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All-Inside Anterior Cruciate Ligament Tibial Avulsion Repair.

ABSTRACT: Anterior cruciate ligament (ACL) tibial avulsion occurs predominantly in children and young adults. It is seen in association with injuries due to hyperextension usually involving movements that are similar to riding a bicycle. Bony ACL avulsion is associated with severe restriction of knee range of motion, swelling, inability to bear weight, and continuous pain. Acute swelling does not allow a conclusive clinical examination. Bony ACL avulsion from the tibial side has been treated by various methods ranging from conservative management to a wide range of operative procedures. The various operative procedures that have been described require challenging operative skills, time, and resources, making these techniques demanding and technically challenging. We describe a technique for the treatment of Meyers-McKeever type II, III, and IV bony tibial ACL avulsions that uses regular anterolateral and anteromedial portals with an additional transpatellar portal. The avulsed fragments along with the ACL are held and buttressed with the help of FiberWires and fixed with the intra-articular portion of the proximal tibia. The technique is performed in an all-inside manner and is easy to master, even for beginners.

SUBMITTER: Jagtap S

PROVIDER: S-EPMC7917030 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:PurposeTo assess failure rate, outcomes, and patient satisfaction in patients who underwent anterior cruciate ligament (ACL) repair with suture augmentation for clinical instability and proximal avulsion of the ACL.MethodsWe retrospectively reviewed consecutive suture-augmented ACL repairs performed by a single surgeon between January 2014 and June 2016 for proximal ACL avulsion. Patients were included if they were at least 24 months postoperative from repair surgery. Patients were excluded from the study if they underwent primary ACL reconstruction instead of repair or if they had a concomitant multiligamentous knee injury. Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS), Veterans RAND-12 (VR-12), Marx Activity, and Single Assessment Numeric Evaluation data were collected.ResultsOf 172 patients who underwent ACL surgery between January 2014 and June 2016, 28 (16%) with Sherman type I or II ACL tears or high-grade partial avulsion with clinical instability underwent ACL repair with suture augmentation. One patient was not available for follow-up. The 27 patients were age 27.4 ± 8.6 years, 18 males (66.7%), and 2.8 ± 0.7 years follow-up (range, 2.0-3.8 years). Of these 27 patients, 4 recurrent ACL injuries (14.8%) required revision to reconstruction. The remaining 23 patients had successful ACL repair with no clinical instability and no subjective complaints at final follow-up. Final scores were KOOS 83.7 ± 12.8, Marx 8.6 ± 4.0, VAS 1.1 ± 1.8, physical VR-12 53.6 ± 5.2, mental VR-12 53.1 ± 8.1, and Single Assessment Numeric Evaluation 83.0 ± 12.9. In the 11 patients with baseline data, significant improvements were observed in composite KOOS (50.4 ± 11.5 to 85.7 ± 8.4; P < .001; VAS: 3.9 ± 2.6 to 0.8 ± 0.8; P = .002; and physical VR-12: 39.9 ± 6.5 to 55.5 ± 3.3; P < .001). All 11 patients (100%) met or exceeded the KOOS composite minimum clinically important difference (mean 34.0 increase).ConclusionsIn patients with proximal ACL avulsion, arthroscopic primary ACL repair with suture augmentation demonstrated high functional outcome and improved patient-reported outcomes at 2-year follow-up. The rate of graft failure was 15%.Level of evidenceLevel IV, therapeutic case series.

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All-Inside Anterior Cruciate Ligament Tibial Avulsion Repair.

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