| Objective: To evaluate biomechanical outcomes of transosseous suture bridge fixation for anterior cruciate ligament(ACL)tibial avulsion fracture,and to determine the clinical and radiological outcomes of patients who underwent arthroscopic reduction and transosseous suture bridge fixation for ACL tibial avulsion fracture.Part 1.Methods: The biomechanical study used 24 porcine knees,randomly divided into 3 comparison fixation groups: double-headed compression screw fixation(group A),suture combined with external screw fixation(group B),and transosseous suture bridge fixation fixation(group C).Fracture fragments were created in a standardized manner and measured for size comparison.After fixation,each knee underwent 2 phases of biomechanical testing.Biomechanical tests involved cyclic loading between 0 N and 60 N for 10 cycles to assess the displacement change,then a single tensile failure test at 1mm/s to assess the ultimate failure load,yield load,and failure mode for each specimen.Results: All knees survived cyclic testing and were subsequently loaded to failure.The ultimate failure load of group B and group C were higher than that of group A(p<0.05),and the displacement group C was lowest compared with the other 2 groups(p<0.05).Different failure modes were found among the 3groups.Group A specimens failed because of screw pullout from the epiphysis(n=5)and fracture fragment breakage(n=3).Group B specimens failed because of fracture fragment breakage(n=3),suture cutting through bone(n=4),ACL rupture(n=1).Group C specimens failed because of anchor pullout from the epiphysis(n=5)and suture cutting through suture cutting through bone(n=3).Conclusion: Transosseous suture bridge technique showed satisfactory biomechanical properties,it provides superior fixation with regard to higher ultimate failure load than double-headed compression screw fixation,and were similar to those of the suture combined with external screw fixation.Under cyclic loading conditions,it provides less displacement.Part 2.Methods: Children and adolescents who underwent arthroscopic reduction and transosseous suture bridge fixation of ACL tibial avulsion fracture between January 2017 and January 2020 were retrospectively analyzed.Postoperative MRI and X-ray examinations were performed to evaluate the presence of epiphyseal plate injury and fracture healing.Moreover,KT-1000 side-to-side difference,Lachman test,range of motion(ROM),the subjective Knee score of the International Knee Documentation Committee(IKDC),Lysholm Knee score and Tegner activity grade score were evaluated preoperatively and at the minimum 1-year follow-up visit.Results: A total of 12 participants(8 male,4 famle;mean age,12.7 years[range,9-16 years];mean time to surgery,6.2 days [range,2-15 days])met the inclusion criteria,and had a minimum of 12 months clinical follow-up(mean,15.8 months;range,12-25 months)after surgery.Postoperative radiographs and MRI showed no injury to the epiphyseal plate,optimal reduction immediately after operation and bone union within 3 months in all patients.All of the following showed significant improvements(pre-vs postoperatively): mean KT-1000 side-to-side difference(8.6 vs 1.5;p < 0.05),Lachman tests(2 grade 7and 3 grade 5 vs 0 grade 10 and 1 grade 2;p < 0.05),IKDC subjective score(48.3 vs 95;p < 0.05),mean Lysholm score(53.9 vs 92.2;p < 0.05),mean Tegner activity score(3.2 vs 8.3;p < 0.05)and mean ROM(42.8°vs 133.2°;p < 0.05).Conclusion: Arthroscopic reduction and transosseous suture bridge fixation for ACL tibial avulsion fracture can effectively restore the stability and function of the knee,and is worthy of clinical promotion. |
PDF Full Text Request