Arthroscopy-assisted Reduction And Internal Fixation For Fracture Of Tibial Intercondylar Anterior Eminence With Cannulated Lag Screw--A Clinical Retrospective Study By Intermediate And Long-term Follow-up

Background and ObjectivesTibial intercondylar anterior eminence fracture which was first reported by Pringle in 1907 as the tibial insertion site fracture of anterior cruciate ligament (ACL). With the increasing sports injuries and traffic accidents,the incidence of such fracture is rising, accounting for 14% of the ACL injury.Tibial intercondylar anterior eminence fracture may disable the function of ACL and is always accompanied with injury of anterior horn of lateral meniscus, which seriously affects the stability of the joint. Poor reduction of this fracture may lead to limited extension and intercondylar fossa impingement sign.It is difficult to achieve anatomic reduction through closed manual reduction, and the traditional open reduction and internal fixation has many complications such as knee postoperative adhesions.Since the application of arthroscopic treatment of tibial intercondylar anterior eminence fracture by Mclennan, the arthroscopic reduction and internal fixation (ARIF) gradually replaced the previous open reduction and internal fixation (ORIF). Compared with traditional surgery, arthroscopic internal fixation for tibial intercondylar anterior eminence fracture has many advantages such as less injury, shorter time of operating and hospitalization, as well as lower cost. So it is inevitable that arthroscopic internal fixation for tibial intercondylar anterior eminence fracture will gradually replace the conventional open surgery.Nowadays, there are many types of fixation materials available in the treatment of tibial intercondylar anterior eminence fracture, including steel wire, sutures, Kirschner. But there is one problem about these methods that the early exercises are not allowed after operation. With the development of material technology, cannulated lag screw have been gradually applied in the clinical treatment of such fractures. We found that the fixation angle under arthroscopy increased as knee flexed, with its maximum angle between 32°and 56°and its average angle 44.17±5.79°by studying 30 patients with unilateral tibial eminence fracture.The biomechanical propertiy of the cannulated lag screw has also been proved that it was better than that of the steel-wire tensile at 45°fixation angle under arthroscopy.However,the long-term effect were not evaluated.In this study,we followed up 37 cases of tibial intercondylar anterior eminence fracture teated by arthroscopic reduction and internal fixation with single cannulated lag screw for intermediate and long-term. And then we established the clinical norms for arthroscopic treatment of tibial intercondylar anterior eminence fracture with single canunate lag screw..Methods37 cases of tibial intercondylar anterior eminence fracture from May. 2004 to June. 2008 were treated by arthroscopic reduction and fixation with single cannulated lag screw. After the adoption of out-patient review and telephone or letter follow-up ,the treatment outcomes were evaluated by X-rays, physical examination, complications,Lysholm and Irrgang knee score system. Comparative analysis was applied among the scores of Meyers-McKeever- Zaricnyl's II, III and IV type fractures. The same approach was used to evaluate the diferrence between the intermediate and long-term effect. Based on our research,we tried to establish the clinical norms for arthroscopic treatment of tibial intercondylar anterior eminence fracture with single canunate lag screw.Results1. 37 cases of patients were followed up for 6 months to 60 months, averaging 30.38±15.48 months. According to the X-ray there were no occurance of nonunion, osteophyte formation and inter-condylar fossa Impingement. Physical examination :Lachman test, ADT, pivot shift test were negative, ROM of 30 cases were normal and other 7 cases had ROM range from 100°-105°. Lysholm scores were 90.41±5.09, Irrgang scores were 86.14±5.99 after operation. Meyers-McKeever-Zaricnyl's II, III, IV type fractures had no significant statistical difference (P> 0.05). There were no occurance of lower extremity thrombosis, myositis ossifican,anchylosis and traumatic arthritis.2. The clinical norms for arthroscopic treatment of tibial intercondylar anterior eminence fracture with single canunate lag screw had been initial established. Conclusion1. Arthroscopic reduction and internal fixation with single canunate lag screw is effective for treating intercondylar anterior eminence Meyers-McKeever-Zaricnyl'stypeII, III, IV fractures.2. Arthroscopic treatment of tibial intercondylar anterior eminence fracture with single canunate lag screw has both a good intermediate and a long-term effect,and it is easy and minimally invasive,with reliable reduction and fixation,which lead to satisfying results.3. The clinical norms for arthroscopic treatment of tibial intercondylar anterior eminence fracture with single canunate lag screw has been initial established, and it may provide reference for clinical applications.