=0.000; t=101.715, P=0.000).
Conclusion
The arthroscopic treatment of ACL tibial eminence avulsion fracture with Ethibond non-absorbable suture fixation combined with mini-plate is an effective procedure with the advantages of minimal trauma, reliable fixation, and satisfactory recovery of the knee joint function.
ObjectiveTo study the biomechanical stability of neckwear-knot-loop-ligature fixation for tibial eminence avulsion fractures by comparing with cannulated screw fixation and suture anchor fixation.
MethodsTwenty-four fresh porcine knee joints were selected. After the model of tibial eminence avulsion fracture (type Ⅲ) was made, 24 samples were randomly divided into 3 groups: neckwear-knot-loop-ligature group (group A), cannulated screw group (group B), and suture anchor group (group C), 8 samples in each group. The Universal electromagnetic and mechanical testing machines were used for the biomechanical tests. After 200 cyclic tests, pull-out test was done until fixation failure. The maximum failure load, yield load, stiffness, and displacement were measured.
ResultsFailure mode: the displacement was beyond limit in 8 samples of group A; screws extraction (5 samples) and bone fragment re-fracture (3 samples) were observed in group B; and suture anchor extraction (4 samples), suture rupture (3 samples), and suture thread cutting (1 sample) were found in group C. Biomechanical test: From groups A to C, the maximum failure load and yield load showed significant decreasing tendency (P<0.05), but the displacements showed significant increasing tendency (P<0.05). The stiffness also gradually decreased, but differences was not significant (P>0.05).
ConclusionCompared with cannulated screw and suture anchor, neckwear-knot-loop-ligature fixation for tibial eminence avulsion fracture has good biomechanical performance and the advantages of firm fixation and simple operation.
ObjectiveTo compare the effectiveness of open reduction of posterior cruciate ligament (PCL) avulsion fracture at tibial insertion of knee joint with absorbable screws fixation and absorbable screw combined with suture anchor fixation. Methods The clinical data of 26 patients with PCL avulsion fracture at tibial insertion who met the selection criteria between March 2015 and October 2021 were retrospectively analyzed. Among them, 14 patients were fixed with simple absorbable screw (group A), and 12 patients were fixed with absorbable screw combined with suture anchors (group B). All patients were confirmed by X-ray film, CT, or MRI preoperatively, and got positive results in preoperative posterior drawer tests. There was no significant difference in gender, age, side of affected limb, time from injury to operation, comorbidities, and preoperative Meyers & McKeever classification, Lysholm score, and International Knee Documentation Committee (IKDC) score between the two groups (P>0.05). The operation time and postoperative complications were recorded and compared between the two groups. At last follow-up, Lysholm score and IKDC score were used to evaluate the improvement of knee function. ResultsThere was no significant difference in operation time between the two groups (P>0.05). All incisions healed by first intention, and no complication such as vascular and nerve injury or venous thrombosis occurred. All 26 patients were followed up 9-89 months, with an average of 55.3 months. The follow-up time of group A and group B was (55.7±23.2) and (56.8±29.3) months, respectively, with no significant difference (t=?0.106, P=0.916). Radiographs showed bone healing in both groups at 3 months after operation, and no complication such as infection and traumatic arthritis occurred. At last follow-up, the posterior drawer test was negative in both groups, and the Lysholm score and IKDC score significantly improved when compared with the pre-operative values (P<0.05). However, there was no significant difference in the improvement value between the two groups (P>0.05). ConclusionFor PCL avulsion fracture at tibial insertion of the knee joint, the open reduction and absorbable screw combined with suture anchor fixation can achieve reliable fracture reduction and fixation, which is conducive to the early rehabilitation and functional exercise, and the postoperative functional recovery of the knee joint is satisfactory.
ObjectiveTo investigate the effectiveness of arthroscopic multi-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of anterior cruciate ligament (ACL) involving the anterior root of lateral meniscus (LM). Methods A retrospective analysis was conducted on the clinical data of 28 patients with tibial insertion avulsion fracture of ACL involving the anterior root of LM who were treated with arthroscopic multi-point fixation with anchor and suture between October 2017 and January 2023. There were 12 males and 16 females with the mean age of 26 years (range, 13-57 years). There were 20 cases of sports injury and 8 cases of traffic accident injury. In 2 cases of old fracture, the time from injury to operation was 45 days and 90 days, respectively; in 26 cases of fresh fracture, the time from injury to operation was 3-20 days (mean, 6.7 days). According to the Meyers-McKeever classification, there were 4 cases of type Ⅱ, 11 cases of type Ⅲ, and 13 cases of type Ⅳ. The preoperative Lysholm knee function score was 42.1±9.0, the International Knee Documentation Committee (IKDC) score was 40.0±7.3, and the Tegner score was 0.7±0.7. ResultsAll operations were successfully completed, and the incisions healed by first intention. All the 28 patients were followed up 5-60 months (mean, 20.4 months). During the follow-up, there was nocomplication such as infection, vascular or nerve injury, loosening or breakage of internal fixator, or stiffness of knee joint. Postoperative X-ray films showed satisfactory fracture reduction and firm fixation. All fractures healed clinically, and the healing time was 8-16 weeks (mean, 10.3 weeks). At last follow-up, Lachman test and anterior drawer test were negative. At last follow-up, Lysholm knee function score was 92.4±5.5, IKDC score was 91.6±4.4, and Tegner score was 5.2±1.1, which significantly improved when compared with preoperative scores (t=?22.899, P<0.001; t=?29.870, P<0.001; t=?19.979, P<0.001). ConclusionMulti-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of ACL involving the anterior root of LM can not only fix the LM, but also effectively reduce and fix the avulsion fracture, which can obtain good effectiveness.
ObjectiveTo investigate the effectiveness of open reduction by mini incision and absorbable screw internal fixation for the treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture.
MethodsBetween January 2006 and July 2012, 90 patients (90 knees) with ACL tibial eminence avulsion fracture were treated. There were 58 males and 32 females, aged from 10 to 58 years with an average of 33.7 years. The causes of injury were traffic accident injury in 60 cases, sports injury in 22 cases, and falling injury in 8 cases. The disease duration was 1-365 days with a median of 106 days. Combined injuries included 14 cases of meniscus injury, 5 cases of medial collateral ligament injury, and 3 cases of avulsion fracture of the anterior horn of the lateral meniscus. All patients underwent open reduction by mini incision and internal fixation with absorbable screw. Postoperative rehabilitation exercise was performed.
ResultsTwo patients had delayed healing of incision, and others obtained primary healing. All the patients were followed up 6-72 months (mean, 40.1 months). X-ray examination showed that bone union was achieved in all patients at 3-12 months after operation; nail tail came off in 7 cases at 4-13 months after operation, and the nail tail was taken out under arthroscopy. At 6-12 months after operation, the range of motion (ROM), Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) score were significantly increased when compared with preoperative ones (P < 0.05).
ConclusionA combination of open reduction by mini incision and absorbable screw internal fixation for the treatment of ACL tibial eminence avulsion fracture has the advantages of easy operation, firm fixation, and satisfactory functional rehabilitation, so it is a safe and effective method for the treatment of ACL tibial eminence avulsion fracture.
ObjectiveTo investigate the surgical technique and effectiveness of arthroscopic ULTRA-Braid suture plane fixation for anterior cruciate ligament (ACL) tibial eminence avulsion fractures.
MethodsBetween June 2012 and October 2014, 16 cases of ACL tibial eminence avulsion fracture were treated with ULTRA-Braid suture plane fixation under arthroscopy. There were 10 males and 6 females, aged from 17 to 38 years (mean, 25.8 years). The left knee was involved in 5 cases and the right knee in 11 cases. The causes were traffic accident injury in 9 cases, falling from height injury in 4 cases, and sports injury in 3 cases. The average interval from injury to operation was 7 days (range, 5-10 days) except 1 patient who received operation at 6 weeks after injury. The knee joint swelling was obvious; the result of Lachman test was positive; and the knee joint Lysholm score was 45.38±9.87. According to classification standard introduced by Meyers-McKeever-Zaricznyj, 7 cases were rated as type Ⅱ, 8 cases as type Ⅲ, and 1 case as type Ⅳ, excluding ligament and meniscus injury.
ResultsAll the incisions healed by first intention. The patients received follow-up of 6-18 months (mean, 10 months). The postoperative X-ray and CT showed anatomic reduction (12 cases) or near anatomic reduction (4 cases); all fractures healed at 6 months after operation. The result of Lachman test was negative in the other 15 patients except 1 patient (Ⅱ degree). One patient had slight knee pain at 6 months postoperatively, and pain symptom disappeared after 1 year; the other cases resumed daily activities. Lysholm score at last follow-up was 98.13±2.34, showing significant difference when compared with preoperative score (t=-20.801, P=0.000).
ConclusionArthroscopic ULTRA-Braid suture plane fixation for ACL tibial eminence avulsion fractures is an effective procedure with the advantages of minimal trauma, reliable fixation, satisfactory functional recovery, and simultaneously avoiding the second surgery.
Objective To compare the effectiveness of arthroscopic screw and suture fixations in treatment of anterior cruciate ligament tibial eminence avulsion fractures. Methods Between January 2002 and January 2009, 43 patients with freshanterior cruciate ligament tibial eminence avulsion fracture were treated, which were rated as types II and III according to Meyers- McKeever-Zaricznyj classification. Fractures were fixed with either screw (screw group, n=21) or nonabsorbable suture (suture group, n=22). There was no significant difference in sex, age, disease duration, and fracture type between 2 groups (P gt; 0.05). The range of motion (ROM) and Lysholm score were compared between 2 groups, and the knee stabil ity was evaluated based on the Lachman test and KT-2000 measurement. Results The operation time was 48-60 minutes (mean, 51.6 minutes) in the screw group, and 55-68 minutes (mean, 63.2 minutes) in the suture group, showing significant difference (t=4.645, P=0.032). Incisions healed by first intention and no compl ication occurred in 2 groups. All patients were followed up (5.7 ± 0.6) years in the screw group and (5.3 ± 0.5) years in the suture group. The fracture healed completely in both groups; the heal ing time was (3.3 ± 0.6) months in the screw group and (3.2 ± 0.4) months in the suture group, showing significant difference (t=3.723, P=0.019). Between the screw group and the suture group, no significant difference was found in ROM [(128.6 ± 10.1)° vs. (130.2 ± 14.1)°, P gt; 0.05] and Lysholm score (94.6 ± 14.5 vs. 95.1 ± 17.2, P gt; 0.05). The stabil ities based on KT-2000 measurement were also similar between 2 groups at last follow-up [(0.9 ± 0.3) mm vs. (1.0 ± 0.4) mm, P gt; 0.05]. Lachman test of 2 groups were negative. Conclusion Boththe screw and nonabsorbable suture fixation techniques for anterior cruciate l igament tibial eminence avulsion fracture (type II or III) have good results in terms of functional outcome and stabil ity. However, some patients show flexion contractures of 5° or 10°.
