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Sun C, Du R, Luo S, Chen L, Ma Q, Cai X. A New Arthroscopic Tightrope Suture-Button Fixation Procedure for Tibial Eminence Avulsion Fracture. J Knee Surg 2023; 36:132-138. [PMID: 34187070 DOI: 10.1055/s-0041-1731326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This case-series outcome study presents a new arthroscopic technique for tibial eminence avulsion fracture (TEAF) with double-tunnel using two tightrope suture buttons. From May 2017 to July 2020, we performed a new arthroscopic technique for TEAF with double tunnels, using two tightrope suture buttons on 13 patients. Clinical assessments included anterior drawer, Lachman, and pivot shift tests, the International Knee Documentation Committee (IKDC), Lysholm knee scores, visual analog scale (VAS) scores, and range of motion (ROM). An independent observer noted conditions before surgery and during the last follow-up. The patients had an average follow-up of 26.2 months, ranging from 15 to 37 months. During the last postsurgical follow-up, the anterior drawer, Lachman, and pivot shift tests were negative in all the cases. According to the IKDC, Lysholm, and VAS final scores, all patients presented a significant knee function improvement at last follow-ups compared with preoperatively. The study shows that satisfactory results about an anatomic reduction of the fragment, knee stability, function, and strength can be achieved with the new arthroscopic technique for TEAF with double tunnels using two tightrope suture buttons. This study is a therapeutic case series and its level of evidence is IV.
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Affiliation(s)
- Changjiao Sun
- Department of Orthopaedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Ruiyong Du
- Department of Orthopaedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Song Luo
- Southern Medical District of Chinese PLA General Hospital, Beijing, China
| | - Lianxu Chen
- Department of Orthopaedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Qi Ma
- Department of Orthopaedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xu Cai
- Department of Orthopaedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Jain S, Modi P, Dayma RL, Mishra S. Clinical outcome of arthroscopic suture versus screw fixation in tibial avulsion of the anterior cruciate ligament in skeletally mature patients. J Orthop 2023; 35:7-12. [PMID: 36325248 PMCID: PMC9619313 DOI: 10.1016/j.jor.2022.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 09/29/2022] [Accepted: 10/17/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Tibial eminence fracture is an intra-articular fracture of bony attachment of ACL. The displaced fragment could hinder the mobility of the knee and may lead joint instabilty; therefore, requires fixation. Arthroscopic suture and screw fixation are the widely used surgical modalities for eminence fractures of the tibia. Past studies have not yet depicted the superiority of one method over the other. Through this cohort study, comparison of the clinical and functional outcomes of these two surgical methods was done. METHODS A prospective, randomized, interventional study was conducted from December 2019 to January 2022 for comparing the clinical outcome of arthroscopic pull through suture fixation and arthroscopic antegrade cancellous screw fixation in skeletally mature individuals. Ninety patients (45 in each group) were randomly assigned and treated with the above two methods. A comprehensive clinical analysis was done after nine months of surgery for assessment of functional outcome, ligament laxity, range of motion, and complications if any. RESULTS 65.55% of anterior tibial eminence fractures were caused by road traffic accidents followed by sports injuries (28.88%). The postoperative mean subjective IKDC score in the suture group was 91.36 and for the screw fixation group was 85.71 (p = 0.001). After nine months of surgery, the mean LKS was 91.96 in patients treated with suture fixation and 86.00 in patients treated with screw fixation (p = 0.001). Pivot shift grading was grade 3 in one patient of the suture group and in three patients of the screw group (p = 0.319). Seven patients who had screw fixation required re-surgery for removal of the implant; however, no such complication was seen in the suture fixation group. CONCLUSION Arthroscopic pull-through suture fixation of tibial avulsion of ACL in skeletally mature patients seems to be a superior intervention over arthroscopic screw fixation with the benefits of better clinical and functional outcomes and decreased chances of re-surgery.
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Affiliation(s)
- Siddharth Jain
- Department of Orthopaedics, S.M.S. Medical College, Jaipur, Rajasthan, India
| | - Prashant Modi
- Department of Orthopaedics, S.M.S. Medical College, Jaipur, Rajasthan, India
| | - Ratan Lal Dayma
- Department of Orthopaedics, S.M.S. Medical College, Jaipur, Rajasthan, India
| | - Sonal Mishra
- Department of Anaesthesiology, S.M.S. Medical College, Jaipur, Rajasthan, India
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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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Mittal R, Digge V, Selvanayagam R. Subintermeniscal Ligament Pullout Suture Technique for Anterior Cruciate Ligament Avulsion Fracture Fixation-AIIMS Technique. J Knee Surg 2021; 34:1355-1358. [PMID: 32330973 DOI: 10.1055/s-0040-1709180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Many methods have been described, including pullout suture technique, for arthroscopic fixation of displaced tibial eminence fracture. We are describing our technique of pullout suture, which is a modification of previously described techniques. We passed two sutures arthroscopically through anterior cruciate ligament (ACL) just above the avulsed fragment and then pulled them out through medial and lateral bone tunnel in anterior aspect of crater in tibial plateau. The third suture passed through ACL was pulled out anteriorly under the transverse intermeniscal ligament through a submeniscal route. All sutures were tied under tension to a screw post placed on the anterior tibia after reducing the avulsed bone fragment. Our technique provides good reduction and even overreduction of the fragment. It also provides good initial fixation strength to work against displacing forces even in small and comminuted bony fragment. This is helpful for achieving adequate stability of knee, complete extension of knee, early rehabilitation, and quicker recovery.
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Affiliation(s)
- Ravi Mittal
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vijaykumar Digge
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rajkumar Selvanayagam
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Arthroscopic Transosseous Suture-bridge Fixation for Anterior Cruciate Ligament Tibial Avulsion Fractures. Arthrosc Tech 2020; 9:e1607-e1611. [PMID: 33134068 PMCID: PMC7586735 DOI: 10.1016/j.eats.2020.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/14/2020] [Indexed: 02/03/2023] Open
Abstract
Few cases of tibial spine avulsion injuries occur in adolescents. An open or arthroscopic surgical approach is indicated for displaced and nonreducible fractures, but evidence for a gold standard is insufficient. Various arthroscopic techniques are available. Suture fixation is popular and shows good results. The proposed technique is a modified suture-bridge fixation using 2 high-strength sutures tied through 2 transosseous tunnels. This simple and low-cost technique avoids the potential complications of hardware fixation within a joint. It represents an arthroscopic treatment option for anterior cruciate ligament tibial avulsion injuries.
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Kuang SD, Su C, Zhao X, Li YS, Xiong YL, Gao SG. "Figure-of-Eight" Suture-Button Technique for Fixation of Displaced Anterior Cruciate Ligament Avulsion Fracture. Orthop Surg 2020; 12:802-808. [PMID: 32351046 PMCID: PMC7307232 DOI: 10.1111/os.12682] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/11/2020] [Accepted: 03/26/2020] [Indexed: 01/13/2023] Open
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.
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Affiliation(s)
- Shi-da Kuang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Chao Su
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Xin Zhao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yu-Sheng Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yi-Lin Xiong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Shu-Guang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China.,Hunan Engineering Research Center of Osteoarthritis, Changsha, China.,National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Elsaid ANS, Zein AMN, ElShafie M, El Said NS, Mahmoud AZ. Arthroscopic Single-Tunnel Pullout Suture Fixation for Tibial Eminence Avulsion Fracture. Arthrosc Tech 2018; 7:e443-e452. [PMID: 29868417 PMCID: PMC5984281 DOI: 10.1016/j.eats.2017.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/01/2017] [Indexed: 02/03/2023] Open
Abstract
Various arthroscopic techniques have been devised for fixation of tibial eminence avulsions, namely percutaneous K-wires, arthroscopy-guided screw fixation, staples, TightRope (Arthrex)-suture button fixation, and transosseous suture fixation. Such techniques provide well-pronounced advantages including less postoperative pain, a reduced hospital stay, and minimal scar with resultant earlier and more compliant rehabilitation. As for transosseous suture fixation, the standard technique comprises the creation of 2 tibial tunnels exiting on both sides of the footprint of the avulsion fracture using an anterior cruciate ligament tibial guide with the angle set at 45°. Our technique entails the creation of a single tibial tunnel directed from the proximal anteromedial tibia to the center of the tibial eminence. The technique uses Ethibond suture (No. 5) and/or FiberWire suture (Arthrex) to fix the tibial eminence by pulling the anterior cruciate ligament fibers and tightening the pullout suture at the tibial exit of the tunnel with a 4-hole button. This modified single-tunnel pullout suture technique is an appealing option that has proved to be effective and economical with a shorter operative time. Moreover, it provides a less invasive option for skeletally immature patients.
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Affiliation(s)
- Ahmed Nady Saleh Elsaid
- Address correspondence to Ahmed Nady Saleh Elsaid, M.D., Department of Orthopedic Surgery and Traumatology, Minia University, Abrag Elgmaa Borg (G), Third Floor, Flat No. 9 Ard Sltan Taha Hessen Street, Minia, Egypt.
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Zhang Q, Yang J, Zhao G, Zheng D, Zhou X, Xu N, Wang Y. A new technique for arthroscopic reduction and fixation of displaced tibial intercondylar eminence fractures, using suture anchor and EndoButton system. J Orthop Surg (Hong Kong) 2017; 25:2309499016685011. [PMID: 28142355 DOI: 10.1177/2309499016685011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIM The study aims to describe a less invasive technique for displaced tibial intercondylar eminence fractures, using only one bone tunnel with suture anchor and EndoButton system. METHODS Seventeen patients were followed up after arthroscopic fixation for tibial eminence fractures using suture anchor and EndoButton. The patients were followed with clinical examinations such as Lysholm, Tegner, and International Knee Documentation Committee (IKDC) rating scales. Radiographic assessments were also performed during the follow-up for evaluating the healing of the fracture. RESULTS There were 14 male patients and 3 female patients with 10 right knees, and 7 left knees included. All the fractures healed anatomically at final follow-up. Also, no clinical signs of anterior cruciate ligament deficiency were detected. The mean Lysholm score improved significantly from 74.72 ± 3.24 (range from 70 to 79) to 96.2 ± 2.54 (range from 89 to 98) ( p < 0.001). The IKDC category was abnormal or severely abnormal preoperatively and all the patients improved to normal or nearly normal at final follow-up. The Tegner score also improved significantly postoperatively from 3.45 ± 1.02 to 6.34 ± 1.22 ( p < 0.001). CONCLUSION The study demonstrated that the procedure is safe and effective, which can be another option for tibial intercondylar eminence fractures.
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Affiliation(s)
- Qiang Zhang
- 1 Department of Orthopaedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, Changzhou, People's Republic of China
| | - Jianjun Yang
- 2 Department of Orthopaedics, Shanghai Tenth People's Hospital, Shanghai, China
| | - Gongyin Zhao
- 1 Department of Orthopaedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, Changzhou, People's Republic of China
| | - Dong Zheng
- 1 Department of Orthopaedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, Changzhou, People's Republic of China
| | - Xianju Zhou
- 3 Department of Neurology, Laboratory of Neurological Diseases, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, Changzhou, People's Republic of China
| | - Nanwei Xu
- 1 Department of Orthopaedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, Changzhou, People's Republic of China
| | - Yuji Wang
- 1 Department of Orthopaedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, Changzhou, People's Republic of China.,4 Department of Orthopaedics, Laboratory of Clinical Orthopaedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, Changzhou, People's Republic of China
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Prevalence of knee stiffness after arthroscopic bone suture fixation of tibial spine avulsion fractures in adults. Orthop Traumatol Surg Res 2016; 102:625-9. [PMID: 27426237 DOI: 10.1016/j.otsr.2016.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/11/2016] [Accepted: 05/13/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tibial spine avulsion fractures (TSAFs) occur chiefly in adolescents. Few published data are available on outcomes after arthroscopic surgical treatment of TSAFs in adults. OBJECTIVES To evaluate outcomes of consecutive patients with TSAFs managed by arthroscopic bone suture followed by a standardised non-aggressive rehabilitation programme. HYPOTHESIS Arthroscopic bone suture followed by non-aggressive rehabilitation therapy reliably produces satisfactory outcomes in adults with TSAF. METHODS Thirteen adults were included. Outcomes were evaluated based on the Tegner score, International Knee Documentation Committee (IKDC) score, anterior-posterior knee laxity, passive and active motion ranges, and radiological appearance. RESULTS After a mean follow-up of 41±27months (12-94months), all 13 patients had healed fractures without secondary displacement. No patient had knee instability. Post-operative stiffness was noted in 5 patients (2 with complex regional pain syndrome and 3 with extension lag), 1 of whom required surgical release. The mean IKDC score was 91.3±11.7. The mean Tegner score was 5.46±1.37 compared to 6.38±0.70 before surgery. Mean tibial translation (measured using the Rolimeter) was 1.09±1.22mm, compared to 5.9±1.85mm before surgery. CONCLUSION The outcomes reported here support the reliability of arthroscopic bone suture for TSAF fixation. Nevertheless, a substantial proportion of patients experienced post-operative stiffness, whose contributory factors may include stunning of the quadriceps due to the short time from injury to surgery and the use of a gentle rehabilitation programme. LEVEL OF EVIDENCE IV, retrospective study of treatment outcomes.
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Liao W, Li Z, Zhang H, Li J, Wang K, Yang Y. Arthroscopic Fixation of Tibial Eminence Fractures: A Clinical Comparative Study of Nonabsorbable Sutures Versus Absorbable Suture Anchors. Arthroscopy 2016; 32:1639-50. [PMID: 27039964 DOI: 10.1016/j.arthro.2016.01.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 12/14/2015] [Accepted: 01/21/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare clinical outcomes of arthroscopic therapy for tibial eminence fracture with nonabsorbable suture and absorbable suture anchor. METHODS Between February 2010 and September 2012, a total of 60 tibial eminence fracture patients were treated with nonabsorbable suture fixation or absorbable suture anchor fixation under arthroscopy. Patients with tibial plateau fractures and other significant injuries, including osteochondral lesions, meniscal tear, and anterior cruciate ligament (ACL) or mutiligament injuries, were excluded from the study. Radiographs, anterior drawer test (ADT), Lachman test, Lysholm score, and International Knee Documentation Committee (IKDC) 2000 subjective score were employed to evaluate clinical outcomes in follow-up. RESULTS A total of 41 patients were analyzed. Among these patients, 22 were treated with nonabsorbable suture fixation and 19 with absorbable suture anchor fixation. According to the modified Meyers-McKeever classification, 15 cases were categorized as type II, 21 as type III, and 5 as type IV fractures. The mean time from injury to surgery was 7.1 days (range, 3 to 12 days). All patients were followed up for a median period of 33.7 months (range, 24 to 45 months). Radiographic evaluation showed optimal reduction immediately after operation and bone union within 3 months in all patients. At the final follow-up, there was no limitation of knee motion range in any patient. Grade II laxity was found in 2 cases from suture group and 1 from suture anchor group, showing no significant difference based on ADT (χ(2) = 0.538, P = .764) and Lachman test (χ(2) = 0.550, P = .760). Lysholm and IKDC 2000 subjective scores were significantly improved (P < .001). However, there were no significant differences in the improvement of Lysholm (t = 0.522, P = .604) and IKDC 2000 subjective scores (t = 0.644, P = .523) between the 2 groups. CONCLUSIONS Nonabsorbable suture fixation and absorbable suture anchor fixation are equivalent techniques in terms of the clinical efficacy of arthroscopic tibial eminence fracture treatment. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Weixiong Liao
- Department of Orthopedics, General Hospital of PLA, Beijing, China
| | - Zhongli Li
- Department of Orthopedics, General Hospital of PLA, Beijing, China.
| | - Hao Zhang
- Department of Orthopedics, General Hospital of PLA, Beijing, China
| | - Ji Li
- Department of Orthopedics, General Hospital of PLA, Beijing, China
| | - Ketao Wang
- Department of Orthopedics, General Hospital of PLA, Beijing, China
| | - Yimeng Yang
- Department of Orthopedics, General Hospital of PLA, Beijing, China
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Najdi H, Thévenin-Lemoine C, Sales de Gauzy J, Accadbled F. Arthroscopic treatment of intercondylar eminence fractures with intraepiphyseal screws in children and adolescents. Orthop Traumatol Surg Res 2016; 102:447-51. [PMID: 27052935 DOI: 10.1016/j.otsr.2016.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 01/26/2016] [Accepted: 02/04/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Tibial intercondylar eminence fracture rarely occurs in childhood. Its treatment requires anatomic reduction to provide knee stability and a rigid fixation to minimize postoperative immobilization time. HYPOTHESIS Arthroscopy combined with fluoroscopy with intra-epiphyseal ASNIS screw fixation can meet the requirements of this treatment. MATERIAL AND METHODS The series comprised 24 patients (mean age: 11 years) with Meyers and McKeever type II tibial intercondylar eminence fractures (n=15) or type III (n=9), operated on between 2011 and 2013. Fixation with 4-mm ASNIS screws was placed arthroscopically. The demographic data, associated lesions, radiological union, stability, functional result, and the Lysholm score were evaluated. RESULTS With a mean follow-up of 2 years, the mean Lysholm score was 99.3 for type II and 98.6 for type III fractures. At the 6th postoperative week, range of motion in the operated knees was identical to the healthy knees. At the 12th postoperative week, there was no sign of anterior laxity. Twelve cases included meniscal entrapment, but no significant difference was observed in the functional results. DISCUSSION, CONCLUSION ASNIS screw fixation under arthroscopy can be successfully applied in the treatment of types II and III tibial intercondylar eminence fractures in children. This technique provides excellent stability, allows early weigh-tbearing, and preserves function of the knee and its growth. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- H Najdi
- Département d'orthopédie et de traumatologie pédiatrique, hôpital des enfants, 330, avenue de Grande Bretagne, TSA 70034, 31059 Toulouse cedex 9, France.
| | - C Thévenin-Lemoine
- Département d'orthopédie et de traumatologie pédiatrique, hôpital des enfants, 330, avenue de Grande Bretagne, TSA 70034, 31059 Toulouse cedex 9, France.
| | - J Sales de Gauzy
- Département d'orthopédie et de traumatologie pédiatrique, hôpital des enfants, 330, avenue de Grande Bretagne, TSA 70034, 31059 Toulouse cedex 9, France.
| | - F Accadbled
- Département d'orthopédie et de traumatologie pédiatrique, hôpital des enfants, 330, avenue de Grande Bretagne, TSA 70034, 31059 Toulouse cedex 9, France.
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Arthroscopic fixation with intra-articular button for tibial intercondylar eminence fractures in skeletally immature patients. J Pediatr Orthop B 2016; 25:31-6. [PMID: 26340367 DOI: 10.1097/bpb.0000000000000223] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The aim of this study was to describe our experiences with arthroscopy-guided intra-articular button fixation in the treatment of displaced tibial eminence fractures in skeletally immature children. Eleven adolescent patients with an average age of 12.2 years were treated arthroscopically between January 2005 and February 2007. At follow-up evaluation at 69 months, we did not find any instability. Only minimal differences were found in the functional outcomes (Lysholm and International Knee Documentation Committee scores: 95.7 and 94.3, respectively). None of the patients had a leg-length discrepancy defined at the time of the final follow-up. The advantages of this technique are as follows: (a) it is a simple and reliable arthroscopic technique with a direct view, (b) the fixation is stable,
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Faivre B, Benea H, Klouche S, Lespagnol F, Bauer T, Hardy P. An original arthroscopic fixation of adult's tibial eminence fractures using the Tightrope® device: a report of 8 cases and review of literature. Knee 2014; 21:833-9. [PMID: 24863950 DOI: 10.1016/j.knee.2014.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 01/03/2014] [Accepted: 02/07/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The objective of this study is to asset the efficiency of the use of the Tightrope® device to treat isolated tibial spine fractures in adults. METHODS All patients treated for isolated tibial spine fracture between November 2007 and February 2011 have been retrospectively included. The main judgment criteria was the post-operative knee laxity measured by Rolimeter® (Aircast) and the secondary criteria were the IKDC scores, the knee mobility, the Lachman test and the bone union. 8 patients have been included. The mean age was 34.2 years (± 12.5). The classification of Meyers and McKeever identified 5 types II, 2 types IIIa and 1 type IIIb. The mean follow-up period was 10 months. RESULTS The mean post-operative anterior knee laxity was 6 ± 2.14 mm for the operated side and 5.6 ± 1.85 mm for the opposite side. No significant difference was found (P=0.73). According to the IKDC classification 3 patients were normal (A), 2 were nearly normal (B), 1 was abnormal (C) and 1 was very abnormal (D). The mean IKDC subjective score was 70.71 ± 17.56. All 8 fractures achieved union without elevation. 3 patients developed motion complications and 2 required an arthroscopic arthrolysis. No other significant complication was noted. The outcome was compared to the different series published during the last 10 years. CONCLUSION The use of the Tightrope® device is a simple technique occurring a rigid fixation, allowing early rehabilitation with a high rate of arthrofibrosis. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Bruno Faivre
- Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, F-92100 Boulogne-Billancourt, France; Université de Versailles Saint-Quentin, F-78035 Versailles, France.
| | - Horea Benea
- Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, F-92100 Boulogne-Billancourt, France; University Clinic of Orthopedics and Traumatology, R-400132 Cluj-Napoca, Romania
| | - Shahnaz Klouche
- Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, F-92100 Boulogne-Billancourt, France; Université de Versailles Saint-Quentin, F-78035 Versailles, France
| | - Florent Lespagnol
- Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, F-92100 Boulogne-Billancourt, France; Université de Versailles Saint-Quentin, F-78035 Versailles, France
| | - Thomas Bauer
- Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, F-92100 Boulogne-Billancourt, France; Université de Versailles Saint-Quentin, F-78035 Versailles, France
| | - Philippe Hardy
- Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, F-92100 Boulogne-Billancourt, France; Université de Versailles Saint-Quentin, F-78035 Versailles, France
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Arthroscopic suture fixation in patients with a tibial intercondylar eminence fracture using a simple device to penetrate the anterior cruciate ligament. Asia Pac J Sports Med Arthrosc Rehabil Technol 2014. [DOI: 10.1016/j.asmart.2014.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wiegand N, Naumov I, Vámhidy L, Nöt LG. Arthroscopic treatment of tibial spine fracture in children with a cannulated Herbert screw. Knee 2014; 21:481-5. [PMID: 24480629 DOI: 10.1016/j.knee.2013.12.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 11/11/2013] [Accepted: 12/16/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Avulsion fractures of the anterior tibial intercondylar eminence in childhood are rare and are severe injuries of the knee. Since the injury is equivalent in aetiology with ruptures of the anterior cruciate ligament, the treatment requires anatomic reduction and preservation of the stability of the joint. The aim of the study was to demonstrate our experiences with the arthroscopy-guided Herbert-screw fixation in the treatment of displaced tibial eminence fractures in children. METHODS Between January 2004 and December 2011, a total of eight children were treated surgically with Type II or Type III anterior tibial eminence fractures; another four children with undisplaced, Type I fractures were treated conservatively, applying with cast fixation for 6 weeks. Radiological consolidation, stability and functional outcome were assessed during the follow-up examinations. RESULTS On the 12th postoperative week, we did not find instability in any of the patients by physical examination. There were only minimal differences found in the functional outcome, comparing the conservatively and operatively treated groups (Lysholm functional scale, average scores: Type I: 97, Type II: 95 and Type III: 94 points). The range of motion (ROM) of the injured knees was identical with healthy sides on the postoperative 6th week. CONCLUSIONS Our results indicate that the presented method can successfully be applied in the treatment of displaced tibial spine fractures; providing excellent stability and preserving the function of the injured knee in the short-term.
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Affiliation(s)
- N Wiegand
- Department of Traumatology and Hand Surgery, Faculty of Medicine, University of Pécs, Pécs, Hungary.
| | - I Naumov
- Department of Traumatology and Hand Surgery, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - L Vámhidy
- Department of Traumatology and Hand Surgery, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - L G Nöt
- Department of Traumatology and Hand Surgery, Faculty of Medicine, University of Pécs, Pécs, Hungary
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Arthroscopic absorbable suture fixation for tibial spine fractures. Arthrosc Tech 2013; 3:e45-8. [PMID: 24749022 PMCID: PMC3986477 DOI: 10.1016/j.eats.2013.08.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 08/15/2013] [Indexed: 02/03/2023] Open
Abstract
The purpose of this technical note and accompanying video is to describe a modified arthroscopic suture fixation technique to treat tibial spine avulsion fractures. Twenty-one patients underwent arthroscopic treatment for tibial spine avulsion with our technique; they were clinically and biomechanically evaluated at 2 years' follow-up and showed optimal clinical and radiographic outcomes. Repair with this arthroscopic technique provides a significant advantage in the treatment of type III and IV fractures of the tibial eminence by obtaining arthroscopic fixation within the substance of the anterior cruciate ligament: suture methods based on the avulsed bone fragment are technically impossible, but sutures through the base of the ligament itself provide secure fixation, reducing the risks of comminution of the fracture fragment and eliminating the time for hardware removal. This arthroscopic technique restores the length and the integrity of the anterior cruciate ligament and provides a simplified, reproducible method of treating patients, including young patients, with low hardware costs in comparison to sutures using anchors or other hardware.
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Sang W, Zhu L, Ma J, Lu H, Yu Y. A comparative study of two methods for treating type III tibial eminence avulsion fracture in adults. Knee Surg Sports Traumatol Arthrosc 2012; 20:1560-4. [PMID: 22072325 DOI: 10.1007/s00167-011-1760-1] [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: 05/13/2011] [Accepted: 10/28/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE Suture fixation is mostly used in arthroscopic treatment of tibial eminence avulsion fractures. However, no clinical studies of metal cable fixation have been reported. We hypothesised that cable fixation can provide equal stability and clinical outcome compared with Ethibond sutures. METHODS Between 2007 and 2008, we treated 42 patients of adult type III tibial eminence avulsion fractures. Twenty-three patients were male, and 19 were female. All patients were confirmed by radiographs, MRI, and arthroscopy during surgery. Ligament injury and meniscus tears were excluded from this study. Twenty-two patients were treated with No. 2 Ethibond suture fixation (group I), and 20 were treated with cable fixation under arthroscopy (group II). Follow-up assessments included imaging evaluation, Lysholm knee score, International Knee Documentation Committee (IKDC) classification, and the Lachman test. RESULTS Bone union was found in radiographic evaluation in all patients within 3 months. At the last follow-up, there was neither extension nor flexion limitation in any patient. There were no significant differences in the Lysholm score between the two groups at follow-up. All 42 patients were classified by the IKDC as normal or nearly normal. Stability based on the Lachman test showed two patients of grade II laxity in group I. At the final follow-up, all 42 patients had returned to their pre-injury activities. CONCLUSIONS Cable fixation to treat type III tibial eminence avulsion fracture can provide a clinical outcome equal to that of Ethibond sutures. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Weilin Sang
- Department of Orthopedics, The First People's Hospital of Shanghai Jiaotong University, No. 100# Haining Road, Shanghai, China
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Kwon OS, Kamath AF, Kelly JD. Arthroscopic treatment of an anterior cruciate ligament avulsion fracture in a skeletally immature patient. Orthopedics 2012; 35:589-92. [PMID: 22784885 DOI: 10.3928/01477447-20120621-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Anterior cruciate ligament injuries in skeletally immature patients usually involve tibial bony avulsion fractures rather than the midsubstance tears usually observed in adults. Several surgical techniques have been reported to provide stable fixation and avoid physeal injury in this pediatric population. The authors propose a novel, reproducible surgical technique using bioabsorbable anchors to obtain biomechanical stability and minimal physeal or articular cartilage damage.
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Affiliation(s)
- Oh Soo Kwon
- Daejeon St Mary’s Hospital, The Catholic University of Korea, Daejeon, Korea.
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Hirschmann MT, Mayer RR, Kentsch A, Friederich NF. Physeal sparing arthroscopic fixation of displaced tibial eminence fractures: a new surgical technique. Knee Surg Sports Traumatol Arthrosc 2009; 17:741-7. [PMID: 19225757 DOI: 10.1007/s00167-009-0733-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Accepted: 01/20/2009] [Indexed: 01/31/2023]
Abstract
We describe a novel physeal sparing arthroscopic technique for anatomic suture refixation of tibial eminence fractures and assess the mid-term results of six consecutive patients (McKeever type II n = 2, III n = 3 and IV n = 1). The mean follow-up was 5 +/- 2 years. Five of six patients were painfree. All patients returned to their preinjury sport level. Mean passive ipsilateral and contralateral flexion was 143 degrees +/- 5 degrees. The IKDC score was A in five and B in one patients. The mean Lysholm score was 97 +/- 3%. The median Tegner score was 8 (range 6-9) preinjury and at follow-up. The mean Total Knee Society score was 197 +/- 4 points. ACL laxity (KT-1000 134 N) showed a side-to-side difference of 2 +/- 2 mm. Two of six patients underwent a tibial screw removal under local anaesthesia. No loss of reduction or grossly physeal disturbance was observed. The reported surgical technique showed excellent to good clinical and radiological results and may be a physeal sparing alternative to previously described procedures.
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Affiliation(s)
- Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Bruderholz, 4101, Bruderholz, Switzerland.
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Huang TW, Hsu KY, Cheng CY, Chen LH, Wang CJ, Chan YS, Chen WJ. Arthroscopic suture fixation of tibial eminence avulsion fractures. Arthroscopy 2008; 24:1232-8. [PMID: 18971052 DOI: 10.1016/j.arthro.2008.07.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 07/01/2008] [Accepted: 07/01/2008] [Indexed: 02/06/2023]
Abstract
PURPOSE This study presents the clinical results of a procedure for treating tibial eminence fractures of the anterior cruciate ligament (ACL) using arthroscopic reduction and No. 5 Ethibond sutures (Ethicon, Somerville, NJ). METHODS This prospective study analyzed 36 patients who underwent arthroscopic reduction and suture fixation for image-proven ACL avulsion fractures of the tibial eminence. The classification of Meyers and McKeever identified 6 type II, 16 type III, and 14 type IV fractures. The mean follow-up period was 34.4 months (range, 24 to 91 months). Follow-up assessment included Lysholm knee score, Tegner activity score, International Knee Documentation Committee (IKDC) score, and KT-1000 arthrometer (MEDmetric, San Diego, CA) and radiographic evaluation. RESULTS The mean preoperative Lysholm score in the 36 knees was 38 (range, 28 to 54); the mean postoperative Lysholm score was 98 (range, 83 to 100). The mean preinjury and preoperative Tegner scores in the 36 knees were 7.5 +/- 1.5 (range, 5 to 9) and 3 +/- 1.7 (range, 2 to 5), respectively. The mean postoperative Tegner score was 7.3 +/- 1.7 (range, 5 to 9). At final follow-up, 34 patients (94.5%) were classified by IKDC score as normal or nearly normal (grade A or B). The IKDC classification was abnormal (grade C) in 2 patients (5.5%). All 36 fractures achieved union within 3 months. No significant complications, such as arthrofibrosis, loss of initial fixation, or wound infection, were noted. CONCLUSIONS Treating ACL avulsion fracture by arthroscopic suture fixation by use of 4 No. 5 Ethibond sutures can restore ACL length, stabilize fragments, promote early motion, and minimize morbidity. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Tsan-Wen Huang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
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In Y, Kim JM, Woo YK, Choi NY, Moon CW, Kim MW. Arthroscopic fixation of anterior cruciate ligament tibial avulsion fractures using bioabsorbable suture anchors. Knee Surg Sports Traumatol Arthrosc 2008; 16:286-9. [PMID: 18157488 DOI: 10.1007/s00167-007-0466-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2007] [Accepted: 11/23/2007] [Indexed: 10/22/2022]
Abstract
This article describes a new technique for the arthroscopic reduction and fixation of anterior cruciate ligament (ACL) tibial avulsion fractures using bioabsorbable suture anchors. This described technique requires the use of anterolateral, anteromedial, medial mid-patellar, and lateral mid-patellar portals. A suture hook loaded with No. 2 polydioxanone (PDS) was used to pierce the ACL through the anteromedial or anterolateral portal, and bioabsorbable suture anchors were inserted through the medial and lateral mid-patellar portals. The five patients treated using this technique were evaluated at 1 year postoperatively. All patients showed bony union without anterior laxity or flexion contracture. The described technique provides firm fixation of fracture fragment and can be used in both skeletally immature and mature patients.
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Affiliation(s)
- Yong In
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Zhang CL, Xu H, Fan HB, Meng CF, Chen H, Cao SL. A novel arthroscopic procedure for fixation of avulsion fracture of tibial attachment of anterior cruciate ligament guided by meniscal stitching needle. Chin J Traumatol 2008; 11:18-21. [PMID: 18230286 DOI: 10.1016/s1008-1275(08)60004-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To introduce a novel technique in which meniscal stitching needle is used as a puller to induct steel wire to secure the tibial eminence avulsion under arthroscopic visualization, and evaluate the clinical results. METHODS From 1999 to 2005, fifteen cases of tibial eminence avulsion were treated with this new technique. Lysholm scoring scale system was used to assess knee function before and after surgery. Regular plain anteroposterior and lateral X-ray films were undertaken to detect the bony healing of avulsed fragment. RESULTS The operating time could be controlled within 30 minutes. No complications such as intraarticular infection, iatrogenic injury, fibroarthritis or nonunion of fracture occurred in this group. X-ray film revealed that bony healing in all 15 cases was achieved from 6 weeks to 12 weeks postoperatively. Lysholm score was improved from 19.1+/-15.2 (ranging from 10 to 56) preoperatively to 97.5+/-3.7 (ranging from 91 to 100) postoperatively on average in 12-54 months follow up (mean 23 months). The statistically significant difference was shown in Student's t test (t equal to 18.483, P equal to 3.100 x 10(-11), P < 0.01). Wire breakage was found in two patients whose wires were removed 8 months and 14 months after initial operation, respectively. CONCLUSION This technique has many advantages, such as simplicity, wide indications from type II to type IV fractures, minimal invasion, short operating time and predictable satisfactory results.
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Affiliation(s)
- Chun-li Zhang
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.
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Bonin N, Jeunet L, Obert L, Dejour D. Adult tibial eminence fracture fixation: arthroscopic procedure using K-wire folded fixation. Knee Surg Sports Traumatol Arthrosc 2007; 15:857-62. [PMID: 17235617 DOI: 10.1007/s00167-006-0284-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 12/20/2006] [Indexed: 02/07/2023]
Abstract
The purpose of this article is to describe a new and simple technique for arthroscopic fixation of tibial intercondylar eminence avulsion fractures using folded surgical pin. This technique allows reduction and fixation of the bone fragment without using special equipment. After standard arthroscopic procedure to explore the knee and to remove fracture debris and blood clot, the bone block is reduced and advanced with the spike of the anterior cruciate ligament tibial drill guide. A 1.8-mm K-wire is drilled through the guide from the proximal tibia into the reduced fragment. It is bent on its end into the joint with a strong needle case. The K-wire is then pulled back until good fragment compression to the tibia appears with the wire starting unbending. Next, the other side is bent on the anterior tibial cortex and cut. This arthroscopic fixation allows elastic compression fragment stabilization that authorizes early weight bearing and rehabilitation programs. The material is extracted by traction after 6 months.
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Affiliation(s)
- Nicolas Bonin
- Orthopaedic and Sports Traumatologic Center, Lyon Sauvegarde Clinic, Avenue Ben Gourion, 69009 Lyon, France.
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Zhao J, Huangfu X. Arthroscopic treatment of nonunited anterior cruciate ligament tibial avulsion fracture with figure-of-8 suture fixation technique. Arthroscopy 2007; 23:405-10. [PMID: 17418334 DOI: 10.1016/j.arthro.2006.12.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Revised: 11/18/2006] [Accepted: 12/10/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical results of arthroscopic treatment of nonunited anterior cruciate ligament (ACL) tibial avulsion fracture with a figure-of-8 suture fixation technique. METHODS Nineteen cases of nonunited ACL tibial avulsion fracture were treated with an arthroscopic figure-of-8 suture fixation technique. The patients were followed up and evaluated according to the International Knee Documentation Committee, Lysholm, and Tegner rating scales. RESULTS The time interval between the previous injury and this operation was 1 to 8 years, with a mean of 3.6 years. Eighteen patients were followed up for more than 2 years (range, 24 to 30 months; mean, 26 months). The fracture was united within 3 months after surgery in all cases. At the latest follow-up, there was neither extension nor flexion limitation in all patients. With the exception of 1 patient who had a 1 degrees positive Lachman test with a firm end-point, all of the patients had a negative Lachman test. The side-to-side difference in knee anterior laxity was 0 to 2 mm in 17 patients and 4 mm in 1 patient. The Lysholm score was 91 to 100, with a mean of 96.7 +/- 1.9 (compared with 74.3 +/- 4.6 before surgery, P < .05). Fifteen patients returned to their former activity level. The Tegner scores before injury, preoperatively, and at latest follow-up were 6.1 +/- 0.6, 3.6 +/- 1.0, and 6.0 +/- 0.8, respectively; there was no statistically significant difference between the preinjury and postoperative Tegner scores (P > .05). According to the International Knee Documentation Committee scale, 17 patients' knees were graded as normal and 1 patient's knee was nearly normal. CONCLUSIONS Arthroscopic treatment of nonunited ACL tibial avulsion fracture with a figure-of-8 suture fixation technique can ensure fracture healing and restore the stability and function of the joint in most patients. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Jinzhong Zhao
- Department of Arthroscopic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China.
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Louis ML, Guillaume JM, Toth C, Launay F, Jouve JL, Bollini G. [Fracture of the intercondylar eminence of the tibia type II in children: 20 surgically-treated cases]. REVUE DE CHIRURGIE ORTHOPEDIQUE ET REPARATRICE DE L'APPAREIL MOTEUR 2007; 93:56-62. [PMID: 17389825 DOI: 10.1016/s0035-1040(07)90204-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE OF THE STUDY The purpose of this study was to detail therapeutic indications for fractures of the intercondylar eminence of the tibia with little displacement and preservation of the posterior hinge (type II fracture in the Zarincznyj classification). MATERIAL AND METHODS We reviewed retrospectively a multicentric serie of type II fractures of the intercondylar eminence observed in children treated surgically. There were twenty patients, ten girls and ten boys, mean age 11.9 years (range 6-16). Imaging included plain x-rays of the knee (anteroposterior and lateral views) in all patients as well as computed tomography (5 patients) and magnetic resonance imaging (1 patient). Surgical treatment was performed in all cases, on average six days after trauma (range 0-25). A medial parapatellar arthrotomy was used in all cases. A non-resorbable thread was used for fixation associated with an anchor in the last four cases. Clinical and radiological assessment was reviewed at mean 3.7 years follow-up. RESULTS All children had resumed their sports activities at the same level as before the accident within 4.8 months on average. None of the children suffered from an unstable knee or functional impairment at last follow-up. The Lysholm score was 88.9 on average (range 70-100) at three months postoperative and 99.2 (range 89-100) at last follow-up. DISCUSSION There is currently agreement that non-displaced fractures of the anterior intercondylar eminence of the tibia should be treated orthopedically and that forms with displacement require surgery. Conversely, the type II fractures with an anterior gap but a preserved posterior hinge, the appropriate treatment remains a subject of debate. In our experience, surgery would appear to be preferable to orthopedic management. Surgery enables putting correct tension on the anterior crucicate ligament and limits the risk of residual laxity which, even though rarely associated with instability, could in the long-term lead to osteoathritic degradation or meniscal damage. CONCLUSION Surgical treatment of fractures of the intercondylar eminence of the tibia with little displacement and preservation of the posterior hinge provides satisfactory results and the best guarantee of long-term stability.
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Affiliation(s)
- M-L Louis
- Service d'Orthopédie Pédiatrique, Hôpital la Timone, 264, rue Saint-Pierre, 13385 Marseille Cedex 5.
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Webster TJ, Ahn ES. Nanostructured biomaterials for tissue engineering bone. ADVANCES IN BIOCHEMICAL ENGINEERING/BIOTECHNOLOGY 2007; 103:275-308. [PMID: 17195467 DOI: 10.1007/10_021] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Advances in several critical research fields (processing, catalytic, optical, actuation, electrical, mechanical, etc.) have started to benefit from nanotechnology. Nano-technology can be broadly defined as the use of materials and systems whose structures and components exhibit novel and significantly changed properties when control is gained at the atomic, molecular, and supramolecular levels. Specifically, such advances have been found for materials when particulate size is decreased to below 100 nm. However, to date, relatively few advantages have been described for biological applications (specifically, those involving bone tissue engineering). This chapter elucidates several promising examples of how nanophase materials can be used to improve orthopedic implant applications. These include mechanical advantages as well as altered cell functions, leading to increased bone tissue regeneration on a wide range of nanophase materials including ceramics, polymers, metals, and composites thereof. Such advances were previously unimaginable with conventional materials possessing large micron-sized particulates.
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Affiliation(s)
- Thomas J Webster
- Division of Engineering and Orthopaedics, Brown University, Providence, RI 02912, USA.
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Bong MR, Romero A, Kubiak E, Iesaka K, Heywood CS, Kummer F, Rosen J, Jazrawi L. Suture versus screw fixation of displaced tibial eminence fractures: a biomechanical comparison. Arthroscopy 2005; 21:1172-6. [PMID: 16226643 DOI: 10.1016/j.arthro.2005.06.019] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Classification and treatment of tibial eminence fractures are determined by the degree of fragment displacement. A variety of surgical procedures have been proposed to stabilize displaced fractures using both open and arthroscopic techniques. Two common fixation techniques involve use of cannulated screws and sutures tied over an anterior tibial bone bridge. We are unaware of any biomechanical studies that have compared the strength of various techniques of fixation. TYPE OF STUDY Biomechanical study in a cadaveric model. METHODS Seven matched pairs of fresh-frozen human cadaveric knees were stripped of all soft tissue except the anterior cruciate ligament (ACL). Simulated type III tibial eminence fractures were created using an osteotome. Fragments of each matched pair were randomized to fixation with either a single 4-mm cannulated cancellous screw with a washer or an arthroscopic suture technique using 3 No. 2 Fiberwire sutures (Arthrex, Naples, FL) passed through the tibial base of the ACL and tied over bone tunnels on the anterior tibial cortex. Specimens were then loaded with a constant load rate of 20 mm/min, and load-deformation curves were generated. The ultimate strength and stiffness were computed for each curve. The failure mode for each test was observed. A paired 2-tailed t test was used to determine the statistically significant difference between the two methods. RESULTS Specimens fixed with Fiberwire had a mean ultimate strength of 319 N with a standard deviation of 125 N. Those fixed with cannulated screws had a mean ultimate strength of 125 N with a standard deviation of 74 N. This difference was statistically significant (P = .0038). There was no significant difference between the mean stiffness of Fiberwire constructs (63 N; SD, 50 N) and the mean stiffness of the cannulated screw constructs (20 N; SD, 32 N). The failure modes of the Fiberwire constructs included 1 ACL failure, 3 failures of suture cutting through the anterior tibial cortex, and 3 of suture cutting through the tibial eminence fragment. The single mode of failure for the cannulated screw constructs was screw pullout of cancellous bone. CONCLUSIONS The initial ultimate strength of Fiberwire fixation of tibial eminence fractures in these specimens was significantly stronger than that of cannulated screw fixation. CLINICAL RELEVANCE It appears that Fiberwire fixation of eminence fractures provides biomechanical advantages over cannulated screw fixation and may influence the type of treatment one chooses for patients with tibial eminence fractures.
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Affiliation(s)
- Matthew R Bong
- Department of Orthopaedics, New York University-Hospital for Joint Diseases, New York, New York 10003, USA
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Kawate K, Fujisawa Y, Yajima H, Sugimoto K, Habata T, Takakura Y. Seventeen-year follow-up of a reattachment of a nonunited anterior tibial spine avulsion fracture. Arthroscopy 2005; 21:760. [PMID: 15944638 DOI: 10.1016/j.arthro.2005.03.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Seventeen years ago we treated a nonunited avulsion fracture of the anterior tibial spine with open reduction and pull-out wires. When the patient was 9 years old, she fell and bruised her left knee. The knee was immobilized for a month in a long cast. When she was 24 years old, she felt severe knee pain and giving way after playing tennis 1 month before her first visit to our hospital. She complained of knee pain, giving way, locking, and 15 degrees loss of knee extension. Radiographs showed a large nonunited fragment at the intercondylar eminence of the tibia. She underwent a reattachment surgery. When she was re-evaluated 17 years after surgery, she had no pain, no giving way, no locking, and no loss of knee extension. On physical examination, there was no instability. Plain anteroposterior and lateral radiographs showed a well-united fragment of the anterior tibial spine. In conclusion, the open reduction for knee pain, giving way, locking, and loss of knee extension caused by nonunion of avulsion of the anterior tibial spine yielded satisfactory results. We believe that in cases of nonunited anterior tibial spine fractures it is necessary to attempt to secure the anterior cruciate ligament in an anatomic position.
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Affiliation(s)
- Kenji Kawate
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan.
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Lubowitz JH, Elson WS, Guttmann D. Part II: arthroscopic treatment of tibial plateau fractures: intercondylar eminence avulsion fractures. Arthroscopy 2005; 21:86-92. [PMID: 15650672 DOI: 10.1016/j.arthro.2004.09.031] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Arthroscopic reduction and internal fixation (ARIF) of tibial intercondylar eminence fractures is the emerging state-of-the-art. ARIF is recommended for displaced type III fractures and should be considered for all cases of displaced type II fractures. Fractures without displacement after closed reduction require careful evaluation to rule out meniscal entrapment. Subjective results of ARIF are uniformly excellent, despite reports of objective anteroposterior laxity. Early range-of-motion exercises are essential to prevent loss of extension. Repair using nonabsorbable suture fixation, when of adequate strength to allow early range-of-motion, has the advantages of eliminating the risks of comminution of the fracture fragment, posterior neurovascular injury, and need for hardware removal, compared with ARIF using screws.
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Affiliation(s)
- James H Lubowitz
- Taos Orthopaedic Institute Research Foundation, Taos, New Mexico 87571, USA
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Hsu SYC. An easy and effective method for reattaching an anterior cruciate ligament avulsion fracture from the tibial eminence. Arthroscopy 2004; 20:96-100. [PMID: 14716286 DOI: 10.1016/j.arthro.2003.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Numerous ways to attach an anterior cruciate ligament avulsion from tibial eminence have been devised, and this report is the first of its kind to describe an easy but effective way of passing nonabsorbable braided sutures through the substance of the anterior cruciate ligament and hold down the avulsed bone fragments by tying knots over a bone bridge.
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Affiliation(s)
- Stephen Y C Hsu
- Department of Orthopaedics and Traumatology, Princess Margaret Hospital, Hong Kong, Hong Kong.
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Abstract
We recommend a treatment algorithm for tibial eminence fracture management (Fig.11). Displaced and irreducible fractures require arthroscopic or open treatment based on surgeon preference. Objective sagittal plane laxity does not translate into long-term clinical or subjective instability. Every effort should be made to obtain the best possible reduction with stable fixation, when needed, to maximize function.
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Affiliation(s)
- William K Accousti
- Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, 2025 Gravier Street, Suite 400, New Orleans, LA 70118, USA.
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