Arthroscopic Absorbable Suture Fixation for Tibial Spine Fractures

Abstract

The purpose of this technical note and accompanying video is to describe a modified arthroscopic suture fixation technique to treat tibial spine avulsion fractures. Twenty-one patients underwent arthroscopic treatment for tibial spine avulsion with our technique; they were clinically and biomechanically evaluated at 2 years' follow-up and showed optimal clinical and radiographic outcomes. Repair with this arthroscopic technique provides a significant advantage in the treatment of type III and IV fractures of the tibial eminence by obtaining arthroscopic fixation within the substance of the anterior cruciate ligament: suture methods based on the avulsed bone fragment are technically impossible, but sutures through the base of the ligament itself provide secure fixation, reducing the risks of comminution of the fracture fragment and eliminating the time for hardware removal. This arthroscopic technique restores the length and the integrity of the anterior cruciate ligament and provides a simplified, reproducible method of treating patients, including young patients, with low hardware costs in comparison to sutures using anchors or other hardware.

Tibial Spine Fractures in Children: Evaluation, Management, and Future Directions

“…16 These include both traditional and headless screws, [58][59][60] cannulated screws, 54,61 or Kirschner wires (Kwires). 18,62 Suture-based techniques are also popular and include absorbable suture, [63][64][65] nonabsorbable suture, 14,19,20,53,[66][67][68][69][70][71][72][73][74][75] suture anchors, 74,76,77 suture bridge and cortical button constructs, [78][79][80] lasso, 81 and meniscus arrow. 82 Those who prefer metal screws report reliability and procedural simplicity.…”

Arthroscopic fixation of ACL avulsion fracture in the saint pault hospital: A review of treatment outcomes: Cohort study

“…The arthroscopic suture fixation has been recently the most common method with various improvements being developed [16]. Thus, there is a whole range of works reporting excellent and good results with high functional scores obtained using suture fixation [17,27]. Ahn and Yoo report a Lysholm score of 95.6 [18], Song et al indicate a 89.5 score [19], while Jadhav and Gotecha report a high of 98.6 [21].…”

“…They are known for encouraging results [7,8,[10], [11], [12], [13], [14], [15]], but they are not without certain drawbacks. Currently, arthroscopic suture fixation with fiber wires is the most common technique [[16], [17], [18], [19], [20], [21]]. However, there are concerns about potential postoperative complications.…”

Arthroscopic Reduction of Tibial Spine Avulsion: Suture Lever Reduction Technique

“…5 This repair has been previously described using open and arthroscopic approaches, with the latter having a decreased risk of soft tissue complications and postoperative pain. 9,10 The avulsion fracture is repaired to the tibia using a variety of methods including the use of screws, button systems, anchors, and sutures.…”