Arthroscopic Single-Tunnel Pullout Suture Fixation for Tibial Eminence Avulsion Fracture

Abstract

Various arthroscopic techniques have been devised for fixation of tibial eminence avulsions, namely percutaneous K-wires, arthroscopy-guided screw fixation, staples, TightRope (Arthrex)–suture button fixation, and transosseous suture fixation. Such techniques provide well-pronounced advantages including less postoperative pain, a reduced hospital stay, and minimal scar with resultant earlier and more compliant rehabilitation. As for transosseous suture fixation, the standard technique comprises the creation of 2 tibial tunnels exiting on both sides of the footprint of the avulsion fracture using an anterior cruciate ligament tibial guide with the angle set at 45°. Our technique entails the creation of a single tibial tunnel directed from the proximal anteromedial tibia to the center of the tibial eminence. The technique uses Ethibond suture (No. 5) and/or FiberWire suture (Arthrex) to fix the tibial eminence by pulling the anterior cruciate ligament fibers and tightening the pullout suture at the tibial exit of the tunnel with a 4-hole button. This modified single-tunnel pullout suture technique is an appealing option that has proved to be effective and economical with a shorter operative time. Moreover, it provides a less invasive option for skeletally immature patients.

Arthroscopic Reduction and Internal Fixation of Tibial Eminence Fractures With Transosseous Suture Bridge Fixation

“…Although the described technique shares similarities with other suture-based techniques, 9 , 10 , 11 , 12 , 13 , 14 , 15 it is the first to use a commercially available meniscal root repair system along with a disposable suture-passage device to facilitate accurate, reliable suture passage and tunnel creation. Boutsiadis et al.…”

“… 6 However, modern suture-based techniques vary in suture configuration, fixation, and technical details that limit critical comparison. 9 , 10 , 11 , 12 , 13 , 14 , 15 …”

Suturing the Anterior Cruciate Ligament Using a No. 16 Intravenous Catheter Needle in Avulsion Anterior Cruciate Ligament Injury

“…The surgeon can create 1, 2, 3, or 4 tunnels. 5 , 6 More than 1 tunnel can provide a good security of fixation. We created 1 anterior tunnel to pull the suture through.…”

Arthroscopic Fixation of Tibial Spine Avulsion in Skeletally Immature Patients by Double Tunnel Pull-out Suture Technique

“…In that situation, the tibial spine is avulsed and the ACL fibers remain intact, although the forces responsible for the fracture may initially strain the ACL and lead to long-lasting deformation and laxity. 2 Generally, there are 2 methods of fixation: screw fixation and suture-based fixation. Although latest studies have revealed the biomechanical advantages of the newer suture-based methods of fixation, several methods were mentioned for tibial spine avulsion fixation of like cannulated screws, suture anchors 3 , and pullout sutures.…”