Implant-Free, Transtibial, Bone Bridge Fixation for Knee Surgery Including Tibial Spine and Meniscal Root Fixation

Fixation over bone bridge is commonly performed during transosseous pullout knee surgeries. This technique requires the drilling of 2 bony tunnels separately. Herein, we describe our technique in which bone bridge fixation is performed with a single bony tunnel. Our technique is described in 4 simple steps. Step 1: A short accessory tunnel is created from a point at least 1 cm away from the aperture of primary bone tunnel and opening into the lumen of the primary tunnel. Step 2: A shuttle suture (PROLENE) loop is passed from the accessory tunnel to the primary tunnel, and the loop is retrieved out of the primary tunnel using an 18-G epidural needle and arthroscopy probe. Step 3: Complimentary limbs of the pullout suture is then shuttled through the accessory tunnel using shuttle suture loop. Step 4: The knots are tied over the intervening bone bridge. Since the sutures are tied over the bone bridge, it has to be strong enough to provide support. This method of fixation is contraindicated when there is severe osteoporosis or if the tunnels are located in metaphysis. A supplemental video demonstration of the technique is included with this article.