ARTHROSCOPIC SUTURE FIXATION OF DISPLACED TIBIAL EMINENCE FRACTURES

The purpose of this article is to describe a technique for arthroscopi c reduction and suture fixation of avulsion fractures of the tibial em inence involving the anterior cruciate ligament (ACL). Six patients (f ive type III, one type II) with tibial eminence fractures underwent ar throscopic evaluation when closed reduction after aspiration failed to yield an anatomic reduction. The study population was composed of fiv e males and one female. Average age was 24 years (range 16-36). One fr acture (type II) was easily reduced after manipulating the interposed anterior horn of the lateral meniscus. In five patients the fragment w as stabilized with multiple sutures. The technique involved arthroscop ic placement of multiple sutures of 2-0 polydioxanone suture (PDS) int o the base of the ACL pulled through a tibia drill hole and tied onto a 4.5-mm screw post. Patients were placed in a standard postoperative ACL protocol. All fractures demonstrated radiographic healing by 8 wee ks, and no patients had subjective complaints of instability at 1 year . All patients obtained full extension intraoperatively, and only one patient lost 2-degrees of terminal extension at latest follow-up. Arth roscopic reduction and suture fixation of avulsion fractures of the ti bial eminence restores the length of the ACL, provides stable fixation promoting early motion with minimal morbidity, and does not require a second operation for metal removal.