Download PDF
J Knee Surg 2019; 32(03): 290-294
DOI: 10.1055/s-0038-1641173
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Tension Band Wire Fixation Technique for Anterior Cruciate Ligament Tibial Avulsion Fracture: A New Fixation Technique

Jing Ding
1   Orthopedic Center, Kunming General Hospital of Chengdu Military Region, Kunming, Republic of China
,
Lianping Wan
2   Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Republic of China
,
Xiaosheng Hou
2   Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Republic of China
,
Yudong Gan
2   Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Republic of China
› Author Affiliations Funding None.
Further Information

Publication History

26 June 2017

25 February 2018

Publication Date:
10 April 2018 (online)

    Permissions and Reprints

Abstract

This study evaluated clinical results of tension band wire fixation technique in the arthroscopic treatment of anterior cruciate ligament (ACL) tibial avulsion fracture. This study included 148 cases of ACL tibial avulsion fracture treated using arthroscopic tension band wire fixation technique. Patients were followed up for 25 to 36 months with an average of 27 months and evaluated in accordance with the International Knee Documentation Committee (IKDC) and Lysholm knee scoring scale. Fractures were united within 3 months after surgery in all cases. During the last follow-up, the anterior drawer, Lachman, and pivot shift tests showed negative, except for eight patients who had a 1-degree positive anterior drawer test. KT-1000 knee stability test showed no anterior instability exceeding 2 mm in 132 patients and 4 mm in 8 patients. In accordance with the IKDC scale, the knees of 132 patients were graded normal, whereas 8 other patients were nearly normal. Lysholm scores before surgery and during the last follow-up were 72.4 ± 3.2 and 97.5 ± 2.2, respectively. Statistically significant differences were observed among the Lysholm scores (p < 0.05). The Tegner scores were 6.5 ± 0.9 before injury and 6.4 ± 0.7 at the last follow-up (p > 0.05). No statistically significant differences between the preinjury and postoperative activity level were observed. All patients were satisfied with the outcomes of operation. Arthroscopic treatment of ACL tibial avulsion fracture by using tension band wire fixation technique ensures fracture healing and restores the stability and function of the joint in most patients. The level of evidence for this study is III.

Keywords

anterior cruciate ligament - tibial avulsion fracture - tension band wire fixation
 

  • References

  • 1 Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am 1959; 41-A (02) 209-220
    PubMedGoogle Scholar
  • 2 Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am 1970; 52 (08) 1677-1684
    CrossrefPubMedGoogle Scholar
  • 3 Zhao J, Huangfu X. Arthroscopic treatment of nonunited anterior cruciate ligament tibial avulsion fracture with figure-of-8 suture fixation technique. Arthroscopy 2007; 23 (04) 405-410
    CrossrefPubMedGoogle Scholar
  • 4 Senekovic V, Veselko M. Anterograde arthroscopic fixation of avulsion fractures of the tibial eminence with a cannulated screw: five-year results. Arthroscopy 2003; 19 (01) 54-61
    PubMedGoogle Scholar
  • 5 Boutsiadis A, Karataglis D, Agathangelidis F, Ditsios K, Papadopoulos P. Arthroscopic 4-point suture fixation of anterior cruciate ligament tibial avulsion fractures. Arthrosc Tech 2014; 3 (06) e683-e687
    CrossrefPubMedGoogle Scholar
  • 6 Brunner S, Vavken P, Kilger R. , et al. Absorbable and non-absorbable suture fixation results in similar outcomes for tibial eminence fractures in children and adolescents. Knee Surg Sports Traumatol Arthrosc 2016; 24 (03) 723-729
    CrossrefPubMedGoogle Scholar
  • 7 Bonin N, Jeunet L, Obert L, Dejour D. Adult tibial eminence fracture fixation: arthroscopic procedure using K-wire folded fixation. Knee Surg Sports Traumatol Arthrosc 2007; 15 (07) 857-862
    CrossrefPubMedGoogle Scholar
  • 8 Huang TW, Hsu KY, Cheng CY. , et al. Arthroscopic suture fixation of tibial eminence avulsion fractures. Arthroscopy 2008; 24 (11) 1232-1238
    CrossrefPubMedGoogle Scholar
  • 9 In Y, Kim JM, Woo YK, Choi NY, Moon CW, Kim MW. Arthroscopic fixation of anterior cruciate ligament tibial avulsion fractures using bioabsorbable suture anchors. Knee Surg Sports Traumatol Arthrosc 2008; 16 (03) 286-289
    CrossrefPubMedGoogle Scholar
  • 10 Lubowitz JH, Elson WS, Guttmann D. Part II: arthroscopic treatment of tibial plateau fractures: intercondylar eminence avulsion fractures. Arthroscopy 2005; 21 (01) 86-92
    CrossrefPubMedGoogle Scholar
  • 11 Sekiya H, Takatoku K, Kimura A, Kanaya Y, Fukushima T, Takeshita K. Arthroscopic fixation with EndoButton for tibial eminence fractures visualised through a proximal superomedial portal: a surgical technique. J Orthop Surg (Hong Kong) 2016; 24 (03) 417-420
    CrossrefPubMedGoogle Scholar
  • 12 Estes AR, Oladeji LO. Arthroscopic treatment of tibial spine malunion with resorbable screws. Am J Orthop 2015; 44 (05) E160-E164
    PubMedGoogle Scholar
  • 13 Verdano MA, Pellegrini A, Lunini E, Tonino P, Ceccarelli F. Arthroscopic absorbable suture fixation for tibial spine fractures. Arthrosc Tech 2013; 3 (01) e45-e48
    PubMedGoogle Scholar
  • 14 Gan Y, Xu D, Ding J, Xu Y. Tension band wire fixation for anterior cruciate ligament avulsion fracture: biomechanical comparison of four fixation techniques. Knee Surg Sports Traumatol Arthrosc 2012; 20 (05) 909-915
    CrossrefPubMedGoogle Scholar
  • 15 Griffith JF, Antonio GE, Tong CW, Ming CK. Cruciate ligament avulsion fractures. Arthroscopy 2004; 20 (08) 803-812
    CrossrefPubMedGoogle Scholar
  • 16 Leeberg V, Lekdorf J, Wong C, Sonne-Holm S. Tibial eminentia avulsion fracture in children - a systematic review of the current literature. Dan Med J 2014; 61 (03) A4792
    PubMedGoogle Scholar
  • 17 Kawate K, Fujisawa Y, Yajima H, Sugimoto K, Habata T, Takakura Y. Seventeen-year follow-up of a reattachment of a nonunited anterior tibial spine avulsion fracture. Arthroscopy 2005; 21 (06) 760
    PubMedGoogle Scholar
  • 18 Mellado JM, Ramos A, Salvadó E, Camins A, Calmet J, Saurí A. Avulsion fractures and chronic avulsion injuries of the knee: role of MR imaging. Eur Radiol 2002; 12 (10) 2463-2473
    CrossrefPubMedGoogle Scholar
  • 19 Chotel F, Raux S, Accadbled F. , et al. Cartilaginous tibial eminence fractures in children: which recommendations for management of this new entity?. Knee Surg Sports Traumatol Arthrosc 2016; 24 (03) 688-696
    CrossrefPubMedGoogle Scholar
  • 20 Jang KM, Bae JH, Kim JG, Wang JH. Novel arthroscopic fixation method for anterior cruciate ligament tibial avulsion fracture with accompanying detachment of the anterior horn of the lateral meniscus: three-point suture fixation. Injury 2013; 44 (08) 1028-1032
    CrossrefPubMedGoogle Scholar
  • 21 Pan RY, Yang JJ, Chang JH, Shen HC, Lin LC, Lian YT. Clinical outcome of arthroscopic fixation of anterior tibial eminence avulsion fractures in skeletally mature patients: a comparison of suture and screw fixation technique. J Trauma Acute Care Surg 2012; 72 (02) E88-E93
    CrossrefPubMedGoogle Scholar
  • 22 Hapa O, Barber FA, Süner G. , et al. Biomechanical comparison of tibial eminence fracture fixation with high-strength suture, EndoButton, and suture anchor. Arthroscopy 2012; 28 (05) 681-687
    CrossrefPubMedGoogle Scholar
  • 23 John BMG. Operative Arthroscopy. 2nd ed. Hagerstown, MD: Lippincott-Raven; 1996: 586-591
    Google Scholar