The Adjustable Locking Suspension Sling Technique for Fixation of the Tibial Eminence Fracture in Adolescents

Abstract

Avulsion fractures of the tibial eminence, although generally a rare injury pattern, are more common in children and adolescents than in adults. Many open and arthroscopic techniques are available with variable degrees of satisfying results and incidence of complications and adverse effects. Arthroscopic fixation appeared to improve the functional outcomes with fewer complications than the open fixation. New techniques were reported using commercially available suspension sling devices for the acromioclavicular joint that offers an easy and rapid method of fixation. However, this technique has the disadvantages of the presence of hardware (button) over the tibial anterior cruciate ligament attachment inside the joint and the need to drill a relatively large tunnel through the center of the avulsed fragment that may increase the chance of fracture. So small-diameter tunnels need to be drilled that will decrease bone loss and growth plate injury in children and adolescents. We describe here a technique that offers a better 4-point fixation through the anterior cruciate ligament with fewer complications by avoiding drilling through the avulsed fragment, absence of hardware inside the joint, and decreasing bone loss in adolescents by drilling only smaller transosseous tunnels and allowing for correction of the fixation using a special configuration of knots and cortical button.

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 …”

Suspension button constructs restore posterior knee laxity in solid tibial avulsion of the posterior cruciate ligament

“…The use of suspension button devices to reduce and secure tibial eminence fractures (ACL) or tibial PCL avulsions is a new procedure in arthroscopic knee surgery [ 1 , 10 , 11 ].…”

“…Adjustable suspension button devices are used to reduce tibial anterior cruciate ligament (ACL) avulsions [ 1 ] or tibial PCL avulsions [ 11 ]. The advantage of these adjustable systems in contrast to rigid fixation is their feasibility and easy application during surgery.…”

Arthroscopic Epiphyseal Plate-Sparing Fixation of Anterior Cruciate Ligament Tibial Avulsion Fracture in Skeletally Immature Patients

“…When fracture reduction and fixation are inevitable choices, measures should be taken to minimize or avoid injury to the epiphysial plate. 2 , 3 , 4 , 5 , 6 , 7 If the patient is in late adolescence and the growth peak has passed, the entire treatment principle and methods are the same as for adults. The following technique was developed for children or patients in early adolescence.…”