Arthroscopic suture fixation of displaced tibial eminence fractures

The purpose of this article is to describe a technique for arthroscopic reduction and suture fixation of avulsion fractures of the tibial eminence involving the anterior cruciate ligament (ACL). Six patients (five type III, one type II) with tibial eminence fractures underwent arthroscopic evaluation when closed reduction after aspiration failed to yield an anatomic reduction. The study population was composed of five males and one female. Average age was 24 years (range 16-36). One fracture (type II) was easily reduced after manipulating the interposed anterior horn of the lateral meniscus. In five patients the fragment was stabilized with multiple sutures. The technique involved arthroscopic placement of multiple sutures of 2-0 polydioxanone suture (PDS) into the base of the ACL pulled through a tibia drill hole and tied onto a 4.5-mm screw post. Patients were placed in a standard postoperative ACL protocol. All fractures demonstrated radiographic healing by 8 weeks, and no patients had subjective complaints of instability at 1 year. All patients obtained full extension intraoperatively, and only one patient lost 2 degrees of terminal extension at latest follow-up. Arthroscopic reduction and suture fixation of avulsion fractures of the tibial eminence restores the length of the ACL, provides stable fixation promoting early motion with minimal morbidity, and does not require a second operation for metal removal.