BIOMECHANICAL STUDY ON SUTURE WITH NECKWEAR-KNOT-LOOPLIGATURE FOR TIBIAL EMINENCE AVULSION FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANGJiangtao ^1,2 , SHENXuezhen ¹ , LIUChang ³ , QIWei ¹ , QUFeng ¹ , YUANBangtuo ¹ , ZHAOGang ¹ , GUOQi ¹ , LIHongliang ¹ , LUXi ¹ , ZHUJuanli ¹ , LIUYang ¹ ,  LIUYujie ¹

1. Department of Orthopaedics, General Hospital of Chinese PLA, Beijing, 100853, P. R. China;
2. The 3rd Department of Orthopaedics, Bethune International Peace Hospital;
3. Department of Orthopaedics, Cangzhou Central Hospital;

Corresponding author：

LIUYujie, Email: liuyujie301@163.com

Keywords：

Tibial eminence avulsion fracture; Neckwear-knot-loop-ligature; Internal fixation; Biomechanics; Porcine

DOI：

10.7507/1002-1892.20150234

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Objective To 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. Methods Twenty-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. Results Failure 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). Conclusion Compared 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.

Citation： WANGJiangtao, SHENXuezhen, LIUChang, QIWei, QUFeng, YUANBangtuo, ZHAOGang, GUOQi, LIHongliang, LUXi, ZHUJuanli, LIUYang, LIUYujie. BIOMECHANICAL STUDY ON SUTURE WITH NECKWEAR-KNOT-LOOPLIGATURE FOR TIBIAL EMINENCE AVULSION FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(9): 1080-1083. doi: 10.7507/1002-1892.20150234 Copy

1.	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.
2.	Hapa O, Barbe FA, Süner G, et al. Biomechanical comparison of tibial eminence fracture fixation with high-strength suture, EndoButton, and suture anchor. Arthroscopy, 2012, 28(5):681-687.
3.	Wang KH, Oh HK, Yoo SH, et al. Arthroscopic transpatellar cannulated screw fixation of tibia eminence fractures in the adult. Orthopedics, 2011, 34(3):181-185.
4.	Sang W, Zhu L, Ma J, 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.
5.	刘玉杰, 王俊良, 齐伟, 等. 不可吸收缝线领带结套扎固定技术治疗胫骨髁间隆突撕脱骨折. 中国修复重建外科杂志, 2011, 25(8): 903-906.
6.	王琪, 李众利, 刘玉杰, 等. 关节镜下带线可吸收双锚钉治疗胫骨髁间嵴撕脱骨折. 中国修复重建外科杂志, 2011, 25(2):220-224.
7.	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.
8.	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.
9.	Senekovic V, Balazic M. Bioabsorbable sutures versus screw fixation of displaced tibial eminence fractures:a biomechanical study. Eur J Orthop Surg Traumatol, 2014, 24(2):209-216.
10.	Kluemper CT, Snyder GM, Coats AC, et al. Arthroscopic suture fixation of tibial eminence fractures. Orthopedics, 2013, 36(11): e1401-e1406.
11.	Schneppendahl J, Thelen S, Twehues S, et al. The use of biodegradable sutures for the fixation of tibial eminence fractures in children:a comparison using PDS Ⅱ, Vicryl and FiberWire. J Pediatr Orthop, 2013, 33(4):409-414.
12.	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.
13.	Anderson CN, Nyman JS, McCullough KA, et al. Biomechanical evaluation of physeal-sparing fixation methods in tibial eminence fractures. Am J Sports Med, 2013, 41(7):1586-1594.
14.	Sawyer GA, Anderson BC, Paller D, et al. Biomechanical analysis of suture bridge fixation for tibial eminence fractures. Arthroscopy, 2012, 28(10):1533-1539.
15.	Sawyer GA, Hulstyn MJ, Anderson BC, et al. Arthroscopic suture bridge fixation of tibial intercondylar eminence fractures. Arthrosc Tech, 2013, 2(4):e315-e318.
16.	Senekovic V, Veselko M. Anterograde arthroscopic fixation of avulsion fractures of the tibial eminence with a cannulated screw: five-year results. Arthroscopy, 2003, 19 (1):54-61.
17.	Fleming BC, Carey JL, Spindler KP, et al. Can suture repair of ACL transection restore normal anteroposterior laxity of the knee? An ex vivo study. J Orthop Res, 2008, 26(11):1500-1505.
18.	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.
19.	Schneppendahl J, Thelen S, Gehrmann S, et al. Biomechanical stability of different suture fixation techniques for tibial eminence fractures. Knee Surg Sports Traumatol Arthrosc, 2012, 20 (10):2092-2097.
20.	Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg (Am), 1970, 52(8):1677-1684.
21.	Zaricznyj B. Avulsion fracture of the tibial eminence:treatment by open reduction and pinning. J Bone Joint Surg (Am), 1977, 59(8): 1111-1114.
22.	Eggers AK, Becker C, Weimann A, et al. Biomechanical evaluation of different fixation methods for tibial eminence fractures. Am J Sports Med, 2007, 35(3):404-410.
23.	Anderson CN, Anderson AF. Tibial eminence fractures. Clin Sports Med, 2011, 30(4):727-742.

1. 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.
2. Hapa O, Barbe FA, Süner G, et al. Biomechanical comparison of tibial eminence fracture fixation with high-strength suture, EndoButton, and suture anchor. Arthroscopy, 2012, 28(5):681-687.
3. Wang KH, Oh HK, Yoo SH, et al. Arthroscopic transpatellar cannulated screw fixation of tibia eminence fractures in the adult. Orthopedics, 2011, 34(3):181-185.
4. Sang W, Zhu L, Ma J, 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.
5. 刘玉杰, 王俊良, 齐伟, 等. 不可吸收缝线领带结套扎固定技术治疗胫骨髁间隆突撕脱骨折. 中国修复重建外科杂志, 2011, 25(8): 903-906.
6. 王琪, 李众利, 刘玉杰, 等. 关节镜下带线可吸收双锚钉治疗胫骨髁间嵴撕脱骨折. 中国修复重建外科杂志, 2011, 25(2):220-224.
7. 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.
8. 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.
9. Senekovic V, Balazic M. Bioabsorbable sutures versus screw fixation of displaced tibial eminence fractures:a biomechanical study. Eur J Orthop Surg Traumatol, 2014, 24(2):209-216.
10. Kluemper CT, Snyder GM, Coats AC, et al. Arthroscopic suture fixation of tibial eminence fractures. Orthopedics, 2013, 36(11): e1401-e1406.
11. Schneppendahl J, Thelen S, Twehues S, et al. The use of biodegradable sutures for the fixation of tibial eminence fractures in children:a comparison using PDS Ⅱ, Vicryl and FiberWire. J Pediatr Orthop, 2013, 33(4):409-414.
12. 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.
13. Anderson CN, Nyman JS, McCullough KA, et al. Biomechanical evaluation of physeal-sparing fixation methods in tibial eminence fractures. Am J Sports Med, 2013, 41(7):1586-1594.
14. Sawyer GA, Anderson BC, Paller D, et al. Biomechanical analysis of suture bridge fixation for tibial eminence fractures. Arthroscopy, 2012, 28(10):1533-1539.
15. Sawyer GA, Hulstyn MJ, Anderson BC, et al. Arthroscopic suture bridge fixation of tibial intercondylar eminence fractures. Arthrosc Tech, 2013, 2(4):e315-e318.
16. Senekovic V, Veselko M. Anterograde arthroscopic fixation of avulsion fractures of the tibial eminence with a cannulated screw: five-year results. Arthroscopy, 2003, 19 (1):54-61.
17. Fleming BC, Carey JL, Spindler KP, et al. Can suture repair of ACL transection restore normal anteroposterior laxity of the knee? An ex vivo study. J Orthop Res, 2008, 26(11):1500-1505.
18. 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.
19. Schneppendahl J, Thelen S, Gehrmann S, et al. Biomechanical stability of different suture fixation techniques for tibial eminence fractures. Knee Surg Sports Traumatol Arthrosc, 2012, 20 (10):2092-2097.
20. Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg (Am), 1970, 52(8):1677-1684.
21. Zaricznyj B. Avulsion fracture of the tibial eminence:treatment by open reduction and pinning. J Bone Joint Surg (Am), 1977, 59(8): 1111-1114.
22. Eggers AK, Becker C, Weimann A, et al. Biomechanical evaluation of different fixation methods for tibial eminence fractures. Am J Sports Med, 2007, 35(3):404-410.
23. Anderson CN, Anderson AF. Tibial eminence fractures. Clin Sports Med, 2011, 30(4):727-742.

Chinese Journal of Reparative and Reconstructive Surgery

BIOMECHANICAL STUDY ON SUTURE WITH NECKWEAR-KNOT-LOOPLIGATURE FOR TIBIAL EMINENCE AVULSION FRACTURES

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