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J Knee Surg 2021; 34(12): 1355-1358
DOI: 10.1055/s-0040-1709180
Original Article

Subintermeniscal Ligament Pullout Suture Technique for Anterior Cruciate Ligament Avulsion Fracture Fixation—AIIMS Technique

Ravi Mittal
1   Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
,
Vijaykumar Digge 
1   Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
,
Rajkumar Selvanayagam
1   Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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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.

Keywords

ACL avulsion - transverse intermeniscal ligament - pullout suture technique


Publication History

Received: 14 March 2019

Accepted: 16 February 2020

Article published online:
24 April 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Poncet A. Arrachement de l'epine du tibia a l'insertion du ligament croise anterieur. Bull Mem Soc Chir Paris 1875; 1: 883-884
    PubMedGoogle Scholar
  • 2 Anderson AF. Transepiphyseal replacement of the anterior cruciate ligament in skeletally immature patients. A preliminary report. J Bone Joint Surg Am 2003; 85 (07) 1255-1263
    CrossrefPubMedGoogle Scholar
  • 3 Stanitski CL, Harvell JC, Fu F. Observations on acute knee hemarthrosis in children and adolescents. J Pediatr Orthop 1993; 13 (04) 506-510
    CrossrefPubMedGoogle Scholar
  • 4 Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am 1970; 52 (08) 1677-1684
    CrossrefPubMedGoogle Scholar
  • 5 Zaricznyj B. Avulsion fracture of the tibial eminence: treatment by open reduction and pinning. J Bone Joint Surg Am 1977; 59 (08) 1111-1114
    CrossrefPubMedGoogle Scholar
  • 6 Bale RS, Banks AJ. Arthroscopically guided Kirschner wire fixation for fractures of the intercondylar eminence of the tibia. J R Coll Surg Edinb 1995; 40 (04) 260-262
    PubMedGoogle Scholar
  • 7 Sundararajan SR, Rajasekaran S, Bernard SL. Displaced anterior cruciate ligament avulsion fractures: arthroscopic staple fixation. Indian J Orthop 2011; 45 (04) 324-329
    CrossrefPubMedGoogle Scholar
  • 8 van Loon T, Marti RK. A fracture of the intercondylar eminence of the tibia treated by arthroscopic fixation. Arthroscopy 1991; 7 (04) 385-388
    CrossrefPubMedGoogle Scholar
  • 9 Fehnel DJ, Johnson R. Anterior cruciate injuries in the skeletally immature athlete: a review of treatment outcomes. Sports Med 2000; 29 (01) 51-63
    CrossrefPubMedGoogle Scholar
  • 10 Hunter RE, Willis JA. Arthroscopic fixation of avulsion fractures of the tibial eminence: technique and outcome. Arthroscopy 2004; 20 (02) 113-121
    CrossrefPubMedGoogle Scholar
  • 11 Zhao J, Huangfu X. Arthroscopic treatment of nonunited anterior cruciate ligament tibial avulsion fracture with figure-of-8 suture fixation technique. Arthroscopy 2007; 23 (04) 405-410
    CrossrefPubMedGoogle Scholar
  • 12 Mann MA, Desy NM, Martineau PA. A new procedure for tibial spine avulsion fracture fixation. Knee Surg Sports Traumatol Arthrosc 2012; 20 (12) 2395-2398
    CrossrefPubMedGoogle Scholar
  • 13 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 (08) 1639-1650
    CrossrefPubMedGoogle Scholar
  • 14 Pandey V, Cps S, Acharya K, Rao SK. Arthroscopic suture pullout fixation of displaced tibial spine avulsion fracture. J Knee Surg 2017; 30 (01) 28-35
    PubMedGoogle Scholar
  • 15 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 (07) 741-747
    CrossrefPubMedGoogle Scholar
  • 16 Lehman Jr RA, Murphy KP, Machen MS, Kuklo TR. Modified arthroscopic suture fixation of a displaced tibial eminence fracture. Arthroscopy 2003; 19 (02) E6
    CrossrefPubMedGoogle Scholar
  • 17 Oohashi Y. A simple technique for arthroscopic suture fixation of displaced fracture of the intercondylar eminence of the tibia using folded surgical steels. Arthroscopy 2001; 17 (09) 1007-1011
    CrossrefPubMedGoogle Scholar
  • 18 Yip DK, Wong JW, Chien EP, Chan CF. Modified arthroscopic suture fixation of displaced tibial eminence fractures using a suture loop transporter. Arthroscopy 2001; 17 (01) 101-106
    CrossrefPubMedGoogle Scholar
  • 19 Boutsiadis A, Karataglis D, Agathangelidis F, Ditsios K, Papadopoulos P. Arthroscopic 4-point suture fixation of anterior cruciate ligament tibial avulsion fractures. Arthrosc Tech 2014; 3 (06) e683-e687
    CrossrefPubMedGoogle Scholar
  • 20 Kobayashi S, Harato K, Udagawa K. et al. Arthroscopic treatment of tibial eminence avulsion fracture with suture tensioning technique. Arthrosc Tech 2018; 7 (03) e251-e256
    CrossrefPubMedGoogle Scholar
  • 21 Ahn JH, Yoo JC. Clinical outcome of arthroscopic reduction and suture for displaced acute and chronic tibial spine fractures. Knee Surg Sports Traumatol Arthrosc 2005; 13 (02) 116-121
    CrossrefPubMedGoogle Scholar
  • 22 Gamboa JT, Durrant BA, Pathare NP, Shin EC, Chen JL. Arthroscopic reduction of tibial spine avulsion: suture lever reduction technique. Arthrosc Tech 2017; 6 (01) e121-e126
    CrossrefPubMedGoogle Scholar