Abstract:

BACKGROUND: The avulsion fracture of tibial insertion of anterior cruciate ligament needs to be operated and fixed as early as possible. At present, the open reduction (absorbable screw, hollow screw, steel wire, and titanium cable) is commonly used in the clinical treatment plan for internal fixation, which is more traumatic and has many postoperative complications. Arthroscopic reduction and elastic (suture) internal fixation of anterior cruciate ligament fracture has the advantages of minimally invasive, clear surgical field, high fixation accuracy, few complications, good fracture reduction and healing, meeting the biomechanical requirements, and allowing rapid recovery of joint function, but also has the disadvantages of insufficient strength, and osteotomy.

OBJECTIVE: To compare the treatment efficacy of arthroscopic technique with Fiber Tape circular fixation and open reduction and fixation for the avulsion fracture of tibial insertion of anterior cruciate ligament.

METHODS: Thirty-two patients with tibial eminence fracture at Department of Orthopedics of Shanghai China Metallurgical Hospital from January 2017 to December 2018 were enrolled. All patients signed the informed consents and the study was approved by the Ethics Committee. The patients were divided into two groups based on surgical methods: minimally invasive group (n=17, arthroscopic reduction and Fiber Tape circular fixation) and open group (n=15, open reduction and hollow tension screw fixation). The operation time, blood loss, and postoperative complications were recorded. The range of motion of knee joint, Lysholm score, and International Knee Documenting Committee score before operation, 1 and 6 months after surgery were recorded. X-ray film was used to evaluate fracture healing.

RESULTS AND CONCLUSION: (1) All patients were followed up for 6-13 months. (2) There were no significant differences in age composition, fracture type, cause of injury or preoperative score between two groups. (3) X-ray film showed satisfactory fracture reduction after operation. There were no neurological, vascular injury or fracture displacement after surgery. The fractures healed well after 6 months. (4) There was no significant difference in the operation time and postoperative complications between two groups. The blood loss showed significant difference between two groups (P=0.036). (5) The range of motion of knee joint at postoperative 1 month in both groups was significantly larger than that at baseline (P < 0.05). The range of motion of knee joint at postoperative 6 months was significantly larger than that at postoperative 1 month (P < 0.05). The range of motion of knee joint at postoperative 1 and 6 months in the minimally invasive group was significantly larger than that in the open group (P < 0.05). (6) The Lysholm and International Knee Documenting Committee scores at postoperative 1 month in both groups were significantly higher than those at baseline (P < 0.05). The scores at postoperative 6 months were significantly higher than those at postoperative 1 month (P < 0.05). The scores at postoperative 1 and 6 months in the minimally invasive group were significantly higher than those in the open group (P < 0.05). (7) These findings suggest that the patients in both groups after undergoing surgical methods had restored motion of range with time going. Compared with open fixation, arthroscopic reduction and Fiber Tape circular fixation for treating tibial eminence fracture has less blood loss, less trauma, shorter recovery time and higher functional recovery. 

Key words:

"> avulsion fracture of tibial insertion of anterior cruciate ligament, arthroscopic technique, Fiber Tape, hollow screw, internal fixation