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Elghaish MAI, El-Lahham SMAI, Helwo AHSA, Elfekky MMAA, Gawish HM. Double Decker anterior cruciate ligament avulsion. Trauma Case Rep 2024; 52:101053. [PMID: 38974525 PMCID: PMC11225012 DOI: 10.1016/j.tcr.2024.101053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 07/09/2024] Open
Abstract
Distal anterior cruciate ligament avulsion from tibial side is an unusual injury. It can be either bony avulsion, which is more common, or rarely a soft tissue peeling of tibial spine with no bone injury. This case report represents a very infrequent injury of combined soft tissue peeling of distal anterior cruciate ligament along with bony avulsion of tibial spine in a 12-years-old boy after falling from his bike.
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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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Purnomo G, Triangga AFR, Magetsari SN, Lee J, Andrianus J. Arthroscopic fixation of chronic bicruciate tibial avulsion fractures: A case report. Chin J Traumatol 2023; 26:106-110. [PMID: 36682986 PMCID: PMC10071323 DOI: 10.1016/j.cjtee.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/18/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023] Open
Abstract
A cruciate ligament avulsion is a much less common form of injury than a cruciate ligament tear. Simultaneous tibial avulsion fractures of both cruciate ligaments occur even more rarely. Over the last decades, many studies have described arthroscopic fixation of acute cruciate tibial avulsion fractures, but arthroscopic treatment in a late presenting patient has not been reported in the literature. This case report presents a 32-year-old female with a chronic tibial avulsion fracture of both anterior cruciate ligament and posterior cruciate ligament. Simultaneous fixation of both fractures was performed arthroscopically at week four post-injury. At one year of follow-up, the patient had demonstrated full knee range of motion and stable knee with no complaints, and achieved excellent clinical outcomes. Radiographs showed union of both fractures, and the patient had resumed high-impact exercises.
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Affiliation(s)
- Glen Purnomo
- St. Vincentius a Paulo Catholic Hospital, Surabaya, Indonesia.
| | - Aditya Fuad Robby Triangga
- Department of Orthopaedics and Traumatology, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Satrio Nugroho Magetsari
- Department of Orthopaedics and Traumatology, Universitas Padjajaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Jansen Lee
- Faculty of Medicine, Universitas Prima Indonesia, Medan, Indonesia
| | - Jeffry Andrianus
- St. Vincentius a Paulo Catholic Hospital, Surabaya, Indonesia; Department of Orthopaedics and Traumatology, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
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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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Chang CJ, Huang TC, Hoshino Y, Wang CH, Kuan FC, Su WR, Hong CK. Functional Outcomes and Subsequent Surgical Procedures After Arthroscopic Suture Versus Screw Fixation for ACL Tibial Avulsion Fractures: A Systematic Review and Meta-analysis. Orthop J Sports Med 2022; 10:23259671221085945. [PMID: 35400137 PMCID: PMC8990705 DOI: 10.1177/23259671221085945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Although arthroscopic screw fixation and suture fixation are mainstream
interventions for displaced anterior cruciate ligament avulsion fractures of
the tibia, the differences in clinical outcomes between them remain
inconclusive. Purpose: To conduct a meta-analysis comparing the clinical and functional outcomes
between arthroscopic screw fixation and suture fixation for tibial avulsion
fractures. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was conducted following the PRISMA (Preferred Reporting
Items for Systematic Reviews and Meta-Analyses) guidelines and using the
PubMed, Embase, and Cochrane Central Register of Controlled Trials
databases. Inclusion criteria were English-language articles that compared
functional outcomes after screw fixation versus suture fixation for tibial
avulsion fractures and had at least 1-year follow-up. Relevant data were
extracted and analyzed statistically using the Mantel-Haenszel method and
variance-weighted means. Random-effects models were used to generate pooled
relative risk (RR) estimates with confidence intervals (CIs). Results: Of 1395 articles initially identified, we included 5 studies with 184
patients (91 patients with screw fixations and 93 patients with suture
fixations). The pooled results indicated similar postoperative outcomes for
screw fixation and suture fixation: Lysholm score (mean difference [MD],
−0.32 [95% CI, −6.08 to 5.44]; P = .91), proportion of
International Knee Documentation Committee score grade A (74% vs 74%; RR,
0.63 [95% CI, 0.10-3.95]; P = .63), Tegner score (MD, 0.10
[95% CI: −1.73 to 1.92]; P = .92), and Lachman test results
(stable knee joint, 82% vs 82%; RR, 0.99; 95% CI: 0.85-1.16;
P = .90). Patients in the screw fixation group had a
significantly higher overall subsequent surgery rate (46% vs 19%; RR, 2.33;
95% CI,1.51-3.60; P = .0001) and implant removal rate (44%
vs 3%; RR, 8.52; 95% CI, 3.58-20.29; P < .00001)
compared with those in the suture fixation group. Nonimplant-related
subsequent surgery rates were similar for the 2 groups. Conclusion: The findings indicated a higher risk of subsequent surgery (RR, 2.33) and
implant removal (RR, 8.52) after screw fixation when compared with suture
fixation for tibial avulsion fractures. However, there were no significant
differences in clinical outcome scores between the 2 techniques.
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Affiliation(s)
- Chao-Jui Chang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Ching Huang
- National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Chi-Hsiu Wang
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Skeleton Materials and Biocompatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Liu Z, Wang S, Tian X, Peng A. The Relationship between the Injury Mechanism and the Incidence of ACL Avulsions in Schatzker Type IV Tibial Plateau Fractures: A 3D Quantitative Analysis Based on Mimics Software. J Knee Surg 2022; 36:644-651. [PMID: 34979582 DOI: 10.1055/s-0041-1740929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Tibial plateau fractures are often accompanied with ligamental and meniscal injuries. Among which, the combined existence of Schatzker type IV fracture with anterior cruciate ligament (ACL) avulsion has been reported rarely. The purpose of this study was to determine the injury mechanism of Schatzker type IV fracture with ACL avulsion based on Mimics software. METHODS Ninety-nine Schatzker type IV tibial plateau fractures were retrospectively analyzed by quantitative three-dimensional measurements. ACL avulsions were diagnosed through the data of computed tomography and magnetic resonance imaging. We simulated the knee posture when an injury occurred and defined different injury patterns. The chi-square test was used for determining the main mechanism which causes Schatzker type IV fractures associated with ACL avulsions. RESULTS There were more ACL avulsions and more displaced ACL avulsions associated with the knee in flexion in the setting of Schatzker type IV fracture (p < 0.05). More ACL avulsions were found in the injury pattern of flexion-valgus than the other injury patterns of the same level (p < 0.05). The rotation of the tibial showed no significant difference in producing ACL avulsion fractures. CONCLUSION This study found that a flexed knee at the occurrence of a Schatzker type IV tibial plateau fracture is a high-risk factor for causing associated ACL avulsion and producing more displaced avulsions. Flexion-valgus pattern was the main cause of Schatzker type IV fractures associated with ACL avulsions. The findings will help orthopedists understand the injury mechanism and enhance their awareness of such injuries to avoid unfavorable prognosis.
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Affiliation(s)
- Zihao Liu
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Shuai Wang
- Department of Orthopedic Surgery, Hebei Chest Hospital, Shijiazhuang, Hebei, China
| | - Xiaochen Tian
- Department of Orthopedic Surgery, No. 1 Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
| | - Aqin Peng
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 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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