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Xiao Y, Shi C, Deng G, Ding Z, Xu J, Chen B. Screw placement through a higher medial portal provides better initial stability in arthroscopic ACL tibial avulsion fracture fixation: a finite element analysis. BMC Musculoskelet Disord 2024; 25:564. [PMID: 39033113 PMCID: PMC11264942 DOI: 10.1186/s12891-024-07695-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 07/16/2024] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVE The objective of this study was to investigate the initial stability of different screw placements in arthroscopic anterior cruciate ligament (ACL) tibial avulsion fracture fixation. METHODS A three-dimensional knee model at 90° flexion was utilized to simulate type III ACL tibial avulsion fracture and arthroscopic screw fixation through different portals, namely the central transpatellar tendon portal (CTP), anterolateral portal (ALP), anteromedial portal (AMP), lateral parapatellar portal (LPP), medial parapatellar portal (MPP), lateral suprapatellar portal (LSP), medial suprapatellar portal (MSP). A shear force of 450 N was applied to the finite element models at 30° flexion to simulate the failure condition. The displacement of the bony fragment and the volume of the bone above 25,000 µ-strain (damaged bone volume) were calculated around the screw path. RESULTS When the screw was implanted through CTP, the displacement of the bony fragment reached the maximum displacement which was 1.10 mm and the maximum damaged bone volume around the screw path was 148.70 mm3. On the other hand, the minimum displacement of the bony fragment was 0.45 mm when the screw was implanted through LSP and MSP. The minimum damaged bone volume was 14.54 mm3 around the screw path when the screw was implanted through MSP. CONCLUSION Screws implanted through a higher medial portal generated less displacement of the bony fragment and a minimum detrimental strain around the screw path. The findings are clinically relevant as they provide biomechanical evidence on optimizing screw placement in arthroscopic ACL tibial avulsion fracture fixation.
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Affiliation(s)
- Yang Xiao
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Changhao Shi
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Geyang Deng
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zichu Ding
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jinhuang Xu
- Department of Trauma and Joint Surgery, The Fourth Hospital affiliated to the Guangzhou Medical University, Guangzhou, China
| | - Bin Chen
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Li Y, Liu JC, Wu J, Peng X, Sun GJ, Li Z, Yin Y. Biomechanical study of posterior cruciate ligament tibial arrest avulsion fracture fixation with triple tibial channel net sutures. Sci Rep 2023; 13:22980. [PMID: 38151505 PMCID: PMC10752874 DOI: 10.1038/s41598-023-50479-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/20/2023] [Indexed: 12/29/2023] Open
Abstract
To investigate the biomechanical properties of posterior cruciate ligament avulsion fractures of the tibia fixed using four different methods, including triple tibial channel net suture fixation. In 40 porcine knees, a standardized bony avulsion of the posterior cruciate ligament was generated. Double tibial bone channel suture fixation was performed in group A, double-head hollow compression screw fixation was performed in group B, triple tibial bone channel net suture fixation was performed in group C, and cortical suspension EndoButton fixation was performed in group D. The constructs were cyclically loaded 500 times (10 to 100 N) to measure the initial displacement and stiffness values. Subsequently, loading to failure was performed, and the yield load and peak load were measured. The results were analysed by one-way ANOVA, with significance set at P < 0.05. The initial displacement in group D (1.00 ± 0.20 mm) was lower than that in group C (1.46 ± 0.33 mm, P = 0.000), group B (1.91 ± 1.71 mm, P = 0.000) and group A (3.91 ± 0.79 mm, P = 0.000), but there was no significant difference between groups B and C (P = 0.055). The initial stiffness in group A (50.59 ± 6.89 N/mm) was lower than that in group C (67.21 ± 12.80 N/mm, P = 0.001), group D (71.18 ± 9.20 N/mm, P = 0.000) and group B (78.67 ± 5.91 N/mm, P = 0.000). However, there was no significant difference between groups B and D or between groups C and D (P = 0.111 and P = 0.391). The yield load in group A (554.86 ± 71.43 N) was lower than that in group C (767.00 ± 34.53 N, P = 0.000), group D (777.62 ± 73.03 N, P = 0.000) and group B (837.50 ± 55.73 N, P = 0.000). There was no significant difference between groups C and D (P = 0.729). The peak load in group A (667.38 ± 61.54 N) was lower than that in group C (842.00 ± 26.20 N, P = 0.000), group D (867.63 ± 63.42 N, P = 0.000) and group B (901.25 ± 54.38 N, P = 0.000). There was no significant difference between groups C and D (P = 0.346). Different failure modes were found among the four groups. The triple tibial bone channel suture fixation group showed better initial stability and fixation strength, which was comparable to that in the cortical suspension EndoButton fixation group and double-head hollow compression screw fixation group and significantly stronger than that in the double tibial bone channel suture fixation group. This study analysed the dynamic and static indexes of posterior cruciate ligament tibial avulsion fractures fixed by four different fixation methods under cyclic loading tests and single failure loading tests, providing a theoretical basis for clinical treatment.
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Affiliation(s)
- Yuan Li
- Department of Joint Surgery, Suining Central Hospital, Suining, 629000, Sichuan, People's Republic of China
| | - Jun-Cai Liu
- Department of Orthopaedics, Sichuan Provincial Laboratory of Orthopaedic Engineering, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, People's Republic of China
| | - Ju Wu
- Department of Stomatology, Suining Central Hospital, Suining, 629000, Sichuan, People's Republic of China
| | - Xu Peng
- Department of Joint Surgery, Suining Central Hospital, Suining, 629000, Sichuan, People's Republic of China
| | - Guan-Jun Sun
- Department of Joint Surgery, Suining Central Hospital, Suining, 629000, Sichuan, People's Republic of China
| | - Zhong Li
- Department of Orthopaedics, Sichuan Provincial Laboratory of Orthopaedic Engineering, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, People's Republic of China.
| | - Yi Yin
- Department of Joint Surgery, Suining Central Hospital, Suining, 629000, Sichuan, People's Republic of China.
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Functional outcomes after using the glenoid fossa as a fixed anchorage for the temporomandibular joint discopexy in patients with disc displacement without reduction. J Craniomaxillofac Surg 2021; 50:26-31. [PMID: 34602316 DOI: 10.1016/j.jcms.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 09/10/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022] Open
Abstract
The aim of the present study was to evaluate the use of the glenoid fossa as an anchorage for the temporomandibular joint (TMJ) disc repositioning in patients with a disc displacement (DD) without reduction. A prospective case series study included patients with DD without reduction. According to the Wilkes staging system for the TMJ internal derangement, preoperative magnetic resonance imaging (MRI) scans and clinical examinations determine the stage of the DD. The discopexy treatment consists of combined endaural/preauricular incision on the tragus, and freeing the anteromedial displaced disc from its attachments. An intra bony hole was drilled 2 mm away from the postero-lateral lip of the glenoid fossa and perpendicular to it. The disc was securely fixed to the roof of the fossa via a Prolene 0 suture in a double-pass suture fashion. The functional assessment was based on the pain visual analogue scale (VAS) and measurements of the maximum inter-incisal opening (MIO) after 1, 6, 12, and 18 months. P values ≤ 0.05 were considered significant. Thirteen of 25 joints were diagnosed with Wilkes stage III. The mean VAS score significantly decreased to 2.2 ± 1.0 and the MIO also significantly improved with a mean of 35.9 ± 3.5 mm after 18 months (P < 0.001). The rest of the cases (12 joints) were diagnosed with Wilkes stage IV, and the VAS score decreased to 1.6 ± 0.7. The MIO increased to 34.2 ± 3.3 mm at the end of the follow-up (P < 0.001). Within the limitations of the study, it seems that using the glenoid fossa as anchorage for the TMJ disc might have some clinical relevance and therefore might be taken into consideration whenever it is deemed appropriate.
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Arthroscopic Fixation of Anterior Cruciate Ligament Avulsion Fracture Using FiberWire Suture With Suture Disc. Arthrosc Tech 2021; 10:e1709-e1715. [PMID: 34336568 PMCID: PMC8322570 DOI: 10.1016/j.eats.2021.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/09/2021] [Indexed: 02/03/2023] Open
Abstract
Controversy still exists regarding how to reduce and fix a displaced tibial avulsion fracture. Open reduction and internal fixation may lead to morbidity due to soft-tissue injury and arthrotomy. As a result, arthroscopic techniques are increasing in popularity. In the literature, sutures, K wires, and screws are suggested to be used as the fixation devices. Screws cannot be used in small or comminuted fractures, whereas K wires and sutures may not provide strong stability. Recently, with the advent of ultrahigh molecular weight polyethylene sutures like FiberWire, it has become possible to use it as the fixation device in even comminuted avulsion fractures with acceptable reduction stability. In this paper, we describe a simple arthroscopic technique using a FiberWire to manage the displaced tibial eminence avulsion fracture.
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Zhang L, Zhang L, Zheng J, Ren B, Kang X, Zhang X, Dang X. Arthroscopic tri-pulley Technology reduction and internal fixation of pediatric Tibial Eminence fracture: a retrospective analysis. BMC Musculoskelet Disord 2020; 21:408. [PMID: 32600299 PMCID: PMC7325093 DOI: 10.1186/s12891-020-03421-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 06/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fixing a tibial eminence fracture with a tri-pulley is a new technique. The purpose of this study was to present the early clinical outcome of arthroscopic tri-pulley suture fixation for tibial eminence fractures in children. METHODS Twenty-one pediatric patients with type II or type III anterior tibial eminence fractures were included in this retrospective study. All Patients underwent surgical fixation by tri-pulley technology and were followed up for at least 24 months. They were evaluated preoperatively and postoperatively by physical, X-ray, and computed tomography (CT) examination and subjectively with the International Knee Documentation Committee (IKDC), and Lysholm questionnaires. RESULTS The patients included 12 males and 9 females; mean age, 12.5 years (range, 8 ~ 16 years). They were followed-up for a median of 27 months (range, 24 ~ 39 months). We did not find post-operative instability in any of the patients by physical examination. The KT-2000 difference of both knees decreased from 9.3 ± 1.2 mm preoperatively to 2.6 ± 0.8 mm 24 months postoperatively (P < 0.001); the IKDC subjective knee evaluation score improved from 43.1 ± 13.2 preoperatively to 83.8 ± 6.3 postoperatively (P < 0.001); and Lysholm improved from 48.3 ± 6.21 to 87.1 ± 9.8 (P < 0.001). No unhealed fractures or epiphyseal damage were reported in the postoperative X-ray and CT. CONCLUSIONS Arthroscopic tri-pulley fixation technology may provide a suitable technique for repair of tibial eminence fractures in skeletally immature patients. LEVEL OF EVIDENCE Case series; Level of evidence IV.
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Affiliation(s)
- Liang Zhang
- Sport Medicine Center, Honghui Hospital Affiliated with the School of Medicine, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Li Zhang
- Anesthesiology Department, Honghui Hospital Affiliated with the School of Medicine, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Jiang Zheng
- Sport Medicine Center, Honghui Hospital Affiliated with the School of Medicine, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Bo Ren
- Sport Medicine Center, Honghui Hospital Affiliated with the School of Medicine, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Xin Kang
- Sport Medicine Center, Honghui Hospital Affiliated with the School of Medicine, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Xian Zhang
- Sport Medicine Center, Honghui Hospital Affiliated with the School of Medicine, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Xiaoqian Dang
- First Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710000, China.
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Shin CH, Lee DJ, Choi IH, Cho TJ, Yoo WJ. Clinical and radiological outcomes of arthroscopically assisted cannulated screw fixation for tibial eminence fracture in children and adolescents. BMC Musculoskelet Disord 2018; 19:41. [PMID: 29409477 PMCID: PMC5801812 DOI: 10.1186/s12891-018-1960-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 01/31/2018] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to determine the efficacy and complications of arthroscopically assisted reduction and fixation with cannulated screws for tibial eminence fracture in skeletally immature patients. Methods This was a retrospective case series study. Forty-eight patients who were skeletally immature at the time of tibial eminence fracture were treated in a tertiary children’s hospital between May 2004 and August 2015. Twenty-one patients were excluded due to non-operative treatment (n = 10), other surgical treatments (n = 9), multiple fracture (n = 1), and follow-up < 1 year (n = 1). Twenty-seven knees of 27 patients were analyzed. Avulsed fragment was reduced arthroscopically. One to three cannulated screws (4.0 mm or 5.0 mm in diameter) were used for fixation. Passive knee motion was started in 3–4 weeks. Clinical outcomes were evaluated by Lysholm score, instability of the knee, and complications. Radiological outcomes including nonunion and malunion of the avulsed fragment and physeal growth disturbance were evaluated. Results Mean age at the time of surgery was 10.1 years (range, 6.2 to 13.8 years). Patients were followed up for a mean of 3.9 years (range, 1.0 to 7.6 years). Fracture types included type III (n = 13), type II (n = 12), and type IV (n = 2) according to Zaricznyj modification of Meyers and McKeever classification. Meniscus was entrapped in five patients. Six patients showed concomitant meniscal tear. Mean Lysholm score at the latest follow-up was 95 (range, 78 to 100). Joint instability was not observed in any patient except one (instability of 5–10 mm). All patients showed full range of knee motion except one (10 degrees of flexion contracture). Screw head impingement against intercondylar notch of the femur was observed in two patients during screw removal procedure. Five knees showed prominent tibial eminence without symptoms. The injured lower limb was longer than the contralateral normal side by a mean of 6.2 mm (range, − 4 to 18 mm). Conclusions Arthroscopically assisted reduction and fixation with cannulated screws is an effective and safe surgical option for treating tibial eminence fracture with few complications.
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Affiliation(s)
- Chang Ho Shin
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Doo Jae Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - In Ho Choi
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Tae-Joon Cho
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Won Joon Yoo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea.
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Arthroscopic repair of "peel-off" lesion of the posterior cruciate ligament at the femoral condyle. Arthrosc Tech 2014; 3:e149-54. [PMID: 24749037 PMCID: PMC3986506 DOI: 10.1016/j.eats.2013.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 09/20/2013] [Indexed: 02/03/2023] Open
Abstract
Posterior cruciate ligament (PCL) injuries are uncommon, and most occur in association with other lesions. The treatment of PCL injuries remains controversial; in addition, PCL injuries have been documented to have a propensity to heal. In the literature several different patterns of PCL injury have been described including midsubstance tears/injuries, tibial bony avulsions, femoral bony avulsions, and femoral "peel-off" injuries. A peel-off injury is a complete or incomplete soft-tissue disruption of the PCL at its femoral attachment site without associated bony avulsion. In recent years arthroscopic repair of femoral avulsion and peel-off lesions of the PCL has been reported. In most of these articles, a transosseous repair with sutures passed through 2 bone tunnels into the medial femoral condyle has been described. We present a case of a femoral PCL avulsion in a 20-year-old collegiate football player with an associated medial collateral ligament injury, and we report about a novel technique for PCL repair using 2 No. 2 FiberWire sutures and two 2.9-mm PushLock anchors (Arthrex) to secure tensioning the ligament at its footprint.
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Chen JL, Allen CR, Stephens TE, Haas AK, Huston LJ, Wright RW, Feeley BT. Differences in mechanisms of failure, intraoperative findings, and surgical characteristics between single- and multiple-revision ACL reconstructions: a MARS cohort study. Am J Sports Med 2013; 41:1571-8. [PMID: 23698386 PMCID: PMC3839418 DOI: 10.1177/0363546513487980] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The factors that lead to patients failing multiple anterior cruciate ligament (ACL) reconstructions are not well understood. HYPOTHESIS Multiple-revision ACL reconstruction will have different characteristics than first-time revision in terms of previous and current graft selection, mode of failure, chondral/meniscal injuries, and surgical charactieristics. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A prospective multicenter ACL revision database was utilized for the time period from March 2006 to June 2011. Patients were divided into those who underwent a single-revision ACL reconstruction and those who underwent multiple-revision ACL reconstructions. The primary outcome variable was Marx activity level. Primary data analyses between the groups included a comparison of graft type, perceived mechanism of failure, associated injury (meniscus, ligament, and cartilage), reconstruction type, and tunnel position. Data were compared by analysis of variance with a post hoc Tukey test. RESULTS A total of 1200 patients (58% men; median age, 26 years) were enrolled, with 1049 (87%) patients having a primary revision and 151 (13%) patients having a second or subsequent revision. Marx activity levels were significantly higher (9.77) in the primary-revision group than in those patients with multiple revisions (6.74). The most common cause of reruptures was a traumatic, noncontact ACL graft injury in 55% of primary-revision patients; 25% of patients had a nontraumatic, gradual-onset recurrent injury, and 11% had a traumatic, contact injury. In the multiple-revision group, a nontraumatic, gradual-onset injury was the most common cause of recurrence (47%), followed by traumatic noncontact (35%) and nontraumatic sudden onset (11%) (P < .01 between groups). Chondral injuries in the medial compartment were significantly more common in the multiple-revision group than in the single-revision group, as were chondral injuries in the patellofemoral compartment. CONCLUSION Patients with multiple-revision ACL reconstructions had lower activity levels, were more likely to have chondral injuries in the medial and patellofemoral compartments, and had a high rate of a nontraumatic, recurrent injury of their graft.
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Affiliation(s)
- James L. Chen
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Christina R. Allen
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Thomas E. Stephens
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Amanda K. Haas
- Department of Orthopaedic Surgery, Washington University, St Louis, Missouri
| | - Laura J. Huston
- Department of Orthopaedic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Rick W. Wright
- Department of Orthopaedic Surgery, Washington University, St Louis, Missouri
| | - Brian T. Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California,Address correspondence to Brian T. Feeley, MD, University of California, San Francisco, 1500 Owens Avenue, Box 3004, San Francisco, CA 94158 ()
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Kim JI, Kwon JH, Seo DH, Soni SM, Muñoz M, Nha KW. Arthroscopic hybrid fixation of a tibial eminence fracture in children. Arthrosc Tech 2013; 2:e117-20. [PMID: 23875135 PMCID: PMC3716210 DOI: 10.1016/j.eats.2012.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 12/21/2012] [Indexed: 02/03/2023] Open
Abstract
The treatment of an anterior cruciate ligament (ACL) avulsion fracture is controversial, especially in skeletally immature patients, because of concerns about physeal damage. To reduce the risk of physeal injury, an arthroscopic technique was performed. A bioabsorbable suture anchor was inserted through anteromedial portals and fixed to a bioabsorbable suture anchor at the center of the fracture bed; it was then passed through the threads at the ACL avulsion fragment and tied with the ACL substance. After this, the avulsion fragment was repaired by an all-inside technique between the distal portion of the ACL and the transverse ligament and periosteum by a suture hook. The arthroscopic hybrid technique using a suture anchor with an all-inside repair is more rigid and safe. In addition, this physeal-sparing fixation is possible in immature patients.
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Affiliation(s)
- Jong In Kim
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University, Ilsan, Korea
| | - Jae Ho Kwon
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University, Ilsan, Korea
| | - Dong Hyun Seo
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University, Ilsan, Korea
| | - Shaishav M. Soni
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University, Ilsan, Korea,Department of Orthopedic Surgery, Siddhi Vinayak Hospital, Ahmedabad, India
| | - Michael Muñoz
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University, Ilsan, Korea,Department of Orthopaedic Surgery, De La Salle Medical Center, Manila, Philippines
| | - Kyung Wook Nha
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University, Ilsan, Korea,Address correspondence to Kyung Wook Nha, M.D., Department of Orthopedic Surgery, Ilsan Paik Hospital, College of Medicine, Inje University, 2240, Daehwa-dong, Ilsan-seogu, Koyang-si, Gyeonggido, South Korea.
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Ezechieli M, Schäfer M, Becher C, Dratzidis A, Glaab R, Ryf C, Hurschler C, Ettinger M. Biomechanical comparison of different fixation techniques for reconstruction of tibial avulsion fractures of the anterior cruciate ligament. INTERNATIONAL ORTHOPAEDICS 2013; 37:919-23. [PMID: 23456017 DOI: 10.1007/s00264-013-1835-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 02/14/2013] [Indexed: 01/29/2023]
Abstract
PURPOSE The most common fixation techniques for tibial avulsion fractures of the anterior cruciate ligament (ACL) described in the literature are screw and suture fixation. The fixation of these fractures with the TightRope® device might be an alternative. Up to now it has been commonly used in other injuries, such as acromioclavicular joint or syndesmosis ruptures. The purpose of this study was to evaluate the biomechanical properties of different fixation techniques for the reconstruction of tibial avulsion fractures. METHODS Type III tibial avulsion fractures were simulated in 40 porcine knees. Each specimen was randomly assigned to one of four groups: (1) anterograde screw fixation, (2) suture fixation, (3) TightRope® fixation or (4) control group. The initial displacement, strength to failure and the failure mode were documented. RESULTS The maximum load to failure was 1,345 ± 155.5 N for the control group, 402.5 ± 117.6 N for the TightRope® group, 367 ± 115.8 N for the suture group and 311.7 ± 120.3 N for the screw group. The maximum load to failure of the control group was significantly larger compared to all other groups. The initial dislocation was 0.28 ± 0.09 mm for the control group, 0.55 ± 0.26 mm for the TightRope® group, 0.84 ± 0.15 mm for the screw group and 1.14 ± 0.9 mm for the suture group. The initial dislocation was significantly larger for the suture group compared to the TightRope® and control groups. CONCLUSIONS The TightRope® fixation shows significantly lower initial displacement compared to the suture group. The TightRope® fixation might be an alternative for the repair of ACL tibial avulsion fractures that can be used arthroscopically.
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Affiliation(s)
- Marco Ezechieli
- Department of Orthopaedic Surgery, Hannover Medical School (MHH), Anna-von-Borries-Strasse 1-7, 30625, Hannover, Germany
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Schneppendahl J, Thelen S, Gehrmann S, Twehues S, Eichler C, Koebke J, Windolf J, Hakimi M, Wild M. Biomechanical stability of different suture fixation techniques for tibial eminence fractures. Knee Surg Sports Traumatol Arthrosc 2012; 20:2092-7. [PMID: 22203047 DOI: 10.1007/s00167-011-1838-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 12/13/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE Displaced tibial eminence fractures require surgical fixation in order to obtain a stable knee joint. Suture fixation with FiberWire(®) seems to be the most favorable therapeutic option. Biomechanical studies show failure of this technique most commonly due to a suture cutout with subsequent fracture of the tibial eminence fragment. The goal of this study is to compare the biomechanical properties of three different techniques of suture fixation using FiberWire(®). METHODS Bone mineral density was evaluated in 18 human knee specimens by pqCT, and three similar groups were formed. A standardized anterior tibial eminence fracture was created, and suture fixation was performed using one of three different techniques in 6 specimens each. Cyclic and destructive testing was conducted. RESULTS Significant differences between the three techniques could be shown neither in the cycles needed to achieve a steady state nor in a failure load or initial stiffness. Almost all specimens failed by suture cutout. CONCLUSION The presented modification of the existing technique for suture fixation of tibial eminence fractures did not lead to an increased initial stability nor did it lower the rate of suture cutout. All tested suture techniques showed comparable initial stiffness and failure load.
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Affiliation(s)
- Johannes Schneppendahl
- Department of Trauma and Hand Surgery, Heinrich Heine University Hospital Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
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