Arthroscopic ACL Tibial Spine Avulsion Fixation Using Suture Pull-Through Double-Tunnel Technique

Avulsion fractures of the tibial spine are uncommon injuries that primarily affect children and adolescents but are increasingly recognized in adults after high-energy trauma. Displaced Meyers and McKeever Type II-IV fractures require fixation to restore anterior cruciate ligament (ACL) function, obtain anatomical reduction, and prevent residual knee instability. Arthroscopic suture pull-through fixation using a double-tibial-tunnel technique avoids intra-articular hardware while providing stable fixation.

The objective of the study was to assess the radiological and clinical outcomes of arthroscopic ACL tibial spine avulsion fixation in skeletally mature patients using the suture pull-through double-tunnel technique.

This prospective observational study included 26 skeletally mature patients with displaced tibial spine avulsion fractures treated using the arthroscopic suture pull-through double-tunnel technique. Functional outcomes were assessed with the Lysholm Knee Score and Tegner Activity Scale, while radiological union, clinically assessed post-operative stability, complications, and return to pre-injury activity were recorded. The study had no control group, and the available follow-up was limited to the early post-operative period.

All 26 patients completed the available follow-up and achieved radiological union by 3 months. The mean pre-operative Lysholm score derived from the patient-level table was 40.8 ± 2.2; the reported post-operative mean was 97, although individual post-operative Lysholm values were unavailable and a paired significance test could not be performed. The Tegner score improved from 2.88 ± 0.77 preoperatively to 5.96 ± 0.77 postoperatively (P < 0.001). Twenty-two patients (approximately 85%) returned to their pre-injury activity level within 4-6 months. Two patients developed a mild extension lag that resolved with supervised physiotherapy. No non-union, fixation failure, clinically significant residual instability, or revision surgery was reported; however, the sample was too small to determine the true incidence of uncommon complications.

In this small observational cohort, arthroscopic suture pull-through double-tunnel fixation was associated with radiological union and favorable early functional recovery while avoiding intra-articular hardware. Because the study was single-Centre, uncontrolled, short-term, and lacked instrumented stability and detailed imaging-based reduction measures, these findings should be interpreted as preliminary rather than evidence of superiority or long-term reliability.