A novel arthroscopic procedure for fixation of avulsion fracture of tibial attachment of anterior cruciate ligament guided by meniscal stitching needle

Objective : To introduce a novel technique in which meniscal stitching needle is used as a puller to induct steel wire to secure the tibial eminence avulsion under arthroscopic visualization, and evaluate the clinical results. Methods : From 1999 to 2005 , fifteen cases of tibial eminence avulsion were treated with this new technique. Lysholm scoring scale system was used to assess knee function before and after surgery. Regular plain anteroposterior and lateral X-ray films were undertaken to detect the bony healing of avulsed fragment. Results : The operating time could be controlled within 30 minutes. No complications such as intraarticular infection, iatrogenic injury, fibroarthritis or nonunion of fracture occurred in this group. X-ray film revealed that bony healing in all 15 cases was achieved from 6 weeks to 12 weeks postoperatively. Lysholm score was improved from 19.1 +/- 15.2 (ranging from 10 to 56) preoperatively to 97.5 +/- 3.7 (ranging from 91 to 100) postoperatively on average in 12-54 months follow up (mean 23 months). The statistically significant difference was shown in Student's t test (t = 18.483 , P = 3.100 x 10(-11), P < 0.01). Wire breakage was found in two patients whose wires were removed 8 months and 14 months after initial operation, respectively. Conclusion : This technique has many advantages , such as simplicity, wide indications from type II to type IV fractures, minimal invasion, short operating time and predictable satisfactory results.