EFFECTIVENESS OF ARTHROSCOPIC TREATMENT OF ANTERIOR CRUCIATE LIGAMENT TIBIAL EMINENCE AVULSION FRACTURE WITH NON-ABSORBABLE SUTURE FIXATION COMBINED WITH MINI-PLATE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Suiyuan , XIAO Yang , TONG Zuoming , LI Guiqiu , JIANG Juhua , YAO Jinghui , WU Zhiyong , LI Tengfei , WU Qun.

Department of Orthopaedics, the Central Hospital of Loudi Affiliated to University of South China, Loudi Hunan, 417000, P.R.China. Corresponding author: WANG Suiyuan, E-mail: wjswsy@qq.com;

Corresponding author：

Keywords：

Anterior cruciate ligament; Tibial eminence avulsion fracture; Arthroscopy; Non-absorbable suture; Mini-plate

DOI：

10.7507/1002-1892.20130227

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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.

Citation： WANG Suiyuan,XIAO Yang,TONG Zuoming,LI Guiqiu,JIANG Juhua,YAO Jinghui,WU Zhiyong,LI Tengfei,WU Qun.. EFFECTIVENESS OF ARTHROSCOPIC TREATMENT OF ANTERIOR CRUCIATE LIGAMENT TIBIAL EMINENCE AVULSION FRACTURE WITH NON-ABSORBABLE SUTURE FIXATION COMBINED WITH MINI-PLATE. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(9): 1041-1044. doi: 10.7507/1002-1892.20130227 Copy

1.	Shelbourne KD, Urch SE, Freeman H. Outcomes after arthroscopic excision of the bony prominence in the treatment of tibial spine avulsion fractures. Arthroscopy, 2011, 27(6): 784-791.
2.	Sharma A, Lakshmanan P, Peehal J, et al. An analysis of different types of surgical fixation for avulsion fractures of the anterior tibial spine. Acta Orthop Belg, 2008, 74(1): 90-97.
3.	Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg (Am), 1970, 52(8): 1677-1684.
4.	Johnson DL, Durbin TC. Physeal-sparing tibial eminence fracture fixation with a headless compression screw. Orthopedics, 2012, 35(7): 604-608.
5.	Cloclaerts S, Dossche L. Combined arthroscopic techniques in the treatment of non-union of the anterior tibial spine. Acta Orthop Belg, 2011, 77(3): 394-397.
6.	Liljeros K, Werner S, Janarv PM. Arthroscopic fixation of anterior tibial spine fractures with bioabsorbable nails in skeletally immature patients. Am J Sports Med, 2009, 37(5): 923-928.
7.	Bonin N, Jeunet L, Obert L, et al. Adult tibial eminence fracture fixation: arthroscopic procedure using K-wire folded fixation. Knee Surg Sports Traumatol Arthrosc, 2007, 15(7): 857-862.
8.	Huang TW, Hsu KY, Cheng CY, et al. Arthroscopic suture fixation of tibial eminence avulsion fractures. Arthroscopy, 2008, 24(11): 1232-1238.
9.	Mahar AT, Duncan D, Oka R, et al. Biomechanical comparison of four different fixation techniques for pediatric tibial eminence avulsion fractures. J Pediatr Orthop, 2008, 28(2): 159-162.
10.	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.
11.	Fabricant PD, Osbahr DC, Green DW. Management of a rare complication after screw fixation of a pediatric tibial spine avulsion fracture: a case report with follow-up to skeletal maturity. J Orthop Trauma, 2011, 25(12): e115-e119.
12.	Kocher MS, Saxon HS, Hovis WD, et al. Management and complications of anterior cruciate ligament injuries in skeletally immature patients: survey of the Herodicus Society and The ACL Study Group. J Pediatr Orthop, 2002, 22(4): 452-457.
13.	Eggers AK, Beeker C, Weimann A, et al. Biomechanical evaluation of different fixation methods for tibial eminence fractures. Am J Sports Med, 2007, 35(3): 404-410.
14.	赵金忠, 蒋垚, 沈灏, 等. 关节镜下8字法缝线固定治疗成人胫骨髁间隆突骨折. 中国修复重建外科杂志, 2003, 17(3): 205-208.
15.	Park HJ, Urabe K, Naruse K, et al. Arthroscopic evaluation after surgical repair of intercondylar eminence fractures. Arch Orthop Trauma Surg, 2007, 127(9): 753-757.
16.	Wang J, Ao Y. Analysis of different kinds of cyclops lesions with or without extension loss. Arthroscopy, 2009, 25(6): 626-631.
17.	Kambhampati S, Ware H. Inverted cyclops lesion after anterior cruciate ligament reconstruction. Ann R Coll Surg Engl, 2012, 94(2): e99-100.

1. Shelbourne KD, Urch SE, Freeman H. Outcomes after arthroscopic excision of the bony prominence in the treatment of tibial spine avulsion fractures. Arthroscopy, 2011, 27(6): 784-791.
2. Sharma A, Lakshmanan P, Peehal J, et al. An analysis of different types of surgical fixation for avulsion fractures of the anterior tibial spine. Acta Orthop Belg, 2008, 74(1): 90-97.
3. Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg (Am), 1970, 52(8): 1677-1684.
4. Johnson DL, Durbin TC. Physeal-sparing tibial eminence fracture fixation with a headless compression screw. Orthopedics, 2012, 35(7): 604-608.
5. Cloclaerts S, Dossche L. Combined arthroscopic techniques in the treatment of non-union of the anterior tibial spine. Acta Orthop Belg, 2011, 77(3): 394-397.
6. Liljeros K, Werner S, Janarv PM. Arthroscopic fixation of anterior tibial spine fractures with bioabsorbable nails in skeletally immature patients. Am J Sports Med, 2009, 37(5): 923-928.
7. Bonin N, Jeunet L, Obert L, et al. Adult tibial eminence fracture fixation: arthroscopic procedure using K-wire folded fixation. Knee Surg Sports Traumatol Arthrosc, 2007, 15(7): 857-862.
8. Huang TW, Hsu KY, Cheng CY, et al. Arthroscopic suture fixation of tibial eminence avulsion fractures. Arthroscopy, 2008, 24(11): 1232-1238.
9. Mahar AT, Duncan D, Oka R, et al. Biomechanical comparison of four different fixation techniques for pediatric tibial eminence avulsion fractures. J Pediatr Orthop, 2008, 28(2): 159-162.
10. 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.
11. Fabricant PD, Osbahr DC, Green DW. Management of a rare complication after screw fixation of a pediatric tibial spine avulsion fracture: a case report with follow-up to skeletal maturity. J Orthop Trauma, 2011, 25(12): e115-e119.
12. Kocher MS, Saxon HS, Hovis WD, et al. Management and complications of anterior cruciate ligament injuries in skeletally immature patients: survey of the Herodicus Society and The ACL Study Group. J Pediatr Orthop, 2002, 22(4): 452-457.
13. Eggers AK, Beeker C, Weimann A, et al. Biomechanical evaluation of different fixation methods for tibial eminence fractures. Am J Sports Med, 2007, 35(3): 404-410.
14. 赵金忠, 蒋垚, 沈灏, 等. 关节镜下8字法缝线固定治疗成人胫骨髁间隆突骨折. 中国修复重建外科杂志, 2003, 17(3): 205-208.
15. Park HJ, Urabe K, Naruse K, et al. Arthroscopic evaluation after surgical repair of intercondylar eminence fractures. Arch Orthop Trauma Surg, 2007, 127(9): 753-757.
16. Wang J, Ao Y. Analysis of different kinds of cyclops lesions with or without extension loss. Arthroscopy, 2009, 25(6): 626-631.
17. Kambhampati S, Ware H. Inverted cyclops lesion after anterior cruciate ligament reconstruction. Ann R Coll Surg Engl, 2012, 94(2): e99-100.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF ARTHROSCOPIC TREATMENT OF ANTERIOR CRUCIATE LIGAMENT TIBIAL EMINENCE AVULSION FRACTURE WITH NON-ABSORBABLE SUTURE FIXATION COMBINED WITH MINI-PLATE

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