Clinical Observation Of Total Intra-articular Suture Bridge Technique In The Treatment Of Anterior Cruciate Ligament Tibial Insertion Avulsion Fractures

Objective: To explore the clinical effects of total intra-articular suture bridge technique in the treatment of anterior cruciate ligament tibial insertion avulsion fractures.Methods: From June 2015 to September 2020,a total of 18 anterior cruciate ligament tibial insertion avulsion fracture patients were treated with total intra-articular suture bridge technique,including 9 males and 9 females,aged from 7 to 51 years,with an average of 26.4±12.3 years.There were 11 cases of left knee and 7 cases of right knee.According to the modified Meyers-Mc Keever-Zaricznyj classification system,there were10 cases of type II,5 cases of type III and 3 cases of type IV.Meniscal injury was found in 5 cases.The causes of injury were traffic injury in 11 cases and sports injury in 7 cases.The average time from injury to operation was 12.8±13.0 days(ranged from 4 to 52 days).Two cases were old fractures and the rest were fresh.The complications during perioperative and follow-up period were recorded.The International Knee Documentation Committee(IKDC)score and Lysholm score of the affected knee and the healthy knee were collected before operation,at 3 months after operation and at the last follow-up.Then the IKDC score and Lysholm score before operation,at 3 months after operation and at the last follow-up of the affected knee were compared to observe the clinical effects of the operation and functional restoration.The IKDC score and Lysholm score of the affected knee and healthy knee at the last follow-up were compared to observe the effect of surgery on the knee function score.Results: All operations were successfully completed.The average operation time was102.1±37.4 minutes(ranged from 30 to 182 minutes)and the average follow-up time was17.7±6.6 months(ranged from 6 to 26 months).The average preoperative IKDC score of the affected knee was 41.7±5.0(ranged from 34 to 53)and the preoperative Lysholm score was 38.1±5.4(ranged from 32 to 48).The average IKDC score of the affected knee was89.9±4.0(ranged from 86 to 97)at 3 months after operation and the Lysholm score was91.6±3.7(ranged from 89 to 100).At the last follow-up,the average IKDC score of the affected knee was 93.4±3.1(ranged from 88 to 98),the average IKDC score of the healthy knee was 95.3±3.2(range from 90 to 100);the average Lysholm score of the affected knee was 94.0±3.3(ranged from 89 to 100),the average Lysholm score of the healthy knee was95.6±3.4(ranged from 90 to 100).The results showed that the IKDC score and the Lysholm score of the affected knee were improved significantly at 3 months after operation when compared with preoperation and at the last follow-up when compared with those at 3 months after operation(P<0.05).There was no significant difference between IKDC score and Lysholm score of the affected knee at the last follow-up and those of the healthy knee(P>0.05).At the last follow-up,the anterior drawer test and Lachman test of the affected knee were negative,the X-ray films showed the fractures healed and all patients could return to normal exercise and daily life smoothly.There were no complications such as poor incision healing,displacement of fracture blocks,nonunion of fractures,epiphyseal injuries and mobility defects during the perioperative and followup period.Conclusion: The total intra-articular suture bridge technique has the advantages of full arthroscopic operation,no tibial canals,no limitations of fracture types,wide exploration,anatomical reduction under direct vision,stability of relative fixation,early functional exercise and so on.The clinical efficacy of total intra-articular suture bridge technique is satisfactory.