"Figure-of-Eight" Suture-Button Technique for Fixation of Displaced Anterior Cruciate Ligament Avulsion Fracture

Overview

Journal Orthop Surg

Specialty Orthopedics

Date 2020 May 1

PMID 32351046

Citations 7

Authors

Shi-da Kuang

Chao Su

Xin Zhao

Yu-Sheng Li

Yi-lin Xiong

Shu-Guang Gao

Affiliations

Soon will be listed here.

Abstract

Objective: To assess the clinical results of the "figure-of-eight" suture-button technique in the arthroscopic treatment of anterior cruciate ligament (ACL) tibial avulsion fractures.

Methods: This was a retrospective study reviewing data from September 2013 to June 2019. A total of 27 patients (13 males and 14 females) who underwent arthroscopic "figure-of-eight" suture-button fixation for displaced ACL avulsion fractures were analyzed. The mean age of the patients in the sample was 15.8 years (10-29 years), with a mean follow-up of 24 months (6-48 months). According to Meyers-McKeever classification, 11 patients were classified as type III and 16 as type IV. All patients were evaluated following the guidelines of the radiological union, the Lysholm knee scoring scale, and the International Knee Documentation Committee (IKDC).

Results: Fractures were united within 3 months after surgery in all 27 cases. During the last follow-up, all the anterior drawer and Lachman tests were negative, except in 1 patient whose anterior drawer test was 1° positive. The range of motion was improved from 72.22° ± 27.92° before surgery to 137.78° ± 7.38° at the last follow-up (P < 0.05); the Lysholm score was improved from 45.81 ± 10.94 before surgery to 93.04 ± 5.66 at the last follow-up (P < 0.05); and the IKDC score was increased from 43.89 ± 11.16 before surgery to 90.26 ± 5.86 at the last follow-up (P < 0.05). In 1 patient, an inflammatory reaction was observed at the medial incision of the tibial tubercle; the symptoms disappeared with administration of antibiotics for 1 week. All patients returned to their preinjury physical activities at the last follow-up.

Conclusion: The "figure-of-eight" suture-button technique achieves a satisfactory clinical outcome and provides an effective method for the treatment of displaced ACL avulsion fractures.

Citing Articles

Arthroscopic mini tunnel suture bridge for ACL tibial avulsion fractures repair.

Pu J, Zheng L, Jian C Sci Rep. 2024; 14(1):25096.

PMID: 39443625 PMC: 11499657. DOI: 10.1038/s41598-024-77121-2.

Double Decker anterior cruciate ligament avulsion.

Elghaish M, El-Lahham S, Helwo A, Elfekky M, Gawish H Trauma Case Rep. 2024; 52:101053.

PMID: 38974525 PMC: 11225012. DOI: 10.1016/j.tcr.2024.101053.

A novel approach for anterior cruciate ligament tibial avulsion fracture: arthroscopic modified suture bridge fixation technique.

Wang X, Zi S, Ji X, Zhu W, Cao L Arch Orthop Trauma Surg. 2024; 144(7):3167-3173.

PMID: 38904681 DOI: 10.1007/s00402-024-05365-8.

Arthroscopic fixation of chronic bicruciate tibial avulsion fractures: A case report.

Purnomo G, Triangga A, Magetsari S, Lee J, Andrianus J Chin J Traumatol. 2023; 26(2):106-110.

PMID: 36682986 PMC: 10071323. DOI: 10.1016/j.cjtee.2023.01.002.

The most economical arthroscopic suture fixation for tibial intercondylar eminence avulsion fracture without any implant.

Yuan L, Shi R, Chen Z, Ding W, Tan H J Orthop Surg Res. 2022; 17(1):327.

PMID: 35752828 PMC: 9233839. DOI: 10.1186/s13018-022-03219-w.

References

Parikh S, Myer D, Eismann E . Prevention of arthrofibrosis after arthroscopic screw fixation of tibial spine fracture in children and adolescents. Orthopedics. 2014; 37(1):e58-65. DOI: 10.3928/01477447-20131219-18. View

Dung T, Du H, Long N, Son L, Thanh D, Son D . Arthroscopic fixation of ACL avulsion fracture in the saint pault hospital: A review of treatment outcomes: Cohort study. Ann Med Surg (Lond). 2019; 48:91-94. PMC: 6849137. DOI: 10.1016/j.amsu.2019.07.008. View

Pan R, Yang J, Chang J, Shen H, Lin L, Lian Y . Clinical outcome of arthroscopic fixation of anterior tibial eminence avulsion fractures in skeletally mature patients: a comparison of suture and screw fixation technique. J Trauma Acute Care Surg. 2012; 72(2):E88-93. DOI: 10.1097/TA.0b013e3182319d5a. View

Gamboa J, Durrant B, Pathare N, Shin E, Chen J . Arthroscopic Reduction of Tibial Spine Avulsion: Suture Lever Reduction Technique. Arthrosc Tech. 2017; 6(1):e121-e126. PMC: 5368284. DOI: 10.1016/j.eats.2016.09.010. View

Jang K, Bae J, Kim J, Wang J . Novel arthroscopic fixation method for anterior cruciate ligament tibial avulsion fracture with accompanying detachment of the anterior horn of the lateral meniscus: three-point suture fixation. Injury. 2013; 44(8):1028-32. DOI: 10.1016/j.injury.2012.12.008. View

Bong M, Romero A, Kubiak E, Iesaka K, Heywood C, Kummer F . Suture versus screw fixation of displaced tibial eminence fractures: a biomechanical comparison. Arthroscopy. 2005; 21(10):1172-6. DOI: 10.1016/j.arthro.2005.06.019. View

Baums M, Klinger H, Harer T . Treatment of malunited fractures of the anterior tibial spine. Knee Surg Sports Traumatol Arthrosc. 2003; 12(2):159-61. DOI: 10.1007/s00167-003-0387-2. View

Koukoulias N, Germanou E, Lola D, Papavasiliou A, Papastergiou S . Clinical outcome of arthroscopic suture fixation for tibial eminence fractures in adults. Arthroscopy. 2012; 28(10):1472-80. DOI: 10.1016/j.arthro.2012.03.014. View

Sinha S, Meena D, Naik A, Selvamari M, Arya R . Arthroscopic Fixation of Tibial Spine Avulsion in Skeletally Immature: The Technique. J Orthop Case Rep. 2018; 7(6):80-84. PMC: 5868892. DOI: 10.13107/jocr.2250-0685.960. View

10.

Meyers M, McKEEVER F . Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am. 1970; 52(8):1677-84. View

11.

Furlan D, Pogorelic Z, Biocic M, Juric I, Mestrovic J . Pediatric tibial eminence fractures: arthroscopic treatment using K-wire. Scand J Surg. 2010; 99(1):38-44. DOI: 10.1177/145749691009900109. View

12.

Sawyer G, Hulstyn M, Anderson B, Schiller J . Arthroscopic suture bridge fixation of tibial intercondylar eminence fractures. Arthrosc Tech. 2014; 2(4):e315-8. PMC: 3882679. DOI: 10.1016/j.eats.2013.04.004. View

13.

Elsaid A, Zein A, Elshafie M, El Said N, Mahmoud A . Arthroscopic Single-Tunnel Pullout Suture Fixation for Tibial Eminence Avulsion Fracture. Arthrosc Tech. 2018; 7(5):e443-e452. PMC: 5984281. DOI: 10.1016/j.eats.2017.11.004. View

14.

Gwinner C, Kopf S, Hoburg A, Haas N, Jung T . Arthroscopic Treatment of Acute Tibial Avulsion Fracture of the Posterior Cruciate Ligament Using the TightRope Fixation Device. Arthrosc Tech. 2014; 3(3):e377-82. PMC: 4130139. DOI: 10.1016/j.eats.2014.02.005. View

15.

Vega J, Irribarra L, Baar A, Iniguez M, Salgado M, Gana N . Arthroscopic fixation of displaced tibial eminence fractures: a new growth plate-sparing method. Arthroscopy. 2008; 24(11):1239-43. DOI: 10.1016/j.arthro.2008.07.007. View

16.

Li J, Yu Y, Liu C, Su X, Liao W, Li Z . Arthroscopic Fixation of Tibial Eminence Fractures: A Biomechanical Comparative Study of Screw, Suture, and Suture Anchor. Arthroscopy. 2018; 34(5):1608-1616. DOI: 10.1016/j.arthro.2017.12.018. View

17.

Elqirem Z, Alhanbali M, Sbieh Y . Double-Row Fixation for Avulsion of Anterior Cruciate Ligament. Arthrosc Tech. 2020; 8(12):e1473-e1477. PMC: 6928369. DOI: 10.1016/j.eats.2019.07.030. View

18.

Oohashi Y . A simple technique for arthroscopic suture fixation of displaced fracture of the intercondylar eminence of the tibia using folded surgical steels. Arthroscopy. 2001; 17(9):1007-11. DOI: 10.1053/jars.2001.24706. View

19.

Brunner S, Vavken P, Kilger R, Vavken J, Rutz E, Brunner R . Absorbable and non-absorbable suture fixation results in similar outcomes for tibial eminence fractures in children and adolescents. Knee Surg Sports Traumatol Arthrosc. 2015; 24(3):723-9. DOI: 10.1007/s00167-015-3844-9. View

20.

Boutsiadis A, Karataglis D, Agathangelidis F, Ditsios K, Papadopoulos P . Arthroscopic 4-point suture fixation of anterior cruciate ligament tibial avulsion fractures. Arthrosc Tech. 2015; 3(6):e683-7. PMC: 4314561. DOI: 10.1016/j.eats.2014.08.008. View