J Korean Orthop Assoc.  2011 Dec;46(6):512-517.

Arthroscopic Bio-Absorbable Suture Anchor Fixation of Tibial Eminence Avulsion Fracture in Children

• Choi ES
• Park KJ
• Kim YM
• Kim DS
• Shon HC
• Cho BK
• Kim DH

Abstract

Surgical treatment for the pediatric anterior cruciate ligament (ACL) avulsion fracture consists of arthroscopic treatment and open surgery. Recently, arthroscopic treatment has been commonly performed rather than open surgery because of less post-operative pain and faster rehabilitation. In arthroscopic treatment, K-wire and cannulated cancellous screws are the main instruments used for fixation of avulsion fracture, but these instruments have the risk of causing damage to the growth plate and an additional surgery to remove the fixation is needed. In spite of the technical difficulty, the suture anchor is used to overcome the risk of damage to the growth plate and the need for an additional surgery. The authors report good results using bio-absorbable suture anchor in arthroscopic treatment for pediatric ACL avulsion fracture.

Keyword

knee joint; anterior cruciate ligament; fracture fixation; arthroscopy; suture anchor

MeSH Terms

Anterior Cruciate Ligament
Arthroscopy
Child
Fracture Fixation
Growth Plate
Humans
Knee Joint
Suture Anchors
Sutures

Figure

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  Figure 1 Preoperative plain radiographs show avulsion fracture of the anterior cruciate ligament.

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  Figure 2 Preoperative magnetic resonance imaging shows avulsion fracture of the anterior cruciate ligament.

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  Figure 3 Arthroscopic findings show avulsion fracture of the anterior cruciate ligament and hematoma at fracture site.

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  Figure 4 Illustration shows the anchor insertion method by using the suprapatellar portal. The trocar is inserted under the patella through the suprapatellar portal, then the patella is lifted while the knee joint is flexed. This makes it possible to approach the area 1-2 mm anterior to the tibial attachment site of the anterior cruciate ligament (ACL), and the suture anchor can be inserted perpendicular to the articular surface. Then, the ACL is fixed with the suture.

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  Figure 5 Arthroscopic findings show accurate fixation of avulsion fracture of the anterior cruciate ligament with a suture anchor.

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  Figure 6 Post-operative radiographs show reduction of the anterior cruciate ligament avulsion fracture.

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  Figure 7 Post-operative radiographs show com plete bony union of the anterior cruciate ligament avulsion fracture at 20 weeks after operation.

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