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.
ObjectiveTo explore the effectiveness of non-absorbable suture or suture anchor fixation by anterior approach in the treatment of anteromedial facet fractures of the ulnar coronoid process. MethodsBetween February 2007 and February 2012,16 cases of anteromedial facet fractures of the ulnar coronoid process were treated with operation.There were 9 males and 7 females,aged 20-80 years (mean,43.5 years).The causes of injury were traffic accident injury in 7 cases,tumble injury in 5 cases,and falling injury from height in 4 cases.The time from injury to operation was 6.8 days on average (range,2-8 days).All cases had closed fractures.According to O'Driscoll classification,there were 4 cases of type Ⅱ a,7 cases of type Ⅱ b,and 5 cases of type Ⅱ c.Among 16 patients,7 had simple anteromedial facet fractures of the ulnar coronoid process,and 9 had associated injury,including terrible triad in 3,Monteggia fractures in 4,and olecranon fractures in 2.All fractures were fixed with non-absorbable suture in 10 cases,and with suture anchor in 6 cases.The Mayo Elbow Performance Score (MEPS),range of motion (ROM),and complications were used to assess the elbow function. ResultsThe incisions all healed by first intension,without neurovascular injury.Fifteen patients were followed up 10-48 months (mean,25.3 months).The X-ray films showed that all fractures healed,with the mean healing time of 17.5 weeks (range,11-30 weeks).At last follow-up,the mean MEPS score was 88.5(range,55-100);the results were excellent in 10 cases,good in 3 cases,fair in 1 case,and poor in 1 case,with an excellent and good rate of 86.7%.The mean ROM of flexion and extension was 118°(range,35-145°),and the mean ROM of forearm rotation was 138°(range,85-165°).One case had elbow instability,and 3 had slight pain.No heterotopic ossification and traumatic arthritis occurred during the follow-up. ConclusionThe anteromedial facet fractures of the ulnar coronoid process can be clearly exposed through anterior approach,and the fracture fixation using non-absorbable suture and suture anchor fixation usually can restore the elbow function.