ObjectiveTo compare the effectiveness of open reduction of posterior cruciate ligament (PCL) avulsion fracture at tibial insertion of knee joint with absorbable screws fixation and absorbable screw combined with suture anchor fixation. Methods The clinical data of 26 patients with PCL avulsion fracture at tibial insertion who met the selection criteria between March 2015 and October 2021 were retrospectively analyzed. Among them, 14 patients were fixed with simple absorbable screw (group A), and 12 patients were fixed with absorbable screw combined with suture anchors (group B). All patients were confirmed by X-ray film, CT, or MRI preoperatively, and got positive results in preoperative posterior drawer tests. There was no significant difference in gender, age, side of affected limb, time from injury to operation, comorbidities, and preoperative Meyers & McKeever classification, Lysholm score, and International Knee Documentation Committee (IKDC) score between the two groups (P>0.05). The operation time and postoperative complications were recorded and compared between the two groups. At last follow-up, Lysholm score and IKDC score were used to evaluate the improvement of knee function. ResultsThere was no significant difference in operation time between the two groups (P>0.05). All incisions healed by first intention, and no complication such as vascular and nerve injury or venous thrombosis occurred. All 26 patients were followed up 9-89 months, with an average of 55.3 months. The follow-up time of group A and group B was (55.7±23.2) and (56.8±29.3) months, respectively, with no significant difference (t=−0.106, P=0.916). Radiographs showed bone healing in both groups at 3 months after operation, and no complication such as infection and traumatic arthritis occurred. At last follow-up, the posterior drawer test was negative in both groups, and the Lysholm score and IKDC score significantly improved when compared with the pre-operative values (P<0.05). However, there was no significant difference in the improvement value between the two groups (P>0.05). ConclusionFor PCL avulsion fracture at tibial insertion of the knee joint, the open reduction and absorbable screw combined with suture anchor fixation can achieve reliable fracture reduction and fixation, which is conducive to the early rehabilitation and functional exercise, and the postoperative functional recovery of the knee joint is satisfactory.
Objective To compare the effectiveness of arthroscopic screw and suture fixations in treatment of anterior cruciate ligament tibial eminence avulsion fractures. Methods Between January 2002 and January 2009, 43 patients with freshanterior cruciate ligament tibial eminence avulsion fracture were treated, which were rated as types II and III according to Meyers- McKeever-Zaricznyj classification. Fractures were fixed with either screw (screw group, n=21) or nonabsorbable suture (suture group, n=22). There was no significant difference in sex, age, disease duration, and fracture type between 2 groups (P gt; 0.05). The range of motion (ROM) and Lysholm score were compared between 2 groups, and the knee stabil ity was evaluated based on the Lachman test and KT-2000 measurement. Results The operation time was 48-60 minutes (mean, 51.6 minutes) in the screw group, and 55-68 minutes (mean, 63.2 minutes) in the suture group, showing significant difference (t=4.645, P=0.032). Incisions healed by first intention and no compl ication occurred in 2 groups. All patients were followed up (5.7 ± 0.6) years in the screw group and (5.3 ± 0.5) years in the suture group. The fracture healed completely in both groups; the heal ing time was (3.3 ± 0.6) months in the screw group and (3.2 ± 0.4) months in the suture group, showing significant difference (t=3.723, P=0.019). Between the screw group and the suture group, no significant difference was found in ROM [(128.6 ± 10.1)° vs. (130.2 ± 14.1)°, P gt; 0.05] and Lysholm score (94.6 ± 14.5 vs. 95.1 ± 17.2, P gt; 0.05). The stabil ities based on KT-2000 measurement were also similar between 2 groups at last follow-up [(0.9 ± 0.3) mm vs. (1.0 ± 0.4) mm, P gt; 0.05]. Lachman test of 2 groups were negative. Conclusion Boththe screw and nonabsorbable suture fixation techniques for anterior cruciate l igament tibial eminence avulsion fracture (type II or III) have good results in terms of functional outcome and stabil ity. However, some patients show flexion contractures of 5° or 10°.
ObjectiveTo evaluate the effectiveness of arthroscopic suture and absorbable screw double fixation for both anterior and posterior cruciate ligament avulsion fractures of tibial insertions. MethodsBetween June 2006 and September 2013, 8 patients with anterior and posterior cruciate ligament avulsion fractures of the tibial eminence underwent arthroscopic treatment with suture and absorbable screw double fixation. There were 5 males and 3 females, with a mean age of 28.9 years (range, 18-43 years). The causes of injury included traffic accident in 5 cases and falling from height in 3 cases. The time from injury to operation was 3-10 days (mean, 6.2 days). The Lysholm knee score, International Knee Documentation Committee (IKDC) score, and Tegner rating scales were used to evaluated the knee function. ResultsPrimary healing of incision was obtained, without infection or deep vein thrombosis. The mean follow-up period was 42.4 months (range, 24 to 65 months). At 3 months after operation, X-ray films showed good reduction and healing of fracture. The anterior and posterior drawer tests were negative. The knee range of motion was normal (0-125°), and it recovered to preoperative level in 7 cases. The IKDC score, Tegner score, and Lysholm score were significantly improved to 90.4±5.2, 7.5±1.6, and 89.2±3.5 from preoperative 52.1±3.3, 3.3±1.0, and 51.9±3.5 respectively (t=-38.680, P=0.000; t=-39.520, P=0.000; t=-41.150, P=0.000). ConclusionA combined injury of anterior and posterior cruciate ligament avulsion fractures of tibial insertions is rare. Arthroscopic treatment with suture and absorbable screw double fixation is a useful technique to restore tibial avulsion injuries with well-documented radiographic healing, good clinical outcomes, and low complication rates.
Objective To analyze the effectiveness of minimally invasive safe approach of the knee joint in the treatment of avulsion fractures of the tibial insertion of the posterior cruciate ligament (PCL). Methods The clinical data of 26 patients with avulsion fractures of tibial insertion of PCL treated with open reduction and internal fixation via minimally invasive safe approach of the knee joint between February 2019 and March 2022 were analyzed retrospectively. There were 18 males and 8 females with an average age of 45.5 years (range, 33-58 years). The causes of injury were traffic accident in 14 cases, falling from height in 7 cases, and sports injury in 5 cases. There were 15 cases of left knee and 11 cases of right knee. The preoperative Lysholm score of knee joint was 34.4±7.3 and the flexion range of motion of knee joint was (69±12)°. According to Meyers classification, there were 8 cases of type Ⅱ and 18 cases of type Ⅲ. The time from injury to operation ranged from 1 to 5 days, with an average of 2 days. ResultsThe operation time was 40-70 minutes, with an average of 55 minutes; the intraoperative blood loss was 10-30 mL, with an average of 15 mL. Delayed incision healing occurred in 1 case after operation, and the incision healed after conservative treatment, and the incisions of the other patients all healed by first intention. Postoperative X-ray films showed satisfactory fracture reduction. All 26 patients were followed up 3-30 months, with an average of 22 months. No complication such as neurovascular injury, infection, and knee extension disorder occurred after operation. X-ray films at 3 months after operation showed that all fractures healed without displacement of the fracture ends; the posterior drawer test was negative. At last follow-up, the flexion range of motion of knee joint was (120±9)°, the Lysholm score was 90.7±3.8, which were significantly improved when compared with those before operation (t=16.376, P<0.001; t=47.665, P<0.001). Conclusion The minimally invasive safe approach of the knee joint for the treatment of PCL tibial insertion avulsion fractures is easy to operate, with minimal surgical trauma, safe and reliable approach, and satisfactory recovery of knee joint function after operation.
Objective To investigate the outcomes of arthroscopic reduction and internal fixation of tibial eminence avulsion fracture using absorbable double suture anchors. Methods Between February 2007 and August 2009, 18 patients with tibial eminence avulsion fracture were treated with arthroscopic reduction and fixation using absorbable doublensuture anchors. There were 12 males and 6 females with an average age of 30.6 years (range, 17-48 years). The disease causes were traffic accident injury in 4 cases, sport injury in 8 cases, and fall ing from height injury in 6 cases; the locations were left side in 7 cases and right side in 11 cases. The results of the anterior drawer test and Lachman test were positive. According to Meyers-McKeever classification, 10 cases were rated as type II, 7 as type III, and 1 as type IV fractures. The time from injury to treatment was 6-20 days (mean, 10.2 days). Results Incision healed primarily. All the patients were followed up 29.1 months (range, 13-43 months). The X-ray films showed good reduction of fracture immediately after operation and fracture heal ing at 3 months. At the last follow-up, the range of motion of knee was 0-130°. The results of Lachman test and anterior drawer test were negative in 18 cases and 16 cases, repectively; and the results of anterior drawer test were weakly positive in 2 cases. The mean Lysholm score was significantly improved from 53.9 ± 6.7 preoperatively to 91.6 ± 4.2 postoperatively (t=22.100, P=0.000). The Inter national knee Documentation Commitee (IKDC) 2000 subject score improved from 58.1 ± 3.7 preoperatively to 92.8 ± 5.9 postoperatively (t=20.700, P=0.000). Conclusion Arthroscopic treatment using absorbable double suture anchors for tibial eminence avulsion fracture can provide satisfactory reduction, stable fixation, and good heal ing of the avulsed fragment, which is a minimally-invasive, simple, and effective treatment for patients with tibial eminence avulsion fracture.
Objective To investigate the effectiveness of one-stage closed reduction and elastic compression fixation with double Kirschner wires for Wehbe-Schneider types ⅠB and ⅡB bony mallet fingers. Methods Between May 2017 and June 2020, 21 patients with Wehbe-Schneider type ⅠB and ⅡB bony mallet fingers were treated with one-stage closed reduction and elastic compression fixation using double Kirschner wires. There were 15 males and 6 females with an average age of 39.2 years (range, 19-62 years). The causes of injury were sports injury in 9 cases, puncture injury in 7 cases, and sprain in 5 cases. The time from injury to admission was 5-72 hours (mean, 21.0 hours). There were 2 cases of index finger injury, 8 cases of middle finger injury, 9 cases of ring finger injury, and 2 cases of little finger injury. The angle of active dorsiflexion loss of distal interphalangeal joint (DIPJ) was (40.04±4.02)°. According to the Wehbe-Schneider classification standard, there were 10 cases of typeⅠB and 11 cases of type ⅡB. The Kirschner wire was removed at 6 weeks after operation when X-ray film reexamination showed bony union of the avulsion fracture, and the functional exercise of the affected finger was started. Results The operation time was 35-55 minutes (mean, 43.9 minutes). The length of hospital stay was 2-5 days (mean, 3.4 days). No postoperative complications occurred. All patients were followed up 6-12 months (mean, 8.8 months). X-ray films reexamination showed that all avulsion fractures achieved bony union after 4-6 weeks (mean, 5.3 weeks). Kirschner wire was removed at 6 weeks after operation. After Kirschner removal, the visual analogue scale (VAS) score of pain during active flexion of the DIPJ was 1-3 (mean, 1.6); the VAS score of pain was 2-5 (mean, 3.1) when the DIPJ was passively flexed to the maximum range of motion. The angle of active dorsiflexion loss of affected finger was (2.14±2.54)°, showing significant difference when compared with preoperative angle (t=52.186, P<0.001). There was no significant difference in the active flexion angle between the affected finger (79.52±6.31)° and the corresponding healthy finger (81.90±5.36)° (t=1.319, P=0.195). At 6 months after operation, according to Crawford functional evaluation criteria, the effectiveness was rated as excellent in 11 cases, good in 9, and fair in 1, with an excellent and good rate of 95.24%. Conclusion For Wehbe-Schneider typesⅠB and ⅡB bony mallet fingers, one-stage closed reduction and elastic compression fixation with double Kirschner wires can effectively correct the deformity and has the advantages of simple surgery, no incision, and no influence on the appearance of the affected finger.
Objective To investigate the effectiveness of three-needle and two-cable structure in the treatment of inferior patellar pole avulsion fractures. Methods A clinical data of 62 patients with inferior patellar pole avulsion fractures who were admitted between January 2023 and December 2023 and met the selection criteria was retrospectively analyzed. Among them, the fractures were fixed with three-needle and two-cable structure in 32 patients (observation group) and traditional steel wire tension band in 30 cases (control group). There was no significant difference in the baseline data of age, gender, side of the affected limb, cause of injury, and disease duration between the two groups (P>0.05). The operation time, fracture healing and healing time, patellar height (Insall-Salvati index), occurrence of complications, knee range of motion, and Böstman score at last follow-up were compared between the two groups. Results The operation time of the observation group was significantly shorter than that of the control group (P<0.05). Patients in both groups were followed up 6-12 months (mean, 10.4 months). X-ray films re-examination showed that all fractures healed, and the fracture healing time was significantly shorter in observation group than in control group (P<0.05); no significant difference was found in Insall-Salvati index between the two groups (P>0.05). During follow-up, the complications occurred in 2 cases (6.25%) of observation group and in 9 cases (30.00%) of control group, and the difference in the incidences between the two groups was significant (P<0.05). At last follow-up, the range of motion and Böstman score of the knee joint in observation group were significantly superior to control group (P<0.05). Conclusion Compared with the traditional steel wire tension band fixation, the three-needle and two-cable structure fixation of the inferior patellar pole avulsion fractures is firm, which allows the knee joint to move early after operation and is conducive to the recovery of knee joint function.
ObjectiveTo evaluate the clinical outcome of stellated plate fixation of olecranal avulsion fracture. MethodsA retrospective analysis was made on the clinical data from 24 cases of olecranal avulsion fracture treated with stellated plate between April 2007 and April 2012. There were 13 males and 11 females, with an average age of 32 years (range, 18-65 years). The causes of injury included falling injury (14 cases), sports injury (7 cases), and machine injury (3 cases). The left elbow was involved in 4 cases and the right side in 20 cases. The average disease duration was 11 hours (range, 3 hours-2 days). According to Colton's classification criteria, all cases were classified as type Ⅱ A (avulsion fracture). One case had supracondylar humeral avulsion fracture, and 15 cases had triceps tendon tears. ResultsAll the cases obtained healing of incision by first intention, without infection and ulnar nerve injury. The average follow-up period was 24 months (range, 18-48 months). All fractures healed after 6-10 weeks (mean, 7 weeks). According to Morrey's elbow performance score, the results were excellent in 17 cases, good in 4 cases, and fair in 3 cases, with an excellent and good rate of 87.5%. There was no significant difference in the elbow range of motion (ROM) between the injured side (136.0±16.2)° and normal side (143.1±2.9)° (t=2.007, P=0.052). The ROM of normal elbow was significantly larger than that of the injured side in 3 patients who achieved fair results (t=2.820, P=0.048), but no significant difference was found in patients who achieved excellent and good results (P>0.05). ConclusionThe stellated plate has good clinical outcome in treatment of olecranal avulsion fracture, which has advantages of simple operation, firm fixation, and early functional exercise.
Objective To investigate the effectiveness of arthroscopic suspension fixation with Endobutton in the treatment of tibial insertion avulsion fractures of posterior cruciate ligament (PCL). Methods A retrospective analysis was conducted on the clinical data of 52 patients (52 knees) with tibial insertion avulsion fractures of PCL, who were treated by arthroscopic suspension fixation with Endobutton between June 2017 and October 2022. There were 29 males and 23 females, with an average age of 40.6 years (range, 19-66 years). There were 24 cases of traffic accident injuries, 17 cases of sports injuries, and 11 cases of fall injuries. The time from injury to operation ranged from 6 to 19 days (mean, 13.3 days). According to the Meyers-McKeever classification, there were 30 cases of type Ⅱ and 22 cases of type Ⅲ fractures. All patients exhibited positive posterior drawer test results. Preoperative knee joint function was assessed with Lysholm score (21.3±6.7), International Knee Documentation Committee (IKDC) score (20.7±5.8), and visual analogue scale (VAS) score (5.3±0.7); and knee joint range of motion was (41.73±3.17)°. Based on preoperative CT three-dimensional reconstruction measurements, the longitudinal diameter of the avulsed bone fragment ranged from 13 to 25 mm (mean, 18.1 mm). Operation time and occurrence of complications were recorded, and postoperative imaging was used to assess fracture healing. Knee joint function and pain severity were evaluated using knee joint range of motion, Lysholm score, IKDC score, and VAS score. Results The operation time ranged from 46 to 81 minutes (mean, 56.2 minutes). All patients were followed up 12-28 months (mean, 20.1 months). The iatrogenic fractures of bone fragments occurred during operation in 4 cases; and knee effusion occurred in 2 cases and anterior knee pain in 1 case after operation. All incisions healed by first intention. Imaging evaluations at 3 months after operation showed the fracture healing and no internal fixation failure. All patients demonstrated good knee function and had returned to normal activities at 12 months after operation. At last follow-up, the knee joint range of motion was (133.44±4.17)°, Lysholm score 93.6±3.1, IKDC score 93.4±2.5, and VAS score 1.0±0.6, with significant differences compared to preoperative scores (P<0.05). Conclusion Arthroscopic suspension fixation with Endobutton in the treatment of tibial insertion avulsion fractures of PCL is simple to operate, and the knee joint function recovers well.
Objective To investigate the early effectiveness of three-point suture technique in treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture by arthroscopy. Methods Between January 2016 and December 2017, 12 patients with ACL tibial eminence avulsion fractures underwent arthroscopic fixation of avulsion fractures with Ethibon suture using three-point suture technique. There were 9 males and 3 females, with an average of 36.4 years (range, 18-50 years). The fracture caused by traffic accident in 10 cases and sports in 2 cases. Among them, 1 patient was old fracture and 11 was fresh fracture. According to the modified Meyers-McKeever classification criteria, the fractures were rated as type Ⅲ in 7 cases and type Ⅳ in 5 cases. There were 2 cases of medial collateral ligament injury and medial meniscus injury. The preoperative International Knee Documentation Committee (IKDC) score was 37.9±4.7 and Lysholm score was 46.0±3.7. Results All operations completed smoothly. The operation time was 45-70 minutes (mean, 61.3 minutes). The incisions healed by first intention in all patients. The hospitalization stays ranged from 4 to 9 days (mean, 5 days). All patients were followed up 3-20 months (mean, 9.3 months). The anterior drawer test, Lachman test, and axis shift test in all patients were negative after operation. At last follow-up, the IKDC score was 89.7±2.5 and Lysholm score was 90.2±1.9, which were significantly higher than those before operation (t=–30.94, P=0.00; t=–33.03, P=0.00). At last follow-up, the X-ray films showed 9 cases of fracture anatomical reduction and 3 cases of almost anatomical reduction, and 12 cases of fracture healing. Conclusion For ACL tibial eminence avulsion fracture, arthroscopic three-point suture technique can effectively restore the stability of knee joint and obtain satisfactory early effectiveness.