J Knee Surg 2023; 36(02): 132-138
DOI: 10.1055/s-0041-1731326
Original Article

A New Arthroscopic Tightrope Suture-Button Fixation Procedure for Tibial Eminence Avulsion Fracture

1   Department of Orthopaedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
,
Ruiyong Du
1   Department of Orthopaedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
,
Song Luo
2   Southern Medical District of Chinese PLA General Hospital, Beijing, China
,
Lianxu Chen
1   Department of Orthopaedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
,
Qi Ma
1   Department of Orthopaedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
,
Xu Cai
1   Department of Orthopaedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
› Author Affiliations
Funding None.

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.

Authors' Contributions

C.S. was the guarantor of integrity of the entire study. C.S. and X.C. provided the study concepts. C.S. also designed the study. C.S., R.D., and Q.M carried out the literature research. C.S. and R.D. contributed in data acquisition. R.D. and C.S. performed data analysis/interpretation. S.L. and C.S. performed statistical analysis. C.S. prepared the manuscript as well as edited it, and provided definition of intellectual content. X.C. carried out manuscript revision/review. All the authors approved the final manuscript version.




Publication History

Received: 04 August 2020

Accepted: 01 May 2021

Article published online:
29 June 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Hargrove R, Parsons S, Payne R. Anterior tibial spine fracture - an easy fracture to miss. Accid Emerg Nurs 2004; 12 (03) 173-175
  • 2 Aderinto J, Walmsley P, Keating JF. Fractures of the tibial spine: epidemiology and outcome. Knee 2008; 15 (03) 164-167
  • 3 Griffith JF, Antonio GE, Tong CW, Ming CK. Cruciate ligament avulsion fractures. Arthroscopy 2004; 20 (08) 803-812
  • 4 Coyle C, Jagernauth S, Ramachandran M. Tibial eminence fractures in the paediatric population: a systematic review. J Child Orthop 2014; 8 (02) 149-159
  • 5 Bogunovic L, Tarabichi M, Harris D, Wright R. Treatment of tibial eminence fractures: a systematic review. J Knee Surg 2015; 28 (03) 255-262
  • 6 Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am 1970; 52 (08) 1677-1684
  • 7 Zaricznyj B. Avulsion fracture of the tibial eminence: treatment by open reduction and pinning. J Bone Joint Surg Am 1977; 59 (08) 1111-1114
  • 8 Shelbourne KD, Urch SE, Freeman H. Outcomes after arthroscopic excision of the bony prominence in the treatment of tibial spine avulsion fractures. Arthroscopy 2011; 27 (06) 784-791
  • 9 Janarv PM, Westblad P, Johansson C, Hirsch G. Long-term follow-up of anterior tibial spine fractures in children. J Pediatr Orthop 1995; 15 (01) 63-68
  • 10 Rademakers MV, Kerkhoffs GM, Kager J, Goslings JC, Marti RK, Raaymakers EL. Tibial spine fractures: a long-term follow-up study of open reduction and internal fixation. J Orthop Trauma 2009; 23 (03) 203-207
  • 11 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
  • 12 Davies EM, McLaren MI. Type III tibial spine avulsions treated with arthroscopic Acutrak screw reattachment. Clin Orthop Relat Res 2001; (388) 205-208
  • 13 Lehman Jr. RA, Murphy KP, Machen MS, Kuklo TR. Modified arthroscopic suture fixation of a displaced tibial eminence fracture. Arthroscopy 2003; 19 (02) E6
  • 14 Lu XW, Hu XP, Jin C, Zhu T, Ding Y, Dai LY. Reduction and fixation of the avulsion fracture of the tibial eminence using mini-open technique. Knee Surg Sports Traumatol Arthrosc 2010; 18 (11) 1476-1480
  • 15 Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am 1959; 41-A (02) 209-220 , discussion 220–222
  • 16 Perugia D, Basiglini L, Vadalà A, Ferretti A. Clinical and radiological results of arthroscopically treated tibial spine fractures in childhood. Int Orthop 2009; 33 (01) 243-248
  • 17 Reynders P, Reynders K, Broos P. Pediatric and adolescent tibial eminence fractures: arthroscopic cannulated screw fixation. J Trauma 2002; 53 (01) 49-54
  • 18 Vega JR, Irribarra LA, Baar AK, Iñiguez M, Salgado M, Gana N. Arthroscopic fixation of displaced tibial eminence fractures: a new growth plate-sparing method. Arthroscopy 2008; 24 (11) 1239-1243
  • 19 Yang SW, Lu YC, Teng HP, Wong CY. Arthroscopic reduction and suture fixation of displaced tibial intercondylar eminence fractures in adults. Arch Orthop Trauma Surg 2005; 125 (04) 272-276
  • 20 Skak SV, Jensen TT, Poulsen TD, Stürup J. Epidemiology of knee injuries in children. Acta Orthop Scand 1987; 58 (01) 78-81
  • 21 Luhmann SJ. Acute traumatic knee effusions in children and adolescents. J Pediatr Orthop 2003; 23 (02) 199-202
  • 22 Gans I, Baldwin KD, Ganley TJ. Treatment and management outcomes of tibial eminence fractures in pediatric patients: a systematic review. Am J Sports Med 2014; 42 (07) 1743-1750
  • 23 Mylle J, Reynders P, Broos P. Transepiphysial fixation of anterior cruciate avulsion in a child. Report of a complication and review of the literature. Arch Orthop Trauma Surg 1993; 112 (02) 101-103
  • 24 Gans I, Babatunde OM, Ganley TJ. Hybrid fixation of tibial eminence fractures in skeletally immature patients. Arthrosc Tech 2013; 2 (03) e237-e242
  • 25 Bong MR, Romero A, Kubiak E. et al. Suture versus screw fixation of displaced tibial eminence fractures: a biomechanical comparison. Arthroscopy 2005; 21 (10) 1172-1176
  • 26 Lafrance RM, Giordano B, Goldblatt J, Voloshin I, Maloney M. Pediatric tibial eminence fractures: evaluation and management. J Am Acad Orthop Surg 2010; 18 (07) 395-405
  • 27 Pan RY, Yang JJ, Chang JH, Shen HC, Lin LC, Lian YT. Clinical outcome of arthroscopic fixation of anterior tibial eminence avulsion fractures in skeletally mature patients: a comparison of suture and screw fixation technique. J Trauma Acute Care Surg 2012; 72 (02) E88-E93
  • 28 Lubowitz JH, Elson WS, Guttmann D. Part II: arthroscopic treatment of tibial plateau fractures: intercondylar eminence avulsion fractures. Arthroscopy 2005; 21 (01) 86-92
  • 29 Koukoulias NE, Germanou E, Lola D, Papavasiliou AV, Papastergiou SG. Clinical outcome of arthroscopic suture fixation for tibial eminence fractures in adults. Arthroscopy 2012; 28 (10) 1472-1480
  • 30 Jang KM, Bae JH, Kim JG, Wang JH. Novel arthroscopic fixation method for anterior cruciate ligament tibial avulsion fracture with accompanying detachment of the anterior horn of the lateral meniscus: three-point suture fixation. Injury 2013; 44 (08) 1028-1032
  • 31 White EA, Patel DB, Matcuk GR. et al. Cruciate ligament avulsion fractures: anatomy, biomechanics, injury patterns, and approach to management. Emerg Radiol 2013; 20 (05) 429-440
  • 32 Ezechieli M, Schäfer M, Becher C. et al. Biomechanical comparison of different fixation techniques for reconstruction of tibial avulsion fractures of the anterior cruciate ligament. Int Orthop 2013; 37 (05) 919-923
  • 33 Strauss EJ, Kaplan DJ, Weinberg ME, Egol J, Jazrawi LM. Arthroscopic management of tibial spine avulsion fractures: principles and techniques. J Am Acad Orthop Surg 2018; 26 (10) 360-367
  • 34 Eggers AK, Becker C, Weimann A. et al. Biomechanical evaluation of different fixation methods for tibial eminence fractures. Am J Sports Med 2007; 35 (03) 404-410
  • 35 Li J, Yu Y, Liu C, Su X, Liao W, Li Z. Arthroscopic fixation of tibial eminence fractures: a biomechanical comparative study of screw, suture, and suture anchor. Arthroscopy 2018; 34 (05) 1608-1616
  • 36 van Loon T, Marti RK. A fracture of the intercondylar eminence of the tibia treated by arthroscopic fixation. Arthroscopy 1991; 7 (04) 385-388
  • 37 Fehnel DJ, Johnson R. Anterior cruciate injuries in the skeletally immature athlete: a review of treatment outcomes. Sports Med 2000; 29 (01) 51-63
  • 38 Hunter RE, Willis JA. Arthroscopic fixation of avulsion fractures of the tibial eminence: technique and outcome. Arthroscopy 2004; 20 (02) 113-121
  • 39 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
  • 40 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
  • 41 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
  • 42 Pandey V, Cps S, Acharya K, Rao SK. Arthroscopic suture pull-out fixation of displaced tibial spine avulsion fracture. J Knee Surg 2017; 30 (01) 28-35
  • 43 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
  • 44 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
  • 45 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