ObjectiveTo 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. MethodsBetween 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. ResultsTwo 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). ConclusionA 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.
ObjectiveTo conclude the effectiveness of arthroscopy combined with Burks and SchaVer's approach in the treatment of posterior cruciate ligament (PCL) avulsion fractures in a floppy lateral position. MethodsBetween May 2010 and March 2014, 21 patients with PCL avulsion fractures were treated. There were 13 males and 8 females, aged 21 to 62 years (mean, 39.1 years). The causes included traffic accident injury in 10 cases, sports injury in 5 cases, and falling injury from height in 6 cases. The time from injury to hospital was 1-6 days (mean, 2.5 days). The results of posterior drawer test were all positive, and the results of anterior drawer test and lateral stress test were all negative. The Lysholm score was 28.0±5.5 before operation. And the American Orthopaedic Foot and Ankle Society (IKDC) score was 46.2±7.6 before operation. According to Meyer standards for fractures classification, 11 cases were rated as type II and 10 cases as type III. Arthroscopy was used to inspect and treat the intra-articular lesions, then avulsion fracture was fixed by Burks and SchaVer's approach in lateral position. Postoperative functional exercises were performed. ResultsPrimary healing of incision was obtained, without nerve and vascular injury or joint infection. All patients were followed up 18-36 months (mean, 27.2 months). The X-ray films of the knee joint showed good fractures reduction and healing at 3 months after operation. The results of posterior drawer test and reverse Lachman test were negative. The knee range of motion was recovered to normal level. At last follow-up, the Lysholm score of the knee joint was significantly improved to 90.9±1.4 from preoperative one (t=54.584, P=0.000), and the IKDC score was significantly increased to 90.5±5.3 from preoperative one (t=15.638, P=0.000), including 19 cases of grade A and 2 cases of grade B. ConclusionA combination of arthroscopy and Burks and SchaVer's approach for the treatment of PCL avulsion fractures in a floppy lateral position has the advantages of minimal invasion and safe approach, short operative time, and early postoperative rehabilitation exercises, so it can provide satisfactory function recovery of the knee joint.
ObjectiveTo compare the early effectiveness of arthroscopic suture bridge technique and conventional double tunnel suture technique in the treatment of avulsion fracture of posterior cruciate ligament (PCL) insertion.MethodsBetween June 2013 and December 2018, 62 patients with tibial avulsion fracture of PCL insertion that met the criteria were selected and randomly divided into trial group (using arthroscopic suture bridge technique) and control group (using conventional double tunnel suture technique), 31 cases in each group. There was no significant difference in gender, age, injured side, cause of injury, time from injury to operation, Meyers & McKeever classification, Kellgren-Lawrence classification, and preoperative knee range of motion, difference of posterior relaxation of bilateral knee joints, International Knee Documentation Committee (IKDC) score, and Lysholm score between the two groups (P>0.05). The operation time and IKDC score, Lysholm score, knee range of motion, the difference of posterior relaxation of bilateral knee joints (measured by KT-2000 under knee flexion of 90° and 30 lbs) were recorded and compared between the two groups before operation and at 3 and 12 months after operation.ResultsBoth groups successfully completed the operation, and the operation time of the trial group and the control group were (61.81±6.83) minutes and (80.42±4.22) minutes respectively, showing significant difference between the two groups (t=12.911, P=0.000). All the incisions healed by first intention, and there was no wound infection and other early postoperative related complications. All patients were followed up 13-18 months (mean, 14.6 months). The fractures in both groups healed at 3 months after operation. No knee pain, limited movement, or other complications occurred. At 3 and 12 months after operation, the IKDC score, Lysholm score, knee range of motion, and the difference of posterior relaxation of bilateral knee joints in both groups were significantly improved when compared with preoperative ones, and further improved at 12 months after operation when compared with at 3 months after operation (P<0.05). At each time point after operation, the above indexes and the grade of the difference of posterior relaxation of bilateral knee joints in the trial group were significantly better than those in the control group (P<0.05).ConclusionArthroscopic suture bridge technique in the treatment avulsion fracture of PCL insertion is simple and reliable, which can significantly improve the function and stability of the knee joint and obtain satisfactory early effectiveness.
ObjectiveTo evaluate the clinical results of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fractures in adolescents with epiphyseal unclosure. MethodsBetween January 2011 and October 2013, 35 knees with ACL tibial eminence avulsion fractures (35 patients with epiphyseal unclosure) were arthroscopically treated with suture fixation. There were 25 males and 10 females, aged 8-16 years (mean, 14.7 years). The causes included sports injury in 24 cases, traffic accident injury in 9 cases, and daily life injury in 2 cases. According to Meyers-McKeever classification criteria, there were 27 cases of type Ⅱ and 8 cases of type Ⅲ. Five cases had meniscus injury. The preoperative the International Knee Documentation Committee (IKDC) score was 48.7±3.2, and Lysholm score was 51.2±4.5. The time from injury to operation was 2-16 days (mean, 5 days). ResultsPrimary healing of incision was obtained in all patients. The mean follow-up time was 22.4 months (range, 12-32 months). Anatomical reduction was achieved in 28 cases and satisfactory reduction in 7 cases. X-ray films showed all fractures healing at last follow-up. There was no limb shortening deformity, varus knee, or valgus knee. Lachman test results were all negative. The other knees had normal range of motion except 1 knee with limited flexion, whose range of motion returned to 0-120° after treatment. At last follow-up, the IKDC score was significantly improved to 93.2±4.1 (t=-53.442, P=0.000), and the Lysholm score was significantly increased to 96.2±2.5 (t=-56.242, P=0.000). ConclusionThe arthroscopic fixation technique has satisfactory results for the reduction and fixation of ACL tibial eminence avulsion fracture in the adolescents with epiphyseal unclosure because of little trauma and quick recovery.
ObjectiveTo compare the early effectiveness of minimally invasive open reduction and internal fixation via posterior median approach versus arthroscopic double-tunnel suture fixation in treatment of tibial avulsion fracture of the posterior cruciate ligament (PCL).MethodsA clinical data of 31 patients with the tibial avulsion fracture of the PCL and met the criteria between January 2015 and January 2019 was retrospectively analyzed. Nineteen patients (group A) were treated with open reduction and internal fixation with cannulated screw via posterior median approach. The other 12 patients (group B) were treated with arthroscopic double-tunnel suture fixation technique. There was no significant difference between the two groups (P>0.05) in the gender, age, side of effected limb, the injury cause, the time from injury to operation, the combined meniscus injury, Meyers & McKeever classification and preoperative Lysholm score, Tegner score, International Knee Documentation Committee (IKDC) score, and the difference of tibial posterior displacement between bilateral knees. The operation time, postoperative complications, fracture healing, and the difference of tibial posterior displacement between bilateral knees, Lysholm score, Tegner score, and IKDC score were recorded.ResultsGroup B spent significantly longer operation time than group A (t=7.347, P=0.000). No postoperative complication occurred in group B, and 1 patient in group A had a screw breakage. All patients were followed up 6-36 months (mean, 22 months). X-ray films showed that all fractures healed at 3 months after operation. At last follow-up, there was no significant difference in the patients with normal knee range of motion between the two groups (P=0.510). At last follow-up, the difference of tibial posterior displacement between bilateral knees, Lysholm score, Tegner score, and IKDC score in the two groups were superior to those before operation (P<0.05); while there was no significant difference between the two groups (P>0.05).ConclusionFor the tibial avulsion fracture of PCL, the minimally invasive open reduction and internal fixation and arthroscopic double-tunnel suture fixation can obtain similar early effectiveness. However, arthroscopic surgery has the advantages of being able to simultaneously deal with intra-articular combined injuries, avoiding internal fixator complications, and eliminating the need for secondary operation.
Objective To evaluate the surgical techniques and effectiveness of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture with non-absorbable suture fixation combined with the mini-plate. Methods Between January 2009 and March 2012, 32 patients with ACL tibial eminence avulsion fractures were treated. There were 18 males and 14 females, aged 12-40 years (mean, 17.5 years). The injury causes included traffic accident injury in 15 cases, sport injury in 6 cases, and falling injury in 11 cases. The time from injury to operation ranged 7-18 days with an average of 9.5 days. Before operation, the results of Lachman test were all positive; the Lysholm score was 52.13 ± 4.22 and the International Knee Documentation Committee (IKDC) score was 44.82 ± 2.44. According to Meyers-McKeever classification criteria, there were 12 cases of type II and 20 cases of type III. After arthroscopic poking reduction of fracture, tibial eminence avulsion fractures were fixed with the Ethibond non-absorbable sutures bypass figure-of-eight tibial tunnel combined with the metacarpal and phalangeal mini-plate. Results Primary healing was obtained in all incisions; no joint infection or skin necrosis occurred after operation. All patients were followed up with an average time of 22.4 months (range, 12-50 months). The patients showed negative Lachman test at 12 weeks after operation. Except 3 patients having knee extension limitation at last follow-up, the knee extension range of motion (ROM) was normal in the other patients; the knee flexion ROM was normal in all patients. The Lysholm score and IKDC score were significantly improved to 94.19 ± 0.93 and 94.35 ± 1.22 at last follow-up, showing significant differences when compared with preoperative values (t=55.080, P=0.000; t=101.715, P=0.000). Conclusion The arthroscopic treatment of ACL tibial eminence avulsion fracture with Ethibond non-absorbable suture fixation combined with mini-plate is an effective procedure with the advantages of minimal trauma, reliable fixation, and satisfactory recovery of the knee joint function.
ObjectiveTo evaluate the effectiveness of arthroscopically assisted treatment of posterior cruciate ligament (PCL) tibial eminence avulsion fractures associated with meniscus posterior horn tear. MethodsBetween January 2012 and December 2014, 21 patients with PCL avulsion fracture and meniscus posterior horn tear were arthroscopically treated with polyester suture and hollow screw fixation. There were 10 males (10 knees) and 11 females (11 knees), aged 14-53 years (mean, 35.7 years). The causes included sport injury in 11 cases, traffic accident injury in 9 cases, and daily life injury in 1 case. Based on the anteroposterior and lateral X-ray films, CT, and MRI, PCL avulsion fractures were diagnosed, and 2 cases had anterior cruciate ligament avulsion fractures. The results of posterior drawer test were positive in all patients, with no end point in 14 cases and with soft end point in 7 cases; all patients showed tibial sink. The preoperative International Knee Documentation Committee (IKDC) score and Lysholm score were 46.5±5.5 and 43.3±4.5 respectively. The time from injury to operation was 6-22 days (mean, 10 days). ResultsThe operation time was 60-100 minutes (mean, 75 minutes). Primary healing of incision was obtained in all patients, without no complication of infection. The mean follow-up time was 27.4 months (range, 12-46 months). The results of posterior drawer test were negative in 19 cases, and positive in 2 cases (having hard end point). Tibial sink disappeared. At last follow-up, X-ray film showed good healing of fracture, and no displacement. The patients had no locking knee, snapping or tenderness of joint space, and the Mcmurray sign was negative; the IKDC score and Lysholm score were significantly improved to 92.0±2.5 and 92.7±2.6 respectively (t=-39.903, P=0.000; t=-43.242, P=0.000). The range of motion was normal in 20 patients (0-130°) except 1 patient having limited flexion (0-80°), whose range of motion returned to 0-120° after release. ConclusionThe arthroscopic fixation technique has satisfactory results for the reduction and fixation of PCL avulsion fracture associated with meniscus posterior horn tear because of easy operation, firm fixation, and economic price.
ObjectiveTo evaluate the specific application and effect of balance point fixation technique in arthroscopic fixation of avulsion fracture of anterior cruciate ligament.MethodsThe data of 65 patients with anterior cruciate ligament avulsion fracture treated by arthroscopy in Department of Orthopaedics, Panzhihua Central Hospital between June 2012 and June 2018 were analyzed retrospectively. According to whether the balance point fixation technique was used or not, the patients were divided into routine operation group (group A, n=22) and balance point fixation group (group B, n=43). The operation time, Visual Analogue Scale (VAS) pain score, length of hospital stay, intraoperative bone re-fracture rate, incidences of limb swelling and deep venous thrombosis, Lysholm score and knee joint stability of the two groups were analyzed. Chi-square test or Fisher’s exact test was used for nominal data. Independent samples t-test or paired samples t-test was used for measurement data. Rank sum test was used for ordinal data. Repeated measures analysis of variance was used for repeated measurement data. Two-sided statistical significance level was set at α=0.05.ResultsThere was no statistically significant difference in age, sex composition, fracture type, combined injury, time from injury to operation, preoperative VAS score, or Lysholm score between the two groups (P>0.05). The incisions of all patients healed in the first stage without incision complications. After adjustment, the reduction of fracture in group A was basically satisfactory, 4 cases (18.2%) had re-fracture; 1 case (2.3%) in group B had re-fracture due to poor bone condition, and group B was better than group A in re-fracture incidence (P=0.041). The operation time and length of hospital stay in group B were shorter than those in group A [(90.27±34.27) vs. (49.67±10.44) min,P<0.001; (8.09±1.23) vs. (5.35±1.07) d, P<0.001], the postoperative VAS score in group B was lower than that in group A (4.23±0.87 vs. 2.60±0.62, P<0.001), the degree of pain relief in group B was better than that in group A (3.32±1.29 vs. 4.44±1.50, P=0.004), the incidence of postoperative limb swelling in group B was lower than that in group A (22.7% vs. 4.7%, P<0.05); the difference in incidence of postoperative deep venous thrombosis between the two groups was not statistically significant (P>0.05). All patients were followed up for more than one year, the fractures healed completely, and the postoperative VAS score and Lysholm score at one year after operation were significantly improved compared with those before operation, but there was no significant difference in the postoperative 6-month Lysholm score, stability evaluation, or postoperative 1-year Lysholm score between the two groups (P>0.05).ConclusionsThe balance point fixation technique plays a positive role in relieving postoperative pain, shortening operation time and average hospital stay, and reducing the incidence of complications by realizing the quantification of the best fixed point to reduce repeated operation and side injury. It can provide a technical reference for clinical work.
Objective To investigate the effectiveness of one-stage closed reduction and elastic compression fixation with double Kirschner wires for Wehbe-Schneider types ⅠB and ⅡB bony mallet fingers. Methods Between May 2017 and June 2020, 21 patients with Wehbe-Schneider type ⅠB and ⅡB bony mallet fingers were treated with one-stage closed reduction and elastic compression fixation using double Kirschner wires. There were 15 males and 6 females with an average age of 39.2 years (range, 19-62 years). The causes of injury were sports injury in 9 cases, puncture injury in 7 cases, and sprain in 5 cases. The time from injury to admission was 5-72 hours (mean, 21.0 hours). There were 2 cases of index finger injury, 8 cases of middle finger injury, 9 cases of ring finger injury, and 2 cases of little finger injury. The angle of active dorsiflexion loss of distal interphalangeal joint (DIPJ) was (40.04±4.02)°. According to the Wehbe-Schneider classification standard, there were 10 cases of typeⅠB and 11 cases of type ⅡB. The Kirschner wire was removed at 6 weeks after operation when X-ray film reexamination showed bony union of the avulsion fracture, and the functional exercise of the affected finger was started. Results The operation time was 35-55 minutes (mean, 43.9 minutes). The length of hospital stay was 2-5 days (mean, 3.4 days). No postoperative complications occurred. All patients were followed up 6-12 months (mean, 8.8 months). X-ray films reexamination showed that all avulsion fractures achieved bony union after 4-6 weeks (mean, 5.3 weeks). Kirschner wire was removed at 6 weeks after operation. After Kirschner removal, the visual analogue scale (VAS) score of pain during active flexion of the DIPJ was 1-3 (mean, 1.6); the VAS score of pain was 2-5 (mean, 3.1) when the DIPJ was passively flexed to the maximum range of motion. The angle of active dorsiflexion loss of affected finger was (2.14±2.54)°, showing significant difference when compared with preoperative angle (t=52.186, P<0.001). There was no significant difference in the active flexion angle between the affected finger (79.52±6.31)° and the corresponding healthy finger (81.90±5.36)° (t=1.319, P=0.195). At 6 months after operation, according to Crawford functional evaluation criteria, the effectiveness was rated as excellent in 11 cases, good in 9, and fair in 1, with an excellent and good rate of 95.24%. Conclusion For Wehbe-Schneider typesⅠB and ⅡB bony mallet fingers, one-stage closed reduction and elastic compression fixation with double Kirschner wires can effectively correct the deformity and has the advantages of simple surgery, no incision, and no influence on the appearance of the affected finger.