Arthroscopic ACL Avulsion Fixation With Adjustable Loop Length Cortical Endobutton

Abstract

Various surgical management techniques have been introduced to treat anterior cruciate ligament avulsion fractures. There is disagreement among orthopedic surgeons about which fixation device to use during arthroscopy. Recently, there has been an increase in the use of arthroscopic techniques for fixation, and different devices such as sutures, screws, and fiber wires are being considered. The development of fiber wires has made it possible to use them in comminuted avulsions with satisfactory stability, whereas screws cannot be used in such cases. Sutures do not provide adequate stability for early range of motion compared to other methods. The article then goes on to describe a specific arthroscopic fixation technique that uses an adjustable loop cortical button to manage the avulsed fragment and provide stability.

Fig 1

The patient is in a supine position with their right knee exposed and accessible. The anterolateral and anteromedial portals have been marked for identification (right knee, supine position; the foot hangs on the edge of the bed).

Fig 2

The figure displays radiographic and computed tomography (CT) scan images, as well as an arthroscopic view of the right knee joint. Anteroposterior and lateral radiographs of the knee joint. The distal femur (DF) and proximal tibia (PT) can be seen in both images (A, B). Coronal and sagittal views of the knee joint in a CT scan. The avulsed part is indicated by the yellow arrows (anterolateral visual arthroscopic portals) (C, D). The arthroscopic view shows the fracture site indicated by the green arrows and the avulsed part indicated by the yellow arrow(E, F).

Fig 3

The figure demonstrates how to reduce an avulsed part using an anterior cruciate ligament (ACL) director tibial tunnel guide. ACL director tibial tunnel guide (A). The reduction of the avulsed part was performed on a moulage model using the ACL director tibial tunnel guide (B). An arthroscopic view of the knee joint during the reduction process using the ACL director tibial tunnel guide (right knee; anterolateral visual arthroscopic portals) (C). DF, distal femur; PT, proximal tibia.

Fig 4

The figure demonstrates the use of an anterior cruciate ligament (ACL) director tibial tunnel guide and a 4.5 reamer to ream the tibial bone. ACL director tibial tunnel guide (red arrow) and 4.5 reamers (purple arrow) are used to ream tibial bone (A). (B) The same process is performed on a moulage model. An arthroscopic view of the knee joint after the avulsed part has been reamed with the 4.5 reamers. The head of the reamer is visible in image (right knee; anterolateral visual arthroscopic portals) (C). DF, distal femur; PT, proximal tibia.

Fig 5

The figure depicts a technique for passing a lasso wire through the reamer over the AC. Lasso wire (A). The lasso wire (green arrow) is passed through the reamer over the ACL the loop of the Lasso wire is placed outside the tibial cortex in the moulage model (B). The reamer, which is shown in purple in the figure, is used to create a channel for the lasso wire to pass through and the lasso wire is passed through the reamer over the ACL in an arthroscopic view (right knee; anterolateral visual arthroscopic portals) (C).

Fig 6

The process of passing the XL adjustable loop cortical Endobutton through a tunnel using a Lasso wire while the avulsed part is reduced by the ACL director tibial tunnel guide. The XL adjustable loop cortical Endobutton (A). moulage model is used to demonstrate the passing of the Endobutton through the tunnel using a Lasso wire, represented by the green arrow(B). The XL adjustable loop cortical Endobutton(orange arrow)is passed by using a lasso wire (green arrow; right knee; supine position; the foot hangs on the edge of the bed) (C). DF, distal femur; PT, proximal tibia.

Fig 7

The process of using direct arthroscopic to flip over the avulsed fragment and pass the XL adjustable loop cortical Endobutton (orange arrow) through the tibial tunnel. The Endobutton is shown being passed through the tibial tunnel (A). Endobutton is passed through the tibial tunnel in the moulage model (B). Endobutton passing avulsed fragment in arthroscopic view (C). Endobutton being tensioned properly as the avulsed fragment (yellow arrow) is fully seated (right knee; supine position; the foot hangs on the edge of the bed; anterolateral visual arthroscopic portals) (D). DF, distal femur; PT, proximal tibia.

Fig 8

A two-hole reconstruction plate is used as an anchor for the XL adjustable loop cortical Endobutton to hold it in place against the tibial cortex (A) and a moulage model (B). Plate is completely fixed by 2 cortical screws in knee extension (right knee; supine position; fixation in knee extension) (C). DF, distal femur; PT, proximal tibia.

Fig 9

Postoperative anteroposterior and lateral radiographic X-ray films (right knee). DF, distal femur; PT, proximal tibia.