Abstract
Background: Anterior cruciate ligament (ACL) tibial avulsion fractures are a special ACL injury type, classified as intra-articular fractures. Presently, the main treatment method is arthroscopic surgery, and various fixation methods are available, including use of steel wires, high-strength sutures, cannulated screws, anchors, Kirschner wires, etc. Joint fixation using wire binding could cut through the bone tunnel. We aimed to evaluate the clinical efficacy of a novel method involving suture anchor fixation outside the tunnel to treat anterior cruciate ligament (ACL) tibial avulsion fractures in children.Methods: This retrospective study analyzed the data of 42 pediatric patients (26 boys and 16 girls; age: 7–13 years) with ACL tibial avulsion fractures. Based on the Meyers–McKeever–Zaricznyj classification of fractures, 22, 14, and 6 patients had types II, III, and IV fractures, respectively. All patients underwent arthroscopic surgery for ACL tibial avulsion fracture; during surgery, double tibial tunnels were established, and high-strength sutures were passed through the tunnels and fixed externally with an anchor. The clinical outcome was evaluated by assessing the pre- and post-operative knee joint range of motion (ROM) and by using the Lysholm knee function score and International Knee Documentation Committee (IKDC) score. Post-operative computed tomography and magnetic resonance images were reviewed to determine the status of fracture displacement, healing, and epiphyseal damage.Results: All 42 patients were followed up for 20–36 months (average of 27.8 months). Knee ROM increased from 48.2°±21.7° pre-operatively to 131.6°±8.7° at the final follow-up (t=23.119, P=0.000). The Lysholm knee function score increased from 37.6±5.2 points pre-operatively to 90.1±6.3 points post-operatively, representing a significant improvement (t=41.651, P=0.000). The IKDC score improved from 43.3±7.5 points pre-operatively to 91.3±5.7 points post-operatively (t=45.521, P=0.000). The imaging findings indicated that the fractures healed with displacement and there was no significant epiphyseal damage.Conclusions: Suture anchor fixation outside the tunnel to treat ACL tibial avulsion fracture in children reduces the cutting action of the sutures on the tunnel, minimizes epiphyseal damage, involves a simple procedure, offers firm fixation, and effectively improves knee function. This approach can enable early functional rehabilitation and achieve satisfactory clinical efficacy.
Henderson Approach For Anchor Fixation Of The Fibular Head Avulsion Fracture