Suture-bridge fixation under arthroscopy in treatment of tibial eminence avulsion fracture of anterior cruciate ligament in adolescents_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YAO Junna ¹ ,  WANG Honggang ² , QUAN Songtao ¹ , FENG Wei ¹ , CAI Litao ¹ , YANG MingLu ¹

1. Department of Knee Surgery, Henan Provincial Luoyang Orthopedic-Traumatological Hospital & Henan Provincial Orthopedic Hospital, Luoyang Henan, 471002, P.R.China;
2. Department of Orthopedics and Microsurgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou Guangdong, 510080, P.R.China;

Corresponding author：

WANG Honggang, Email: docwhg@sina.com

Keywords：

Arthroscopy; anterior cruciate ligament; tibial insertion avulsion fracture; suture-bridge fixation; adolescent

DOI：

10.7507/1002-1892.201804002

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Objective To explore effectiveness of suture-bridge fixation under arthroscopy in treatment of tibial eminence avulsion fracture of anterior cruciate ligament in adolescents. Methods Between June 2013 and October 2016, 18 adolescent patients suffered from tibial eminence avulsion fracture of anterior cruciate ligament were treated by suture-bridge fixation under arthroscopy. There were 11 males and 7 females with an average age of 12.5 years (range, 5-17 years). The injury caused by bruise in 6 cases, by sprain in 4 cases, and by sport injury in 8 cases. The interval between injury and admission ranged from 2 hours to 10 months (median, 2 months). The results of preoperative Lachman and anterior drawer tests were positive. There were 10 cases of knee pain, 4 cases of knee extension limitation, and 4 cases of knee extension without strength. According to the Meyer-McKeever classification criteria, 12 cases were type Ⅱ and 6 cases were type Ⅲ. Results All incisions healed by first intention. All 18 patients were followed up 10-18 months after operation, with an average of 12 months. Postoperative X-ray films showed that all fractures healed after 6-12 weeks (mean, 8 weeks). The results of postoperative Lachman and anterior drawer tests were negative. At last follow-up, the Lysholm knee score was 90.1±5.0 and 93.1±6.2 for affected and unaffected sides, respectively, showing no signifi cant difference (t=0.669, P=0.184). There was no premature closure of skeleton or leg length discrepancy deformity. Conclusion For tibial eminence avulsion fracture of anterior cruciate ligament in adolescents, the suture-bridge fixation under arthroscopy is an effective method with many advantages, such as minimal invasion, reliable fixation, good fracture healing, and no need for second operation to remove implants.

Citation： YAO Junna, WANG Honggang, QUAN Songtao, FENG Wei, CAI Litao, YANG MingLu. Suture-bridge fixation under arthroscopy in treatment of tibial eminence avulsion fracture of anterior cruciate ligament in adolescents. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(11): 1402-1405. doi: 10.7507/1002-1892.201804002 Copy

1.	Lu XW, Hu XP, Jin C, et al. Reduction and fixation of the avulsion fracture of the tibial eminence using mini-open technique. Knee Surg Sports Traumatol Arthrosc, 2010, 18(11): 1476-1480.
2.	Noyes FR, Berrios-Torres S, Barber-Westin SD, et al. Prevention of permanent arthrofibrosis after anterior cruciate ligament reconstruction alone or combined with associated procedures: a prospective study in 443 knees. Knee Surg Sports Traumatol Arthrosc, 2000, 8(4): 196-206.
3.	Huang TW, Hsu KY, Cheng CY, et al. Arthroscopic suture fixation of tibial eminence avulsion fractures. Arthroscopy, 2008, 24(11): 1232-1238.
4.	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.
5.	王庆, 黄华扬, 张涛, 等. 关节镜下螺钉与缝线固定前交叉韧带胫骨止点撕脱骨折的疗效比较. 中华创伤骨科杂志, 2015, 17(4): 309-313.
6.	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.
7.	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.
8.	Louis ML, Guillaume JM, Launay F, et al. Surgical management of type Ⅱ tibial intercondylar eminence fractures in children. J Pediatr Orthop B, 2008, 17(5): 231-235.
9.	Zhang X, Cai G, Xu J, et al. A minimally invasive postero-medial approach with suture anchors for isolated tibial avulsion fracture of the posterior cruciate ligament. Knee, 2013, 20(2): 96-99.
10.	张青松, 李涛, 方禹舜, 等. 关节镜下" 人”字缝线固定治疗后交叉韧带胫骨止点撕脱骨折. 中华创伤骨科杂志, 2016, 18(11): 998-1000.
11.	Yoon JR, Park CD, Lee DH. Arthroscopic suture bridge fixation technique with multiple crossover ties for posterior cruciate ligament tibial avulsion fracture. Knee Surg Sports Traumatol Arthrosc, 2018, 26(3): 912-918.
12.	Li R, Cai M, Tao K. Arthroscopic reduction and fixation for displaced greater tuberosity fractures using the modified suture-bridge technique. Int Orthop, 2017, 41(6): 1257-1263.
13.	赵德伟, 王本杰. 关节镜下应用带血管蒂骨瓣转移治疗股骨头缺血性坏死. 中华显微外科杂志, 2004, 27(4): 254-255.
14.	刘宁, 郇松玮, 余国荣, 等. 微创治疗桡骨远端难复性复杂性腕关节内骨折 21 例. 中华显微外科杂志, 2014, 37(4): 381-382.
15.	冯仕明, 王爱国, 张在轶, 等. 全踝关节镜技术治疗 Tillaux-Chaput 骨折的疗效分析. 中华创伤杂志, 2016, 32(12): 1080-1084.
16.	Park JS, McGarry MH, Campbell ST, et al. The optimum tension for bridging sutures in transosseous-equivalent rotator cuff repair: a cadaveric biomechanical study. Am J Sports Med, 2015, 43(9): 2118-2125.
17.	Connelly TM, Shaw A, O’Grady P. Outcome of open massive rotator cuff repairs with double-row suture knotless anchors: case series. Int Orthop, 2015, 39(6): 1109-1114.
18.	高庆峰, 成雪, 张磊, 等. 关节镜下规避骺板八字缝线固定法治疗儿童前交叉韧带胫骨止点撕脱骨折. 中华小儿外科杂志, 2014, 35(10): 746-750.

1. Lu XW, Hu XP, Jin C, et al. Reduction and fixation of the avulsion fracture of the tibial eminence using mini-open technique. Knee Surg Sports Traumatol Arthrosc, 2010, 18(11): 1476-1480.
2. Noyes FR, Berrios-Torres S, Barber-Westin SD, et al. Prevention of permanent arthrofibrosis after anterior cruciate ligament reconstruction alone or combined with associated procedures: a prospective study in 443 knees. Knee Surg Sports Traumatol Arthrosc, 2000, 8(4): 196-206.
3. Huang TW, Hsu KY, Cheng CY, et al. Arthroscopic suture fixation of tibial eminence avulsion fractures. Arthroscopy, 2008, 24(11): 1232-1238.
4. 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.
5. 王庆, 黄华扬, 张涛, 等. 关节镜下螺钉与缝线固定前交叉韧带胫骨止点撕脱骨折的疗效比较. 中华创伤骨科杂志, 2015, 17(4): 309-313.
6. 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.
7. 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.
8. Louis ML, Guillaume JM, Launay F, et al. Surgical management of type Ⅱ tibial intercondylar eminence fractures in children. J Pediatr Orthop B, 2008, 17(5): 231-235.
9. Zhang X, Cai G, Xu J, et al. A minimally invasive postero-medial approach with suture anchors for isolated tibial avulsion fracture of the posterior cruciate ligament. Knee, 2013, 20(2): 96-99.
10. 张青松, 李涛, 方禹舜, 等. 关节镜下" 人”字缝线固定治疗后交叉韧带胫骨止点撕脱骨折. 中华创伤骨科杂志, 2016, 18(11): 998-1000.
11. Yoon JR, Park CD, Lee DH. Arthroscopic suture bridge fixation technique with multiple crossover ties for posterior cruciate ligament tibial avulsion fracture. Knee Surg Sports Traumatol Arthrosc, 2018, 26(3): 912-918.
12. Li R, Cai M, Tao K. Arthroscopic reduction and fixation for displaced greater tuberosity fractures using the modified suture-bridge technique. Int Orthop, 2017, 41(6): 1257-1263.
13. 赵德伟, 王本杰. 关节镜下应用带血管蒂骨瓣转移治疗股骨头缺血性坏死. 中华显微外科杂志, 2004, 27(4): 254-255.
14. 刘宁, 郇松玮, 余国荣, 等. 微创治疗桡骨远端难复性复杂性腕关节内骨折 21 例. 中华显微外科杂志, 2014, 37(4): 381-382.
15. 冯仕明, 王爱国, 张在轶, 等. 全踝关节镜技术治疗 Tillaux-Chaput 骨折的疗效分析. 中华创伤杂志, 2016, 32(12): 1080-1084.
16. Park JS, McGarry MH, Campbell ST, et al. The optimum tension for bridging sutures in transosseous-equivalent rotator cuff repair: a cadaveric biomechanical study. Am J Sports Med, 2015, 43(9): 2118-2125.
17. Connelly TM, Shaw A, O’Grady P. Outcome of open massive rotator cuff repairs with double-row suture knotless anchors: case series. Int Orthop, 2015, 39(6): 1109-1114.
18. 高庆峰, 成雪, 张磊, 等. 关节镜下规避骺板八字缝线固定法治疗儿童前交叉韧带胫骨止点撕脱骨折. 中华小儿外科杂志, 2014, 35(10): 746-750.

Chinese Journal of Reparative and Reconstructive Surgery

Suture-bridge fixation under arthroscopy in treatment of tibial eminence avulsion fracture of anterior cruciate ligament in adolescents

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