Evaluation of arthroscopic balance point fixation in the treatment of avulsion fracture of anterior cruciate ligament_West China Medical Journal

Authors：

WU Feipeng ^1,2 , TANG Xin ¹ , TAO Hong ³ , LAN Yuping ² ,  LI Jian ¹

1. Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Orthopaedics, Panzhihua Central Hospital, Panzhihua, Sichuan 617067, P. R. China;
3. Department of Operation Center, Panzhihua Central Hospital, Panzhihua, Sichuan 617067, P. R. China;

Corresponding author：

LI Jian, Email: hxlijian.china@163.com

Keywords：

Balance point fixation; Anterior cruciate ligament; Avulsion fracture; Arthroscopy

DOI：

10.7507/1002-0179.202006149

Video：

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Objective To evaluate the specific application and effect of balance point fixation technique in arthroscopic fixation of avulsion fracture of anterior cruciate ligament.Methods The data of 65 patients with anterior cruciate ligament avulsion fracture treated by arthroscopy in Department of Orthopaedics, Panzhihua Central Hospital between June 2012 and June 2018 were analyzed retrospectively. According to whether the balance point fixation technique was used or not, the patients were divided into routine operation group (group A, n=22) and balance point fixation group (group B, n=43). The operation time, Visual Analogue Scale (VAS) pain score, length of hospital stay, intraoperative bone re-fracture rate, incidences of limb swelling and deep venous thrombosis, Lysholm score and knee joint stability of the two groups were analyzed. Chi-square test or Fisher’s exact test was used for nominal data. Independent samples t-test or paired samples t-test was used for measurement data. Rank sum test was used for ordinal data. Repeated measures analysis of variance was used for repeated measurement data. Two-sided statistical significance level was set at α=0.05.Results There was no statistically significant difference in age, sex composition, fracture type, combined injury, time from injury to operation, preoperative VAS score, or Lysholm score between the two groups (P>0.05). The incisions of all patients healed in the first stage without incision complications. After adjustment, the reduction of fracture in group A was basically satisfactory, 4 cases (18.2%) had re-fracture; 1 case (2.3%) in group B had re-fracture due to poor bone condition, and group B was better than group A in re-fracture incidence (P=0.041). The operation time and length of hospital stay in group B were shorter than those in group A [(90.27±34.27) vs. (49.67±10.44) min,P<0.001; (8.09±1.23) vs. (5.35±1.07) d, P<0.001], the postoperative VAS score in group B was lower than that in group A (4.23±0.87 vs. 2.60±0.62, P<0.001), the degree of pain relief in group B was better than that in group A (3.32±1.29 vs. 4.44±1.50, P=0.004), the incidence of postoperative limb swelling in group B was lower than that in group A (22.7% vs. 4.7%, P<0.05); the difference in incidence of postoperative deep venous thrombosis between the two groups was not statistically significant (P>0.05). All patients were followed up for more than one year, the fractures healed completely, and the postoperative VAS score and Lysholm score at one year after operation were significantly improved compared with those before operation, but there was no significant difference in the postoperative 6-month Lysholm score, stability evaluation, or postoperative 1-year Lysholm score between the two groups (P>0.05).Conclusions The balance point fixation technique plays a positive role in relieving postoperative pain, shortening operation time and average hospital stay, and reducing the incidence of complications by realizing the quantification of the best fixed point to reduce repeated operation and side injury. It can provide a technical reference for clinical work.

Citation： WU Feipeng, TANG Xin, TAO Hong, LAN Yuping, LI Jian. Evaluation of arthroscopic balance point fixation in the treatment of avulsion fracture of anterior cruciate ligament. West China Medical Journal, 2020, 35(10): 1205-1211. doi: 10.7507/1002-0179.202006149 Copy

1.	Osti M, Benedetto KP. Results of arthroscopically assisted refixation of fractures of the intercondylar eminence. Z Orthop Unfall, 2010, 148(3): 288-291.
2.	Sang WL, Zhu LB, Ma JZ, et al. A comparative study of two methods for treating type III tibial eminence avulsion fracture in adults. Knee Surg Sports Traumatol Arthrosc, 2012, 20(8): 1560-1564.
3.	王琪, 李众利, 刘玉杰, 等. 关节镜下两种方法治疗胫骨髁间嵴骨折的疗效对比. 中华关节外科杂志(电子版), 2019, 13(2): 161-167, 205.
4.	韩俊, 刘国辉. 前交叉韧带止点撕脱性骨折关节镜下交叉不可吸收缝线固定与空芯螺钉固定的临床对比分析. 临床外科杂志, 2019, 27(9): 788-790.
5.	李洪秋, 邓纯博, 冯时, 等. 关节镜下 Endobutton 联合 Orthocord 缝线固定治疗成人前交叉韧带胫骨止点撕脱骨折的短期疗效评价. 中国医师进修杂志, 2019, 42(10): 904-908.
6.	褚青波, 邢雅昶, 刘大旭. 3 种方式治疗Ⅱ-Ⅲ型前交叉韧带胫骨止点撕脱骨折的疗效比较. 安徽医学, 2018, 39(1): 95-98.
7.	夏炎, 李云龙. 关节镜下经套管钢丝固定治疗胫骨髁间前棘骨折的体会. 中华关节外科杂志(电子版), 2018, 12(4): 113-116.
8.	Koukoulias NE, Germanou E, Lola DA, et al. Clinical outcome of arthroscopic suture fixation for tibial eminence fractures in adults. Arthroscopy, 2012, 28(10): 1472-1480.
9.	Li J, Liu CH, Li ZL, et al. Arthroscopic fixation for tibial eminence fractures: comparison of double-row and transosseous anchor knot fixation techniques with suture anchors. Med Sci Monit, 2018, 24: 7348-7356.
10.	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.
11.	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.
12.	Mayo MH, Mitchell JJ, Axibal DP, et al. Anterior cruciate ligament injury at the time of anterior tibial spine fracture in young patients: an observational cohort study. J Pediatr Orthop, 2019, 39(9): e668-e673.
13.	Rhee SJ, Choi YY, Suh JT. Arthroscopic reduction of posterior cruciate ligament tibial avulsion fracture using two cross-linked pull-out sutures: a surgical technique and case series. Injury, 2019, 50(3): 804-810.
14.	Chotel F, Raux S, Accadbled F, et al. Cartilaginous tibial eminence fractures in children: which recommendations for management of this new entity?. Knee Surg Sports Traumatol Arthrosc, 2016, 24(3): 688-696.
15.	Sawyer GA, Anderson BC, Paller DA, et al. Biomechanical analysis of suture bridge fixation for tibial eminence fractures. Arthroscopy, 2012, 28(10): 1533-1539.
16.	Momaya AM, Read C, Steirer M, et al. Outcomes after arthroscopic fixation of tibial eminence fractures with bioabsorbable nails in skeletally immature patients. J Pediatr Orthop B, 2018, 27(1): 8-12.
17.	Osti L, Buda M, Soldati F, et al. Arthroscopic treatment of tibial eminence fracture: a systematic review of different fixation methods. Br Med Bull, 2016, 118(1): 73-90.
18.	Bogunovic L, Tarabichi M, Harris D, et al. Treatment of tibial eminence fractures: a systematic review. J Knee Surg, 2015, 28(3): 255-262.
19.	向先祥, 张春刚, 王卫明. 前十字韧带股骨直接纤维止点重建的力学特征及近期临床疗效. 中华骨科杂志, 2020, 40(7): 397-407.
20.	Dong JT, Gao SJ, Men XQ, et al. Incidence of deep venous thrombosis in Chinese patients undergoing arthroscopic knee surgery for cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2015, 23(12): 3540-3544.
21.	倪建龙, 时志斌, 党晓谦, 等. 关节镜下双股 ETHIBOND 线固定治疗后交叉韧带胫骨止点撕脱骨折的疗效观察. 中国骨与关节杂志, 2016, 5(10): 735-738.
22.	Gans I, Baldwin KD, Ganley TJ. Treatment and management outcomes of tibial eminence fractures in pediatric patients: a systematic review. Am J Sports Med, 2014, 42(7): 1743-1750.

1. Osti M, Benedetto KP. Results of arthroscopically assisted refixation of fractures of the intercondylar eminence. Z Orthop Unfall, 2010, 148(3): 288-291.
2. Sang WL, Zhu LB, Ma JZ, et al. A comparative study of two methods for treating type III tibial eminence avulsion fracture in adults. Knee Surg Sports Traumatol Arthrosc, 2012, 20(8): 1560-1564.
3. 王琪, 李众利, 刘玉杰, 等. 关节镜下两种方法治疗胫骨髁间嵴骨折的疗效对比. 中华关节外科杂志(电子版), 2019, 13(2): 161-167, 205.
4. 韩俊, 刘国辉. 前交叉韧带止点撕脱性骨折关节镜下交叉不可吸收缝线固定与空芯螺钉固定的临床对比分析. 临床外科杂志, 2019, 27(9): 788-790.
5. 李洪秋, 邓纯博, 冯时, 等. 关节镜下 Endobutton 联合 Orthocord 缝线固定治疗成人前交叉韧带胫骨止点撕脱骨折的短期疗效评价. 中国医师进修杂志, 2019, 42(10): 904-908.
6. 褚青波, 邢雅昶, 刘大旭. 3 种方式治疗Ⅱ-Ⅲ型前交叉韧带胫骨止点撕脱骨折的疗效比较. 安徽医学, 2018, 39(1): 95-98.
7. 夏炎, 李云龙. 关节镜下经套管钢丝固定治疗胫骨髁间前棘骨折的体会. 中华关节外科杂志(电子版), 2018, 12(4): 113-116.
8. Koukoulias NE, Germanou E, Lola DA, et al. Clinical outcome of arthroscopic suture fixation for tibial eminence fractures in adults. Arthroscopy, 2012, 28(10): 1472-1480.
9. Li J, Liu CH, Li ZL, et al. Arthroscopic fixation for tibial eminence fractures: comparison of double-row and transosseous anchor knot fixation techniques with suture anchors. Med Sci Monit, 2018, 24: 7348-7356.
10. 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.
11. 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.
12. Mayo MH, Mitchell JJ, Axibal DP, et al. Anterior cruciate ligament injury at the time of anterior tibial spine fracture in young patients: an observational cohort study. J Pediatr Orthop, 2019, 39(9): e668-e673.
13. Rhee SJ, Choi YY, Suh JT. Arthroscopic reduction of posterior cruciate ligament tibial avulsion fracture using two cross-linked pull-out sutures: a surgical technique and case series. Injury, 2019, 50(3): 804-810.
14. Chotel F, Raux S, Accadbled F, et al. Cartilaginous tibial eminence fractures in children: which recommendations for management of this new entity?. Knee Surg Sports Traumatol Arthrosc, 2016, 24(3): 688-696.
15. Sawyer GA, Anderson BC, Paller DA, et al. Biomechanical analysis of suture bridge fixation for tibial eminence fractures. Arthroscopy, 2012, 28(10): 1533-1539.
16. Momaya AM, Read C, Steirer M, et al. Outcomes after arthroscopic fixation of tibial eminence fractures with bioabsorbable nails in skeletally immature patients. J Pediatr Orthop B, 2018, 27(1): 8-12.
17. Osti L, Buda M, Soldati F, et al. Arthroscopic treatment of tibial eminence fracture: a systematic review of different fixation methods. Br Med Bull, 2016, 118(1): 73-90.
18. Bogunovic L, Tarabichi M, Harris D, et al. Treatment of tibial eminence fractures: a systematic review. J Knee Surg, 2015, 28(3): 255-262.
19. 向先祥, 张春刚, 王卫明. 前十字韧带股骨直接纤维止点重建的力学特征及近期临床疗效. 中华骨科杂志, 2020, 40(7): 397-407.
20. Dong JT, Gao SJ, Men XQ, et al. Incidence of deep venous thrombosis in Chinese patients undergoing arthroscopic knee surgery for cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2015, 23(12): 3540-3544.
21. 倪建龙, 时志斌, 党晓谦, 等. 关节镜下双股 ETHIBOND 线固定治疗后交叉韧带胫骨止点撕脱骨折的疗效观察. 中国骨与关节杂志, 2016, 5(10): 735-738.
22. Gans I, Baldwin KD, Ganley TJ. Treatment and management outcomes of tibial eminence fractures in pediatric patients: a systematic review. Am J Sports Med, 2014, 42(7): 1743-1750.

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Evaluation of arthroscopic balance point fixation in the treatment of avulsion fracture of anterior cruciate ligament

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