Arthroscopic treatment of both anterior and posterior cruciate ligament tibial insertion avulsion fractures with suture and absorbable screw double fixation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAODaohong ¹ ,  LIYanlin ² , JIANGZhaowei ³ , LIYan ³ , ZHANGJun ¹ , WUZhidan ¹ , WANGFuke ² , WANGGuoliang ² , HEChuan ²

1. Department of Orthopedics, Second Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650101, P. R. China;
2. Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University;
3. Department of Orthopedics, the First People Hospital of Dehong Prefecture;

Corresponding author：

LIYanlin, Email: 852387873@qq.com

Keywords：

rthroscopy; Anterior cruciate ligament; Posterior cruciate ligament; Tibial avulsion fracture; Suture fixation

DOI：

10.7507/1002-1892.20160168

Video：

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Objective To evaluate the effectiveness of arthroscopic suture and absorbable screw double fixation for both anterior and posterior cruciate ligament avulsion fractures of tibial insertions. Methods Between June 2006 and September 2013, 8 patients with anterior and posterior cruciate ligament avulsion fractures of the tibial eminence underwent arthroscopic treatment with suture and absorbable screw double fixation. There were 5 males and 3 females, with a mean age of 28.9 years (range, 18-43 years). The causes of injury included traffic accident in 5 cases and falling from height in 3 cases. The time from injury to operation was 3-10 days (mean, 6.2 days). The Lysholm knee score, International Knee Documentation Committee (IKDC) score, and Tegner rating scales were used to evaluated the knee function. Results Primary healing of incision was obtained, without infection or deep vein thrombosis. The mean follow-up period was 42.4 months (range, 24 to 65 months). At 3 months after operation, X-ray films showed good reduction and healing of fracture. The anterior and posterior drawer tests were negative. The knee range of motion was normal (0-125°), and it recovered to preoperative level in 7 cases. The IKDC score, Tegner score, and Lysholm score were significantly improved to 90.4±5.2, 7.5±1.6, and 89.2±3.5 from preoperative 52.1±3.3, 3.3±1.0, and 51.9±3.5 respectively (t=-38.680, P=0.000; t=-39.520, P=0.000; t=-41.150, P=0.000). Conclusion A combined injury of anterior and posterior cruciate ligament avulsion fractures of tibial insertions is rare. Arthroscopic treatment with suture and absorbable screw double fixation is a useful technique to restore tibial avulsion injuries with well-documented radiographic healing, good clinical outcomes, and low complication rates.

Citation： ZHAODaohong, LIYanlin, JIANGZhaowei, LIYan, ZHANGJun, WUZhidan, WANGFuke, WANGGuoliang, HEChuan. Arthroscopic treatment of both anterior and posterior cruciate ligament tibial insertion avulsion fractures with suture and absorbable screw double fixation. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(7): 822-825. doi: 10.7507/1002-1892.20160168 Copy

1.	Griffith JF, Antonio GE, Tong CW, et al. Cruciate ligament avulsion fractures. Arthroscopy, 2004, 20(8): 803-812.
2.	White EA, Patel DB, Matcuk GR, et al. Cruciate ligament avulsion fractures: Anatomy, biomechanics, injury patterns, and approach to management. Emerg Radiol, 2013, 20(5): 429-440.
3.	Calpur OU, Copuroglu C, Ozcan M. Avulsion fractures of both anterior and posterior cruciate ligament tibial insertions. Knee Surg Sports Traumatol Arthrosc, 2002, 10(4): 223-225.
4.	Meyers MH. Isolated avulsion of the tibial attachment of the posterior cruciate ligament of the knee. J Bone Joint Surg (Am), 1975, 57(5): 669-672.
5.	Shino K, Mae T, Maeda A, et al. Graft fixation with predetermined tension using a new device, the double spike plate. Arthroscopy, 2002, 18(8): 908-911.
6.	Shino K, Nakata K, Mae T, et al. Arthroscopic fixation of tibial bony avulsion of the posterior cruciate ligament. Arthroscopy, 2003, 19(2): 343-349.
7.	Ziegler CG, Pietrini SD, Westerhaus BD, et al. Arthroscopically pertinent landmarks for tunnel positioning in single-bundle and double-bundle anterior cruciate ligament reconstructions. Am J Sports Med, 2011, 39(4): 743-752.
8.	Kato Y, Ingham SJ, Maeyama A, et al. Biomechanics of the human triple-bundle anterior cruciate ligament. Arthroscopy, 2012, 28(2): 247-254.
9.	Hapa O, Barber FA, Süner G, et al. Biomechanical comparison of tibial eminence fracture fixation with high-strength suture, EndoButton, and suture anchor. Arthroscopy, 2011, 22(4): 442-449.
10.	Choi NH, Kim SJ. Arthroscopic reduction and fixation of bony avulsion of the posterior cruciate ligament of the tibia. Arthroscopy, 1997, 13(6): 759-762.
11.	Littlejohn SG, Geissler WB. Arthroscopic repair of a posterior cruciate ligament avulsion. Arthroscopy, 1995, 11(2): 235-238.
12.	Pandey V, Cps S, Acharya K, et al. Arthroscopic suture pull-out fixation of displaced tibial spine avulsion fracture. J Knee Surg, 2016, 10(3): 212-216.
13.	王江涛, 申学振, 刘畅, 等.缝线领带结套扎固定胫骨髁间嵴撕脱骨折的生物力学研究.中国修复重建外科杂志, 2015, 29(9): 1080-1083.
14.	Sabat D, Jain A, Kumar V. Displaced posterior cruciate ligament avulsion fractures: a retrospective comparative study between open posterior approach and arthroscopic single-tunnel suture fixation. Arthroscopy, 2016, 32(1): 44-53.
15.	李桓毅, 吴海山, 吴宇黎, 等.关节镜下两种固定方式治疗前交叉韧带止点撕脱骨折的疗效比较.中国修复重建外科杂志, 2011, 25(8): 899-902.
16.	Leeberg V, Lekdorf J, Wong C, et al. Tibial eminentia avulsion fracture in children-a systematic review of the current literature. Dan Med J, 2014, 61(3): A4792.
17.	Chen LB, Wang H, Tie K, et al. Arthroscopic fixation of an avulsion fracture of the tibia involving the posterior cruciate ligament: a modified technique in a series of 22 cases. Bone Joint J, 2015, 97-B(9): 1220-1225.
18.	Lee KW, Yang DS, Lee GS, et al. Suture bridge fixation technique for posterior cruciate ligament avulsion fracture. Clin Orthop Surg, 2015, 7(4): 505-508.

1. Griffith JF, Antonio GE, Tong CW, et al. Cruciate ligament avulsion fractures. Arthroscopy, 2004, 20(8): 803-812.
2. White EA, Patel DB, Matcuk GR, et al. Cruciate ligament avulsion fractures: Anatomy, biomechanics, injury patterns, and approach to management. Emerg Radiol, 2013, 20(5): 429-440.
3. Calpur OU, Copuroglu C, Ozcan M. Avulsion fractures of both anterior and posterior cruciate ligament tibial insertions. Knee Surg Sports Traumatol Arthrosc, 2002, 10(4): 223-225.
4. Meyers MH. Isolated avulsion of the tibial attachment of the posterior cruciate ligament of the knee. J Bone Joint Surg (Am), 1975, 57(5): 669-672.
5. Shino K, Mae T, Maeda A, et al. Graft fixation with predetermined tension using a new device, the double spike plate. Arthroscopy, 2002, 18(8): 908-911.
6. Shino K, Nakata K, Mae T, et al. Arthroscopic fixation of tibial bony avulsion of the posterior cruciate ligament. Arthroscopy, 2003, 19(2): 343-349.
7. Ziegler CG, Pietrini SD, Westerhaus BD, et al. Arthroscopically pertinent landmarks for tunnel positioning in single-bundle and double-bundle anterior cruciate ligament reconstructions. Am J Sports Med, 2011, 39(4): 743-752.
8. Kato Y, Ingham SJ, Maeyama A, et al. Biomechanics of the human triple-bundle anterior cruciate ligament. Arthroscopy, 2012, 28(2): 247-254.
9. Hapa O, Barber FA, Süner G, et al. Biomechanical comparison of tibial eminence fracture fixation with high-strength suture, EndoButton, and suture anchor. Arthroscopy, 2011, 22(4): 442-449.
10. Choi NH, Kim SJ. Arthroscopic reduction and fixation of bony avulsion of the posterior cruciate ligament of the tibia. Arthroscopy, 1997, 13(6): 759-762.
11. Littlejohn SG, Geissler WB. Arthroscopic repair of a posterior cruciate ligament avulsion. Arthroscopy, 1995, 11(2): 235-238.
12. Pandey V, Cps S, Acharya K, et al. Arthroscopic suture pull-out fixation of displaced tibial spine avulsion fracture. J Knee Surg, 2016, 10(3): 212-216.
13. 王江涛, 申学振, 刘畅, 等.缝线领带结套扎固定胫骨髁间嵴撕脱骨折的生物力学研究.中国修复重建外科杂志, 2015, 29(9): 1080-1083.
14. Sabat D, Jain A, Kumar V. Displaced posterior cruciate ligament avulsion fractures: a retrospective comparative study between open posterior approach and arthroscopic single-tunnel suture fixation. Arthroscopy, 2016, 32(1): 44-53.
15. 李桓毅, 吴海山, 吴宇黎, 等.关节镜下两种固定方式治疗前交叉韧带止点撕脱骨折的疗效比较.中国修复重建外科杂志, 2011, 25(8): 899-902.
16. Leeberg V, Lekdorf J, Wong C, et al. Tibial eminentia avulsion fracture in children-a systematic review of the current literature. Dan Med J, 2014, 61(3): A4792.
17. Chen LB, Wang H, Tie K, et al. Arthroscopic fixation of an avulsion fracture of the tibia involving the posterior cruciate ligament: a modified technique in a series of 22 cases. Bone Joint J, 2015, 97-B(9): 1220-1225.
18. Lee KW, Yang DS, Lee GS, et al. Suture bridge fixation technique for posterior cruciate ligament avulsion fracture. Clin Orthop Surg, 2015, 7(4): 505-508.

Chinese Journal of Reparative and Reconstructive Surgery

Arthroscopic treatment of both anterior and posterior cruciate ligament tibial insertion avulsion fractures with suture and absorbable screw double fixation

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