Summary

Arthroscopic three points suture fixation technique for ACL tibia avulsion fracture could achieve excellent clinical results.

Abstract

Purpose

The purpose of this study was to evaluate the clinical results of arthroscopic treatment of tibia avulsion fracture of the anterior cruciate ligament (ACL) with suture fixation technique through three bone tunnels. Type of study: Retrospective case series. Methods: 11 adult ACL tibia avulsion fracture cases have been treated with three points suture fixation technique under arthroscopy. During the surgery, three grands of No.2 polyester sutures were utilized. Surgical procedures: Anteromedial and anterolateral portals were set up, three grands of No.2 polyester sutures were introduced into the joint cavity, wrapped around the ACL proximal to the ACL bony fragment, crossed in front of the ACL. Then two 4.5mm bone tunnels were drilled from the medial tibia toward the ACL bone bed. The internal outlets were located at the medial side and lateral side of the ACL bone bed, the two ends of the three grands sutures passed through the lateral and medial bone tunnels separately. Attempt to pull the two suture ends tight and try to reset the ACL bony fragment. By this way, the mostly unstable anterior potion of the bony fragment was inspected, then the third 4.5mm bone tunnel was drilled toward the unstable potion, internal outlet was set nearly to this point. The upper portion sutures which located posteriorly and upper to the suture cross were pulled forward, and a suture ring was made, then the suture ring was pulled outside through the third bone tunnel, the ring-made sutures end was passed through the suture ring, pull the sutures end tight at 0 degree knee extension, and then knot the two ends tight directly or fixed the two sutures arms with one outside-row anchor. Postsurgical rehabilitation program normal includes: knee brace fixation at 0 extension for two weeks, followed by a regular rehabilitation program. Usually, get 90 degree knee flexion within 6 weeks, and get normal mobile range within 12 weeks. Follow-up time points were set at 6W, 12W and 24W postoperatively, when x-ray were performed. At the final follow-up, Lysholm score scale, Tegner rating scale, and KD-2000 measurement were evaluated according to the International Knee Documentation Committee. Results: All the cases get bony union at three months postoperatively; there were no knee relaxation under manual examination. Before surgery and at the final follow-up, the Lysholm score were 15.5±4.1vs.99±1.8(P<0.05), KD-2000 measurement (mm)were 9±2.72vs.2.55±0.52 (P<0.05); at 24 weeks postoperatively, the tibia front displacement results (mm)for the injured knees and the contralateral healthy knees were 2.55±0.52vs.2.18±0.60(P>0.05). There were no significant difference about mobile range scope between the injured knee and the contralateral healthy knee since 12W postoperatively.

Conclusions

Three points suture fixation technique for ACL tibia avulsion fracture under arthroscopy have been proved to be with the following advantages: easy operation, perfect bony fragment reduction, stable fixation, allowing for early functional exercise and achieving excellent results. Evidence: Level IV. Key words: anterior cruciate ligament, suture fixation, tibia avulsion fracture