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Wang X, Zi S, Ji X, Zhu W, Cao L. A novel approach for anterior cruciate ligament tibial avulsion fracture: arthroscopic modified suture bridge fixation technique. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05365-8. [PMID: 38904681 DOI: 10.1007/s00402-024-05365-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/05/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) tibial avulsion fracture is a rare injury, which usually happens in adults with traffic accidents or sports injuries. Surgery interventions are common treatment methods, they can restore knee function and help to return to normal life. In this study, we described an arthroscopic modified suture bridge fixation technique for ACL tibial avulsion fractures and explored the feasibility and therapeutic effects. MATERIALS AND METHODS This retrospective study reviewed data from January 2020 to May 2022. Data were collected on 18 patients (10 males and 8 females) with ACL tibial avulsion fractures and underwent arthroscopic modified suture bridge fixation technique. The study analyzed surgical data about intraoperative blood loss, operation time, hospital stay, fracture healing time, and visual analog scale (VAS). Functional evaluation of the knee joint was performed using the anterior drawer test, Lysholm knee scoring scale, International Knee Documentation Committee (IKDC), and knee range of motion (ROM). RESULTS All 18 patients were followed up between 12 and 20 months, with an average of 15.22 ± 1.96 months. The intraoperative blood loss was approximately 15-40 mL, averaging 25.78 ± 6.19 mL. The operation time was 65-85 min, with a mean of 74.89 ± 4.86 min. The hospital stay of patients was 3-5 days, with a mean of 3.89 ± 0.76 days. The mean fracture healing time was 8-12 weeks after surgery, with a mean of 9.22 ± 1.7 weeks. All incisions healed grade I without infection. There were no internal fixation failures, neurovascular injuries, and lower extremity deep venous thrombosis. The anterior drawer test was negative in all patients. At the final follow-up, the mean VAS score was 0-3, averaging 1.56 ± 0.71. The Lysholm score of the injured knee was 89-96, with an average of 92.50 ± 2.50; the IKDC score was 88-93, with an average of 90.44 ± 1.89; the knee ROM was 110-126°, with an average of 120.67° ± 4.31°. CONCLUSION Results demonstrated that the modified suture bridge fixation technique under arthroscope could provide reliable fixation and favorable clinical effects for ACL tibial avulsion fractures. This is a simple, minimally invasive, effective, and clinically applicable surgical method for ACL tibial avulsion fracture.
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Affiliation(s)
- Xiong Wang
- Department of Orthopedics, Shanghai Baoshan Luodian Hospital, No. 121, Luoxi Road, Baoshan District, Shanghai, 201908, China
| | - Shuming Zi
- Department of Orthopedics, Shanghai Baoshan Luodian Hospital, No. 121, Luoxi Road, Baoshan District, Shanghai, 201908, China
| | - Xiaoxi Ji
- Department of Sports Medicine, Huashan Hospital, Fudan University, 12 Wulumuqizhong Road, Shanghai, 200040, China
| | - Wenhui Zhu
- Department of Sports Medicine, Huashan Hospital, Fudan University, 12 Wulumuqizhong Road, Shanghai, 200040, China.
| | - Liehu Cao
- Department of Orthopedics, Shanghai Baoshan Luodian Hospital, No. 121, Luoxi Road, Baoshan District, Shanghai, 201908, China.
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戴 祝, 刘 超, 陈 丹, 刘 江, 黄 文, 吴 彪, 范 伟. [Treatment of tibial insertion avulsion fracture of anterior cruciate ligament involving anterior root of lateral meniscus with multi-point fixation with anchor and suture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:1342-1346. [PMID: 37987042 PMCID: PMC10662408 DOI: 10.7507/1002-1892.202308021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/14/2023] [Indexed: 11/22/2023]
Abstract
Objective To investigate the effectiveness of arthroscopic multi-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of anterior cruciate ligament (ACL) involving the anterior root of lateral meniscus (LM). Methods A retrospective analysis was conducted on the clinical data of 28 patients with tibial insertion avulsion fracture of ACL involving the anterior root of LM who were treated with arthroscopic multi-point fixation with anchor and suture between October 2017 and January 2023. There were 12 males and 16 females with the mean age of 26 years (range, 13-57 years). There were 20 cases of sports injury and 8 cases of traffic accident injury. In 2 cases of old fracture, the time from injury to operation was 45 days and 90 days, respectively; in 26 cases of fresh fracture, the time from injury to operation was 3-20 days (mean, 6.7 days). According to the Meyers-McKeever classification, there were 4 cases of type Ⅱ, 11 cases of type Ⅲ, and 13 cases of type Ⅳ. The preoperative Lysholm knee function score was 42.1±9.0, the International Knee Documentation Committee (IKDC) score was 40.0±7.3, and the Tegner score was 0.7±0.7. Results All operations were successfully completed, and the incisions healed by first intention. All the 28 patients were followed up 5-60 months (mean, 20.4 months). During the follow-up, there was nocomplication such as infection, vascular or nerve injury, loosening or breakage of internal fixator, or stiffness of knee joint. Postoperative X-ray films showed satisfactory fracture reduction and firm fixation. All fractures healed clinically, and the healing time was 8-16 weeks (mean, 10.3 weeks). At last follow-up, Lachman test and anterior drawer test were negative. At last follow-up, Lysholm knee function score was 92.4±5.5, IKDC score was 91.6±4.4, and Tegner score was 5.2±1.1, which significantly improved when compared with preoperative scores ( t=-22.899, P<0.001; t=-29.870, P<0.001; t=-19.979, P<0.001). Conclusion Multi-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of ACL involving the anterior root of LM can not only fix the LM, but also effectively reduce and fix the avulsion fracture, which can obtain good effectiveness.
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Affiliation(s)
- 祝 戴
- 南华大学附属第一医院骨科中心运动医学专科(湖南衡阳 421000)Department of Sports Medicine, Orthopaedic Center, the First Affiliated Hospital of University of South China, Hengyang Hunan, 421000, P. R. China
| | - 超 刘
- 南华大学附属第一医院骨科中心运动医学专科(湖南衡阳 421000)Department of Sports Medicine, Orthopaedic Center, the First Affiliated Hospital of University of South China, Hengyang Hunan, 421000, P. R. China
| | - 丹 陈
- 南华大学附属第一医院骨科中心运动医学专科(湖南衡阳 421000)Department of Sports Medicine, Orthopaedic Center, the First Affiliated Hospital of University of South China, Hengyang Hunan, 421000, P. R. China
| | - 江华 刘
- 南华大学附属第一医院骨科中心运动医学专科(湖南衡阳 421000)Department of Sports Medicine, Orthopaedic Center, the First Affiliated Hospital of University of South China, Hengyang Hunan, 421000, P. R. China
| | - 文 黄
- 南华大学附属第一医院骨科中心运动医学专科(湖南衡阳 421000)Department of Sports Medicine, Orthopaedic Center, the First Affiliated Hospital of University of South China, Hengyang Hunan, 421000, P. R. China
| | - 彪 吴
- 南华大学附属第一医院骨科中心运动医学专科(湖南衡阳 421000)Department of Sports Medicine, Orthopaedic Center, the First Affiliated Hospital of University of South China, Hengyang Hunan, 421000, P. R. China
| | - 伟杰 范
- 南华大学附属第一医院骨科中心运动医学专科(湖南衡阳 421000)Department of Sports Medicine, Orthopaedic Center, the First Affiliated Hospital of University of South China, Hengyang Hunan, 421000, P. R. China
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Calvisi V, Romanini E, Staniscia D, Di Brigida G, Venosa M. Technical Note: Tibial Spine Avulsion Treatment with Arthroscopic Reduction and Internal Fixation with Kirschner Wires in Skeletally Immature Patients. Healthcare (Basel) 2023; 11:2404. [PMID: 37685438 PMCID: PMC10486765 DOI: 10.3390/healthcare11172404] [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: 07/24/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Tibial spine avulsion injury, tibial eminence injury, tibial spine fracture, and anterior cruciate ligament (ACL) avulsion are multiple terms that express the same pathological condition. It can be encountered both in the pediatric and adult population. A wide array of surgical techniques have been proposed to manage displaced tibial spine avulsions. Anyway, insufficient evidence is currently available to prefer one fixation technique over another, and a gold-standard arthroscopy-based technique is still missing. In this article, we describe a mini-invasive, safe and user-friendly technique for arthroscopic reduction and internal fixation of displaced tibial eminence fractures. MATERIALS AND METHODS Standard and patient-specific accessory arthroscopic portals allow for full access to knee visualization and management of concomitant intraarticular lesions. After performing the debridement of the inflammatory tissue and the release of eventual interposed tissues in the fracture site, the tibial eminence avulsion can be reduced by using a less-invasive bone impactor. With the knee flexed to 90°, the fracture fragments are then synthesized (under fluoroscopic control) with three thin Kirschner wires inserted in a proximal-distal direction in a cross-shaped geometry. RESULTS This technique allows a fast surgical and hospitalization time, a punctiform arthrotomy, proximal tibial physis preservation, and an early rehabilitation program. CONCLUSIONS This novel technique seems attractive and very promising since it is respectful of the epiphyseal growth plates and is thus suitable for children and adolescents.
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Affiliation(s)
- Vittorio Calvisi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Via Vetoio Coppito 2, 67100 L’Aquila, Italy; (V.C.)
- UOSD, Department of Mini-Invasive and Computer-Assisting Orthopedic Surgery, San Salvatore Hospital, Via L. Natali 1, 67100 L’Aquila, Italy
| | - Emilio Romanini
- RomaPro, Polo Sanitario San Feliciano, Via Mattia Battistini, 44, 00167 Rome, Italy
- GLOBE, Italian Working Group on Evidence-Based Orthopedics, Via Nicola Martelli, 3, 00197 Rome, Italy
| | - Donato Staniscia
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Via Vetoio Coppito 2, 67100 L’Aquila, Italy; (V.C.)
| | - Giovanni Di Brigida
- UOSD, Department of Mini-Invasive and Computer-Assisting Orthopedic Surgery, San Salvatore Hospital, Via L. Natali 1, 67100 L’Aquila, Italy
| | - Michele Venosa
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Via Vetoio Coppito 2, 67100 L’Aquila, Italy; (V.C.)
- RomaPro, Polo Sanitario San Feliciano, Via Mattia Battistini, 44, 00167 Rome, Italy
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Sun K, Fan M. Study of double button plate and cannulated screw fixation for posterior cruciate ligament avulsion fracture. Front Surg 2023; 9:887010. [PMID: 36713664 PMCID: PMC9880984 DOI: 10.3389/fsurg.2022.887010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 10/20/2022] [Indexed: 01/15/2023] Open
Abstract
Background The posterior cruciate ligament (PCL) plays an important role in maintaining the stability of the knee joint. To date, researchers have not reached agreement on which type of fixation material should be used to treat PCL tibial avulsion fractures. The aim of this study was to investigate the effects of double button plate and cannulated screw fixation in the treatment of PCL avulsion fractures. Methods We retrospectively reviewed our database, which was collected prospectively. From January 2019 to January 2020, 46 patients with posterior cruciate ligament avulsion fractures who were treated with double button plate and cannulated screw fixation. The primary outcomes of this study were surgical complications (fixation failure/displacement, implant breakage, nonunion, infection), radiological parameters, and knee function and secondary outcomes included reoperation rates for the fixation methods and the prevalence of symptomatic hardware causing soft tissue irritation outcomes were included. Values were analysed using multiple comparisons, where P-values of 0.05 or less were considered significant. Results Double button plate fixation had significantly higher values than cannulated screw fixation. The results showed that double button plate fixation was related to greater decreases in the length of surgery, intraoperative blood loss, hospital days, full weight bearing time, and incidence of complications, as well as greater increases in postoperative range of motion and Knee Society Score function and Lysholm scores. Conclusion Compared with cannulated screw fixation, the use of double button plate fixation technology has the following advantages: less trauma, shorter operation time, convenient use of instruments and fixtures, and it does not need to be removed, thus avoiding secondary trauma. Moreover, double button plate fixation under direct vision is safe and reliable without the need for additional equipment.
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Niu HM, Wang QC, Sun RZ. Therapeutic effect of two methods on avulsion fracture of tibial insertion of anterior cruciate ligament. World J Clin Cases 2022; 10:9641-9649. [PMID: 36186203 PMCID: PMC9516907 DOI: 10.12998/wjcc.v10.i27.9641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/11/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The tibial stop of anterior cruciate ligament (ACL) is fan-shaped and attached to the medial groove in front of the intercondylar spine, which is located between the anterior horn of the medial and lateral meniscus. The incidence of this fracture is low previously reported, which is common in children and adolescents. With the increase of sports injury and traffic injury and the deepening of under-standing, it is found that the incidence of the disease is high at present.
AIM To explore the difference between open reduction and internal fixation with small incision and high-intensity non-absorbable suture under arthroscopy in the treatment of tibial avulsion fracture of ACL.
METHODS Seventy-six patients with tibial avulsion fracture of anterior cruciate ligament diagnosed and treated in Guanyun County People's Hospital from April 2018 to June 2020 were retrospectively analyzed. According to the surgical methods, they were divided into group A (40 cases) and group B (36 cases). Patients in group A were treated with arthroscopic high-strength non-absorbable suture, and patients in group B were treated with small incision open reduction and internal fixation. The operation time, fracture healing time, knee joint activity and functional score before and after operation, and surgical complications of the two groups were compared.
RESULTS The operation time of group A was higher than that of group B, and the difference was statistically significant (P < 0.05); the fracture healing time of group A was compared with that of group B, and the difference was not statistically significant (P > 0.05); The knee joint function activity was compared between two groups before operation, 3 mo and 6 mo after operation, and the difference was not statistically significant (P > 0.05); the knee joint function activity of group A and group B at 3 mo and 6 mo after operation was significantly higher than that before operation (P < 0.05); the limp, support, lock, instability, swelling, upstairs, squatting, pain and Lysholm score were compared between the two groups before and 6 mo after operation, and the difference was not statistically significant (P > 0.05); the scores of limp, support, lock, instability, swelling, upstairs, squatting, pain and Lysholm in group A and group B at 6 mo after operation were significantly higher than those before operation (P > 0.05); the surgical complication rate of group A was 2.63%, which was lower than 18.42% of group B, and the difference was statistically significant (P > 0.05).
CONCLUSION Both small incision open reduction and internal fixation and arthroscopic high-strength non-absorbable sutures can achieve good results in the treatment of anterior cruciate ligament tibial avulsion fractures. The operation time of arthroscopic high-strength non-absorbable sutures is slightly longer, but the complication rate is lower.
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Affiliation(s)
- Hai-Ming Niu
- Department of Orthopedics, Guanyun People's Hospital, Lianyungang 222200, Jiangsu Province, China
| | - Qing-Chun Wang
- Department of Orthopedics, Guanyun People's Hospital, Lianyungang 222200, Jiangsu Province, China
| | - Rui-Zhao Sun
- Department of Orthopedics, Guanyun People's Hospital, Lianyungang 222200, Jiangsu Province, China
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Yuan L, Shi R, Chen Z, Ding W, Tan H. The most economical arthroscopic suture fixation for tibial intercondylar eminence avulsion fracture without any implant. J Orthop Surg Res 2022; 17:327. [PMID: 35752828 PMCID: PMC9233839 DOI: 10.1186/s13018-022-03219-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Avulsion fracture of the tibial intercondylar eminence is a rare injury, which mainly occurs in adolescents aged 8–14 years and in those with immature bones. The current commonly used surgery may result in severe surgical trauma, affecting knee joint function and accompanied by serious complications. In this study, we described an all-inside and all-epiphyseal arthroscopic suture fixation technique for a patient to treat tibial intercondylar eminence fracture. Methods ETHIBOND EXCEL-coated braided polyester sutures were used for fixation. Three ETHIBOND sutures were passed through the ACL at 2, 6 and 10 o’clock of the footprint of the ACL and made a cinch-knot loop separately. Under the guidance of ACL tibial locator, three corresponding tibial tunnels were drilled with K-wires at 2, 6 and 10 o’clock of the fracture bed, and the two ends of the suture were pulled out through the tunnel with double-folded steel wire heads. After reduction of the tibial eminence, three sutures were tightened and tied to the medial aspect of the tibial tubercle. Results After all the surgical treatments surgically performed by this method and following a standard postoperative protocol, our patient's ROM, stability, and functional structural scores all improved significantly. Conclusion This three-point suture technique provides a suitable reduction and stable fixation and is suitable for patients with all types of avulsion fractures of the tibial intercondylar eminence.
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Affiliation(s)
- Libo Yuan
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920Th Hospital, No. 212 Daguan Road, Xi Shan District, Kunming, 650032, Yunnan, China
| | - Rongmao Shi
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920Th Hospital, No. 212 Daguan Road, Xi Shan District, Kunming, 650032, Yunnan, China
| | - Zhian Chen
- Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Wei Ding
- College of Medicine Technology, Yunnan Medical Health College, Kunming, 650106, Yunnan, China
| | - Hongbo Tan
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920Th Hospital, No. 212 Daguan Road, Xi Shan District, Kunming, 650032, Yunnan, China.
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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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Hsu JC, Linhoff JC. Arthroscopic Treatment of Chronic Tibial Spine Malunion. Arthrosc Tech 2021; 10:e1695-e1702. [PMID: 34354914 PMCID: PMC8322451 DOI: 10.1016/j.eats.2021.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/09/2021] [Indexed: 02/03/2023] Open
Abstract
Reports of surgical resection and internal fixation for symptomatic tibial spine malunion are rare, and the reported techniques typically involve an open surgical approach. We present an all-arthroscopic technique of tibial spine malunion treatment, with selective arthroscopic bone resection below the tibial spine, preserving the anterior cruciate ligament attachment, followed by internal fixation of the tibial spine with a hybrid transtibial and suture-bridge construct using knotless anchors and tape sutures.
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Affiliation(s)
- Jim C. Hsu
- Address correspondence to Jim C. Hsu, M.D., The Polyclinic, 904 7th Ave., 4th Floor, Seattle, WA 98104.
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Tang J, Zhao J. Arthroscopic Suture-to-Adjustable Loop Fixation of Adult Anterior Cruciate Ligament Tibial Avulsion Fracture. Arthrosc Tech 2021; 10:e1573-e1579. [PMID: 34258206 PMCID: PMC8252818 DOI: 10.1016/j.eats.2021.02.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/15/2021] [Indexed: 02/03/2023] Open
Abstract
Adult tibial avulsion fracture of the anterior cruciate ligament (ACL) occurs not as frequently as ACL tear but still is concerning. There are many methods of arthroscopic fixation of this special fracture. However, a simple and effective method is still being pursued. We would like to introduce an arthroscopic suture-to-adjustable loop fixation technique, which features are a reduction of lateral displacement of the fragment by special suture configuration and tensioning, and a final reduction of residual displacement by tensioning the adjustable loop. We consider the introduction of this technique will provide additional choice in the treatment of adult ACL tibial avulsion fracture.
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Affiliation(s)
- Jin Tang
- Operating Theater, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China,Address correspondence to Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, 600 Yishan Rd., Shanghai 200233, China.
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