Functional Outcomes and Subsequent Surgical Procedures After Arthroscopic Suture Versus Screw Fixation for ACL Tibial Avulsion Fractures: A Systematic Review and Meta-analysis

Abstract

Background: Although arthroscopic screw fixation and suture fixation are mainstream interventions for displaced anterior cruciate ligament avulsion fractures of the tibia, the differences in clinical outcomes between them remain inconclusive. Purpose: To conduct a meta-analysis comparing the clinical and functional outcomes between arthroscopic screw fixation and suture fixation for tibial avulsion fractures. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and using the PubMed, Embase, and Cochrane Central Register of Controlled Trials databases. Inclusion criteria were English-language articles that compared functional outcomes after screw fixation versus suture fixation for tibial avulsion fractures and had at least 1-year follow-up. Relevant data were extracted and analyzed statistically using the Mantel-Haenszel method and variance-weighted means. Random-effects models were used to generate pooled relative risk (RR) estimates with confidence intervals (CIs). Results: Of 1395 articles initially identified, we included 5 studies with 184 patients (91 patients with screw fixations and 93 patients with suture fixations). The pooled results indicated similar postoperative outcomes for screw fixation and suture fixation: Lysholm score (mean difference [MD], −0.32 [95% CI, −6.08 to 5.44]; P = .91), proportion of International Knee Documentation Committee score grade A (74% vs 74%; RR, 0.63 [95% CI, 0.10-3.95]; P = .63), Tegner score (MD, 0.10 [95% CI: −1.73 to 1.92]; P = .92), and Lachman test results (stable knee joint, 82% vs 82%; RR, 0.99; 95% CI: 0.85-1.16; P = .90). Patients in the screw fixation group had a significantly higher overall subsequent surgery rate (46% vs 19%; RR, 2.33; 95% CI,1.51-3.60; P = .0001) and implant removal rate (44% vs 3%; RR, 8.52; 95% CI, 3.58-20.29; P < .00001) compared with those in the suture fixation group. Nonimplant-related subsequent surgery rates were similar for the 2 groups. Conclusion: The findings indicated a higher risk of subsequent surgery (RR, 2.33) and implant removal (RR, 8.52) after screw fixation when compared with suture fixation for tibial avulsion fractures. However, there were no significant differences in clinical outcome scores between the 2 techniques.

Simultaneous Displaced Anterior and Posterior Cruciate Ligament Avulsion Fractures After Fall From a Bicycle

“…There are several reports in the literature of isolated ACL and PCL avulsion fractures 1-4,6,7 . These injuries have been successfully treated by both open and arthroscopic methods.…”

“…We believed that the best way to achieve an anatomic reduction and stable internal fixation and to test the fixation manually would be by open methods. However, both arthroscopic and open techniques have been shown to work equally well and generate equivalent outcomes in the treatment of both ACL and PCL avulsion fractures 1,4,6,7 . The combined fractures of the ACL and PCL is exceedingly rare, and there is little documented in the published literature.…”

“…Displaced fracture fragments may also cause impingement and limit knee range of motion 2,4,6 . Displaced fractures in younger active patients are typically treated with surgical stabilization, either by open or arthroscopic techniques, to minimize the risk of malunion or nonunion with subsequent stiffness, instability, and impingement [1][2][3][4]6,7 . Combined avulsion fractures of the ACL and PCL are extremely rare and have been rarely reported 8 .…”

“…T ibial avulsion fractures of the anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) have been described in the literature [1][2][3][4][5][6][7] . Like typical midsubstance ACL and PCL tears, these bony injuries can result in knee instability 1,4,7 . Displaced fracture fragments may also cause impingement and limit knee range of motion 2,4,6 .…”

Techniques for Fixing Anterior Cruciate Ligament Tibial Avulsion Fractures in Multiligament Knee Injuries

“…However, there was a higher risk of subsequent surgery and implant removal with screw fixation. 1 Here are our references and thank you for watching our video.…”