EFFECTIVENESS OF MINI INCISION AND ABSORBABLE SCREW FIXATION FOR TREATMENT OF ANTERIOR CRUCIATE LIGAMENT TIBIAL EMINENCE AVULSION FRACTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUNHejun , LIQi , TANGXin , DENGLanlan , ZHENGGuo , WANGFei , FUWeili ,  LIJian

Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding?author：

LIJian, Email: hxlijian.china@163.com

Keywords：

Knee joint; Anterior cruciate ligament tibial eminence avulsion fracture; Internal fixation; Absorbable screw

DOI：

10.7507/1002-1892.20140234

Video：

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Objective To investigate the effectiveness of open reduction by mini incision and absorbable screw internal fixation for the treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture. Methods Between January 2006 and July 2012, 90 patients (90 knees) with ACL tibial eminence avulsion fracture were treated. There were 58 males and 32 females, aged from 10 to 58 years with an average of 33.7 years. The causes of injury were traffic accident injury in 60 cases, sports injury in 22 cases, and falling injury in 8 cases. The disease duration was 1-365 days with a median of 106 days. Combined injuries included 14 cases of meniscus injury, 5 cases of medial collateral ligament injury, and 3 cases of avulsion fracture of the anterior horn of the lateral meniscus. All patients underwent open reduction by mini incision and internal fixation with absorbable screw. Postoperative rehabilitation exercise was performed. Results Two patients had delayed healing of incision, and others obtained primary healing. All the patients were followed up 6-72 months (mean, 40.1 months). X-ray examination showed that bone union was achieved in all patients at 3-12 months after operation; nail tail came off in 7 cases at 4-13 months after operation, and the nail tail was taken out under arthroscopy. At 6-12 months after operation, the range of motion (ROM), Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) score were significantly increased when compared with preoperative ones (P < 0.05). Conclusion A combination of open reduction by mini incision and absorbable screw internal fixation for the treatment of ACL tibial eminence avulsion fracture has the advantages of easy operation, firm fixation, and satisfactory functional rehabilitation, so it is a safe and effective method for the treatment of ACL tibial eminence avulsion fracture.

Citation： SUNHejun, LIQi, TANGXin, DENGLanlan, ZHENGGuo, WANGFei, FUWeili, LIJian. EFFECTIVENESS OF MINI INCISION AND ABSORBABLE SCREW FIXATION FOR TREATMENT OF ANTERIOR CRUCIATE LIGAMENT TIBIAL EMINENCE AVULSION FRACTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(9): 1072-1076. doi: 10.7507/1002-1892.20140234 Copy

1.	Andersen JW, Mejdahl S.Bilateral fracture of the tibial spine.Acta Orthop Belg, 1993, 59(4):394-397.
2.	Kendall NS, Hsu SY, Chan KM.Fracture of the tibial spine in adults and children.A review of 31 cases.J Bone Joint Surg (Br), 1992, 74(6):848-852.
3.	Hsu SY.An easy and effective method for reattaching an anterior cruciate ligament avulsion fracture from the tibial eminence.Arthroscopy, 2004, 20(1):96-100.
4.	Meyers MH, McKeever FM.Fracture of the intercondylar eminence of the tibia.J Bone Joint Surg (Am), 1970, 52(8):1677-1684.
5.	Lysholm J, Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale.Am J Sports Med, 1982, 10(3):150-154.
6.	Hefti E, Müller W, Jakob RP, et al.Evaluation of knee ligament injuries with the IKDC form.Knee Surg Sports Traumatol Arthrosc, 1993, 1(3-4):226-234.
7.	高彥平, 吳宇峰, 伍中慶, 等.前交叉韌帶脛骨棘止點撕脫骨折不同內固定療效分析.中國矯形外科雜志, 2006, 14(2):89-92.
8.	譚慶遠, 黃相杰, 姜紅江, 等.可吸收螺釘治療膝交叉韌帶損傷.骨與關節損傷雜志, 2004, 19(3):195-196.
9.	李鑫, 田金徽, 楊克虎, 等.可吸收螺釘和金屬擠壓螺釘比較重建前交叉韌帶的Meta分析.中國循證醫學雜志, 2010, 10(7):848-856.
10.	Markolf KL, Slouterbeck JR, Armstrong KL, et al.A biomechannical study of replacement of the postertior cruciate ligament with a graft.Part 1:Isometry, pre-tension of the graft, and anterior-posterior laxity.J Bone Joint Surg (Am), 1997, 79(3):375-380.
11.	B?stman O, Partio E, Hirvensalo E, et al.Foreign-body reactions to polyglycolide screws.Observation in 24/216 malleolar fracture cases.Acra Orthop Scand, 1992, 63(2):173-176.
12.	Senekovic V, Veselko M.Anterograde arthroscopic fixation of avulsion fracture of the tibial eminence with a cannulated screw:five-year result.Arthroscopy, 2003, 19(1):54-61.
13.	黃長明, 董輝詳, 范華強.關節鏡下前交叉韌帶脛骨止點撕脫性骨折病理解剖觀察與手術技術選擇.臨床骨科雜志, 2009, 12(4):361-363.
14.	Thomas P Rüedi, Richard E Buckley, Christopher G Moran.骨折治療的AO原則.王滿宜, 曾炳芳, 譯.2版.上海:上海科學技術出版社, 2010:168-172.
15.	Ahn JH, Lee YS, Lee DH, et al.Arthroscopic physeal sparing all inside repair of the tibial avulsion fracture in the anterior cruciate ligament:technical note.Arch Orthop Trauma Surg, 2008, 128(11):1309-1312.
16.	In Y, Kwak DS, Moon CW, et al.Biomechanical comparison of three techniques for fixation of tibial avulsion fractures of the anterior cruciate ligament.Knee Surg Sports Traumatol Arthrosc, 2012, 20(8):1470-1478.

1. Andersen JW, Mejdahl S.Bilateral fracture of the tibial spine.Acta Orthop Belg, 1993, 59(4):394-397.
2. Kendall NS, Hsu SY, Chan KM.Fracture of the tibial spine in adults and children.A review of 31 cases.J Bone Joint Surg (Br), 1992, 74(6):848-852.
3. Hsu SY.An easy and effective method for reattaching an anterior cruciate ligament avulsion fracture from the tibial eminence.Arthroscopy, 2004, 20(1):96-100.
4. Meyers MH, McKeever FM.Fracture of the intercondylar eminence of the tibia.J Bone Joint Surg (Am), 1970, 52(8):1677-1684.
5. Lysholm J, Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale.Am J Sports Med, 1982, 10(3):150-154.
6. Hefti E, Müller W, Jakob RP, et al.Evaluation of knee ligament injuries with the IKDC form.Knee Surg Sports Traumatol Arthrosc, 1993, 1(3-4):226-234.
7. 高彥平, 吳宇峰, 伍中慶, 等.前交叉韌帶脛骨棘止點撕脫骨折不同內固定療效分析.中國矯形外科雜志, 2006, 14(2):89-92.
8. 譚慶遠, 黃相杰, 姜紅江, 等.可吸收螺釘治療膝交叉韌帶損傷.骨與關節損傷雜志, 2004, 19(3):195-196.
9. 李鑫, 田金徽, 楊克虎, 等.可吸收螺釘和金屬擠壓螺釘比較重建前交叉韌帶的Meta分析.中國循證醫學雜志, 2010, 10(7):848-856.
10. Markolf KL, Slouterbeck JR, Armstrong KL, et al.A biomechannical study of replacement of the postertior cruciate ligament with a graft.Part 1:Isometry, pre-tension of the graft, and anterior-posterior laxity.J Bone Joint Surg (Am), 1997, 79(3):375-380.
11. B?stman O, Partio E, Hirvensalo E, et al.Foreign-body reactions to polyglycolide screws.Observation in 24/216 malleolar fracture cases.Acra Orthop Scand, 1992, 63(2):173-176.
12. Senekovic V, Veselko M.Anterograde arthroscopic fixation of avulsion fracture of the tibial eminence with a cannulated screw:five-year result.Arthroscopy, 2003, 19(1):54-61.
13. 黃長明, 董輝詳, 范華強.關節鏡下前交叉韌帶脛骨止點撕脫性骨折病理解剖觀察與手術技術選擇.臨床骨科雜志, 2009, 12(4):361-363.
14. Thomas P Rüedi, Richard E Buckley, Christopher G Moran.骨折治療的AO原則.王滿宜, 曾炳芳, 譯.2版.上海:上海科學技術出版社, 2010:168-172.
15. Ahn JH, Lee YS, Lee DH, et al.Arthroscopic physeal sparing all inside repair of the tibial avulsion fracture in the anterior cruciate ligament:technical note.Arch Orthop Trauma Surg, 2008, 128(11):1309-1312.
16. In Y, Kwak DS, Moon CW, et al.Biomechanical comparison of three techniques for fixation of tibial avulsion fractures of the anterior cruciate ligament.Knee Surg Sports Traumatol Arthrosc, 2012, 20(8):1470-1478.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF MINI INCISION AND ABSORBABLE SCREW FIXATION FOR TREATMENT OF ANTERIOR CRUCIATE LIGAMENT TIBIAL EMINENCE AVULSION FRACTURE

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