All-Inside Anterior Cruciate Ligament Tibial Avulsion Repair

Abstract

Anterior cruciate ligament (ACL) tibial avulsion occurs predominantly in children and young adults. It is seen in association with injuries due to hyperextension usually involving movements that are similar to riding a bicycle. Bony ACL avulsion is associated with severe restriction of knee range of motion, swelling, inability to bear weight, and continuous pain. Acute swelling does not allow a conclusive clinical examination. Bony ACL avulsion from the tibial side has been treated by various methods ranging from conservative management to a wide range of operative procedures. The various operative procedures that have been described require challenging operative skills, time, and resources, making these techniques demanding and technically challenging. We describe a technique for the treatment of Meyers-McKeever type II, III, and IV bony tibial ACL avulsions that uses regular anterolateral and anteromedial portals with an additional transpatellar portal. The avulsed fragments along with the ACL are held and buttressed with the help of FiberWires and fixed with the intra-articular portion of the proximal tibia. The technique is performed in an all-inside manner and is easy to master, even for beginners.A nterior cruciate ligament (ACL) avulsion injuries from the tibial side are seen most commonly among children and young adults. 1 They are commonly associated with sports injuries like those usually seen during hyperextension combined with a rotational injury of the knee. 2 ACL avulsion from the tibial side can be extremely debilitating because it limits daily activities, restricts range of motion, and is commonly found in association with continuous pain with or without weight bearing, knee swelling, and instability. Per the Meyers and McKeever classification, 3 types II, III, and IV are displaced avulsion fracture injuries for which one should consider intervening. It is important to realize that however small a tibial avulsion fragment may be, it can be very limiting to the patient. If not addressed adequately, this avulsion is associated with joint laxity, constant pain, fracture nonunion, and loss

Ten Pearls for Anterior Cruciate Ligament Reconstruction

“…This portal is typically placed during knee flexion at ∼1 cm below the inferior patellar pole ( Fig 3 ). 17 Incisions made should be vertical and run in parallel to the patellar tendon fibers.

Fig 3 In order to establish acceptable anterolateral and antermedial arthroscopic portals for assistance with ACL reconstruction, first palpate the inferior pole of the patella.

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Arthroscopic Fixation of Anterior Cruciate Ligament Avulsion Fracture Using FiberWire Suture With Suture Disc

“…Arthroscopic reduction and fixation have become popular due to limited skin incision and soft-tissue injury. A wide variety of devices, including screw, 9,10 staple, 11 tension wiring, 12 K wire, 13,14 suspensory fixation, 15 suture, [16][17][18][19][20][21] and anchor sutures 2,22,23 have been used to fix the ACL avulsion fracture during arthroscopy. In this article, we describe our technique for arthroscopic fixation of the ACL avulsion fracture (Video 1) and further delineate its pros and cons for managing ACL avulsion fracture.…”