ObjectiveTo evaluate the clinical results of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fractures in adolescents with epiphyseal unclosure. MethodsBetween January 2011 and October 2013, 35 knees with ACL tibial eminence avulsion fractures (35 patients with epiphyseal unclosure) were arthroscopically treated with suture fixation. There were 25 males and 10 females, aged 8-16 years (mean, 14.7 years). The causes included sports injury in 24 cases, traffic accident injury in 9 cases, and daily life injury in 2 cases. According to Meyers-McKeever classification criteria, there were 27 cases of type Ⅱ and 8 cases of type Ⅲ. Five cases had meniscus injury. The preoperative the International Knee Documentation Committee (IKDC) score was 48.7±3.2, and Lysholm score was 51.2±4.5. The time from injury to operation was 2-16 days (mean, 5 days). ResultsPrimary healing of incision was obtained in all patients. The mean follow-up time was 22.4 months (range, 12-32 months). Anatomical reduction was achieved in 28 cases and satisfactory reduction in 7 cases. X-ray films showed all fractures healing at last follow-up. There was no limb shortening deformity, varus knee, or valgus knee. Lachman test results were all negative. The other knees had normal range of motion except 1 knee with limited flexion, whose range of motion returned to 0-120° after treatment. At last follow-up, the IKDC score was significantly improved to 93.2±4.1 (t=-53.442, P=0.000), and the Lysholm score was significantly increased to 96.2±2.5 (t=-56.242, P=0.000). ConclusionThe arthroscopic fixation technique has satisfactory results for the reduction and fixation of ACL tibial eminence avulsion fracture in the adolescents with epiphyseal unclosure because of little trauma and quick recovery.
ObjectiveTo investigate the clinical effects of the Ultrabraid suture with FOOTPRINT rivet by arthroscopic technique for the treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture. MethodsBetween May 2011 and December 2013, 19 adolescent patients with ACL tibial eminence avulsion fracture were treated with arthroscopic reduction and fixation by Ultrabraid sutures with FOOTPRINT rivet. There were 13 males and 6 females with an average age of 15.8 years (range, 8-18 years). The left knees were involved in 10 cases and the right knees in 9 cases. The injury causes included traffic accident injury in 8 cases, sport injury in 6 cases, and sprain injury in 5 cases. Three patients had old fractures, and the others had fresh fractures. The results of Lachman test and anterior drawer test were both positive. The International Knee Documentation Committee (IKDC) subject score was 54.2±4.0. Based on Meyers-McKeever classification, there were 3 cases of type Ⅱ, 10 cases of type Ⅲ, and 6 cases of type IV. ResultsThe operation time was 50-60 minutes (mean, 55.2 minutes). X-ray film showed satisfactory fracture reduction at 1 day after operation. Primary healing of incision was obtained with no infection. Eighteen patients were followed up for 1-3 years (mean, 1.7 years). All fractures healed with smooth joint surface on the X-ray film at 3 months after operation. The results of Lachman test and anterior drawer test were both negative in 17 cases, and the results was negative for anterior drawer test and was weakly positive for Lachman test in 1 case. The IKDC subject score was significantly improved to 96.1±2.1 at last follow-up (t=34.600, P=0.000). ConclusionIt could achieve early restoration of knee joint function to treat the ACL tibial eminence avulsion fracture by arthroscopic technique of the Ultrabraid suture with FOOTPRINT rivet because of satisfactory reduction, reliable fixation, small wound, and early rehabilitation.
ObjectiveTo conclude the effectiveness of arthroscopy combined with Burks and SchaVer's approach in the treatment of posterior cruciate ligament (PCL) avulsion fractures in a floppy lateral position. MethodsBetween May 2010 and March 2014, 21 patients with PCL avulsion fractures were treated. There were 13 males and 8 females, aged 21 to 62 years (mean, 39.1 years). The causes included traffic accident injury in 10 cases, sports injury in 5 cases, and falling injury from height in 6 cases. The time from injury to hospital was 1-6 days (mean, 2.5 days). The results of posterior drawer test were all positive, and the results of anterior drawer test and lateral stress test were all negative. The Lysholm score was 28.0±5.5 before operation. And the American Orthopaedic Foot and Ankle Society (IKDC) score was 46.2±7.6 before operation. According to Meyer standards for fractures classification, 11 cases were rated as type II and 10 cases as type III. Arthroscopy was used to inspect and treat the intra-articular lesions, then avulsion fracture was fixed by Burks and SchaVer's approach in lateral position. Postoperative functional exercises were performed. ResultsPrimary healing of incision was obtained, without nerve and vascular injury or joint infection. All patients were followed up 18-36 months (mean, 27.2 months). The X-ray films of the knee joint showed good fractures reduction and healing at 3 months after operation. The results of posterior drawer test and reverse Lachman test were negative. The knee range of motion was recovered to normal level. At last follow-up, the Lysholm score of the knee joint was significantly improved to 90.9±1.4 from preoperative one (t=54.584, P=0.000), and the IKDC score was significantly increased to 90.5±5.3 from preoperative one (t=15.638, P=0.000), including 19 cases of grade A and 2 cases of grade B. ConclusionA combination of arthroscopy and Burks and SchaVer's approach for the treatment of PCL avulsion fractures in a floppy lateral position has the advantages of minimal invasion and safe approach, short operative time, and early postoperative rehabilitation exercises, so it can provide satisfactory function recovery of the knee joint.
ObjectiveTo evaluate the specific application and effect of balance point fixation technique in arthroscopic fixation of avulsion fracture of anterior cruciate ligament.MethodsThe 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.ResultsThere 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).ConclusionsThe 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.