Biomechanical And Clinical Evaluation Of Different Fixations For Tibial Eminence Avulsion Fracture

Objective:to study the biomechanical stability of different fixation methods for tibial eminence avulsion fractures and to evaluate the clinical result of fixation with neckwear knot loop ligatureMethod:1.48 porcine knee joints were involved in this experiment,which were randomly divided into six groups, neckwear knot loop ligature group(NKLL), suture fixation group(SF), cannulated screw group(CS) and single suture anchor group(SSA), double suture anchor group(DSA) and double biological non-knotted locking nail(DBNKL) eight cases in each group. After the fracture model was made in uniform size, it then was fixed by either of above methods. Biomechanical tests were made of cyclic fatigue test and pull-out test. Each specimen was first underwent 200 cyclic tests, then pull-out test. The maximum failure load, yield load, stiffness and displacement were analyzed 2.clinical cases of tibial eminence fracture treating with NKLL were collected, and then evaluating the therapeutic effect.Results:1. NKLL group had better performance than other groups at maximum failure load, the second is DBNKL, the third SSA, the fourth SF, the fifth CS, the sixth SSA. These differences were statistically significant(P<0.01).2、At yield load, DBNKL had better performance, the second is NKLL, the third SSA, the fourth SF, the fifth CS, the sixth SSA. The differences were statistically significant(P<0.05).3、As to stiffness, DBNKL had better result than other groups, the difference was significant(P<0.05). Differences of stiffness between the other groups had no statistically significancc(P>0.05).4、At displacement, NKLL was smaller than other groups, the second is DBNKL, the third SSA, the fourth CS, the fifth SSA, the sixth SF. These differences were statistically significant(P<0.05)5、60 cases were treated with fixation of neckwear knot loop ligature, Duration was 4months to 12years (average 5.6years). All incisions healed primarily, no neurological and vascular injuries were found. At last follow-up, the function of knee joints were very good with the active ROM of 1300-00-00, Lachman test and anterior dislocation test were negative, the rating score of Lysholm was 31.0±4.2 preoperatively and 93.8±3.6 postoperatively, the difference was significant(P<0.05), all patients were satisfied with the functional recovery from their disease, the clinical therapeutic effect were good.Conclusion:1.The instability of fixation with NKLL, DBNKL or SSA for tibial eminence avulsion fractures are better than that with SF, SA and CS.2.Arthroscopic treatment with NKLL for tibial eminence avulsion fracture is simple and convient, economic and practical, and the curative effect is reliable.