2015 ISAKOS Biennial Congress ePoster #1348

Suture Bridge Fixation for ACL Avulsion Fracture - Pitfalls and Solutions with Clinical Results in Operated Patients

Rohan Bansal, MBBS,MS,FASM,FSS, Nagpur, Maharashtra INDIA
Rohan Bansal, MBBS,MS,FASM,FSS, Nagpur, Maharashtra INDIA
David V. Rajan, MS(Orth), MNAMS(Orth), FRCS(G), Coimbatore, Tamil Nadu INDIA
Karthik Selvaraj Murugappan, MBBS, MS(Orth), DNB, MRCS, Coimbatore, Tamil Nadu INDIA
Shyam Sundar., Peelamedu Coimbatore, Tamil Nadu INDIA
Karthik Chandrasekaran, MS (Orth), Tirupur, Tamil Nadu INDIA
Vinay Kumaraswamy, Mysore INDIA
Deebak Kumar Srinivasan, MBBS,MS, Chennai INDIA
Rajeev Raj Manandhar, MBBS,MS, FASM (ISAKOS), Kathmandu, Bagmati NEPAL
Arun Gr, MBBS,MS,FASM, Mysore, karnataka INDIA
Dinesh L, MBBS,MS,DNB, Chennai, Tamil Nadu INDIA
Ortho-one hospital, Coimbatore, Tamil Nadu, INDIA

FDA Status Cleared

Summary: Arthroscopic Suture bridge fixation is the treatment of choice for all ACL avulsion fractures which require surgical interventions and is associated with a favourable outcome

Abstract:

Objectives: To describe the difficulties one may encounter with suture bridge fixation technique for ACL Avulsion fractures and the solutions for the difficult situation one may face during surgery as well the results of Suture Bridge Fixation for ACL Avulsion Fractures.

Methods

After diagnostic arthroscopy, 2 parallel drill holes are made using ACL tibial drill guide through which fibre-wire is suture shuttled anterior and posterior to ACL avulsion fragment. These wires are brought out and tied over a bony bridge of tibia after reducing the fracture. Modifications of this technique can be used to fix difficult situations like lateral Meniscus root avulsion with ACL tibial avulsion fracture(using cross sutures),communited tibial bone fragment(using multiple suture loops through same drilled holes),large tibial bone fragment (using wider bone bridge),small bone fragment (using divergent bone bridge), unstable fragment reduction(using multiple suture loops through same drilled holes) or the elevated(non-anatomically reduced ) bone fragment(using debridement).Patients were followed-up for a period ranging from 6 months to 4 years. Patients post-operative IKDC,Tegner and Lysholm scores were evaluated along with the return to activities.

Results

34 patients with ACL avulsion fracture were treated at our hospital with follow-up ranging from1- 5 years. All patients had improvement in IKDC score. No patient had subjective instability and all had a firm end point on clinical examination. In 2 patients there was non-anatomical reduction of the ACL avulsion fracture but patients remain asymptomatic and were able to return to all routine activities with improved IKDC scores. All patients were treated with Suture bridge type of arthroscopic ACL avulsion fracture fixation.

Conclusion

Arthroscopic Suture bridge fixation can be the treatment of choice for all ACL avulsion fractures [including Lateral Meniscus root avulsion with ACL tibial avulsion fracture, communited tibial bone fragment, large or small tibial bone fragment, communited bone fragment or the elevated(non-anatomically reduced) bone fragment]which require surgical interventions and is associated with a favourable outcome.