Arthroscopic fixation with figure of 8 suture versus ladder mesh suture for anterior cruciate ligament tibial avulsion fracture

Abstract

Objective To compare the primary clinical results of arthroscopic figure of 8 suture and ladder mesh suture fixations in treating anterior cruciate ligament (ACL) tibial avulsion fractures. Methods From August 2013 to November 2016, a total of 37 patients with ACL tibial avulsion fracture who had closed epiphyses underwent arthroscopy. By the Meyers-McKeever-Zaricznyj classification, 10 cases were type II, 22 type III and 5 type IV. There were 25 cases in the figure of 8 suture fixation group with two No.2 high-strength sutures crossed to form a 8 figure to pull out and fix the fracture through the tibial tunnels, including 17 males and 8 females with an average age of 18.91±9.34 years (range 14-36 years). The ladder mesh suture fixation group with three No.2 high-strength sutures woven into a mesh to pull out and fix the fracture through the tibial tunnels had 12 cases, including 8 males and 4 females with an average age of 19.63±7.85 years (range 15-33 years). At the latest follow-up, the Lysholm and International Knee Documentation Committee (IKDC) scores were used to estimate knee joint function, while the Lachman test and Pivot-shift test were used to estimate knee joint instability. The operation duration, knee range of motion (ROM) and the number of case with flexion contracture were evaluated. Results All 37 cases were followed up. The average follow-up duration was 16.35±5.27 months (range 10-22 months) in figure of 8 suture fixation group and 14.06±7.18 months (range 10-21 months) in ladder mesh suture fixation group. In figure of 8 suture fixation group, the Lysholm and IKDC average scores were 95.86±5.74 and 90.53±4.61, respectively. However, they were 96.53±3.17 and 92.15±5.54 in ladder mesh suture fixation group with no significant difference between the two groups after operation (t=0.723, P=0.462; t=1.018, P=0.279). The percentage of negative Lachman test and Pivot-shift test in the figure of 8 suture group was 92% (23/25) . There was no significant difference in the negative rate in the ladder mesh suture fixation group 100% (12/12, χ2=0.904, P=0.265). The average operation duration of ladder mesh suture fixation group was 61.8±6.3 minutes, which was longer than that of figure of 8 suture fixation group 43.5±5.9 minutes (t=2.714, P=0.025). Flexion contracture of ≥5° occurred in 4 cases in the figure of 8 suture group and 0 case in the ladder mesh suture fixation group with significant difference between the two groups (χ2=0.450, P=0.032). Conclusion In treating ACL tibial avulsion fractures, arthroscopic figure of 8 suture fixation and ladder mesh suture fixation can achieve satisfied functional recovery and stability. The ladder mesh suture fixation can effectively achieve reduction of fracture fragments and knee flexion contracture. It may have more advantages in treating rotational type III and type IV comminuted fractures. However, some disadvantages in this technique, such as high technical requirements and long operation time, have to be considered. Key words: Arthroscopy; Sutures; Fracture fixation, internal; Anterior cruciate ligament