A simple, modified arthroscopic suture fixation of avulsion fracture of the tibial intercondylar eminence in children

Abstract

The purpose of this study was to describe a simple and modified technique for arthroscopic suture fixation in a 12-year-old boy who sustained a displaced type III intercondylar eminence of the tibial. The arthroscopic fixation was modified by using the Arthrex suture lasso device to place two nonabsorbable sutures into the anterior cruciate ligament (ACL). However, the procedure became simple with the help of the Acufex ACL guide to reduce the avulsed tibial spine fragment and to place an appropriate tibial tunnel. Sutures were then passed through the tibial tunnel and secured over a bony bridge with the knee at 20° of flexion. At 6 months, the patient had a full range of motion with normal Lachman and anterior drawer testing, and he had returned to his daily activities. Radiographs showed complete fracture healing. Repair using the Arthrex suture lasso device provides a significant advantage in the treatment of type III and IV fractures of the tibial eminence by obtaining arthroscopic fixation with the substance of the ACL, thus eliminating the risks of comminution of the fracture fragment and hardware removal. This arthroscopic technique restores the length and integrity of the ACL, and provides a simplified, reproducible method of treatment for this injury.