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Title: [Treatment of tibial insertion avulsion fracture of anterior cruciate ligament involving anterior root of lateral meniscus with multi-point fixation with anchor and suture].
Author: Dai Z, Liu C, Chen D, Liu J, Huang W, Wu B, Fan W.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2023 Nov 15; 37(11):1342-1346. PubMed ID: 37987042.
Abstract:
OBJECTIVE: To investigate the effectiveness of arthroscopic multi-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of anterior cruciate ligament (ACL) involving the anterior root of lateral meniscus (LM). METHODS: A retrospective analysis was conducted on the clinical data of 28 patients with tibial insertion avulsion fracture of ACL involving the anterior root of LM who were treated with arthroscopic multi-point fixation with anchor and suture between October 2017 and January 2023. There were 12 males and 16 females with the mean age of 26 years (range, 13-57 years). There were 20 cases of sports injury and 8 cases of traffic accident injury. In 2 cases of old fracture, the time from injury to operation was 45 days and 90 days, respectively; in 26 cases of fresh fracture, the time from injury to operation was 3-20 days (mean, 6.7 days). According to the Meyers-McKeever classification, there were 4 cases of type Ⅱ, 11 cases of type Ⅲ, and 13 cases of type Ⅳ. The preoperative Lysholm knee function score was 42.1±9.0, the International Knee Documentation Committee (IKDC) score was 40.0±7.3, and the Tegner score was 0.7±0.7. RESULTS: All operations were successfully completed, and the incisions healed by first intention. All the 28 patients were followed up 5-60 months (mean, 20.4 months). During the follow-up, there was nocomplication such as infection, vascular or nerve injury, loosening or breakage of internal fixator, or stiffness of knee joint. Postoperative X-ray films showed satisfactory fracture reduction and firm fixation. All fractures healed clinically, and the healing time was 8-16 weeks (mean, 10.3 weeks). At last follow-up, Lachman test and anterior drawer test were negative. At last follow-up, Lysholm knee function score was 92.4±5.5, IKDC score was 91.6±4.4, and Tegner score was 5.2±1.1, which significantly improved when compared with preoperative scores ( t=-22.899, P<0.001; t=-29.870, P<0.001; t=-19.979, P<0.001). CONCLUSION: Multi-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of ACL involving the anterior root of LM can not only fix the LM, but also effectively reduce and fix the avulsion fracture, which can obtain good effectiveness. 目的: 探讨关节镜下带线锚钉结合缝线多点固定治疗累及外侧半月板（lateral meniscus，LM）前根的前交叉韧带（anterior cruciate ligament，ACL）胫骨止点撕脱骨折的临床疗效。. 方法: 回顾分析2017年10月—2023年1月采用关节镜下带线锚钉结合缝线多点固定治疗的28例累及LM前根的ACL胫骨止点撕脱骨折患者临床资料。其中男12例，女16例；年龄13～57岁，平均26岁。运动损伤20例，交通事故伤8例。陈旧性骨折2例，受伤至手术时间分别为45、90 d；新鲜骨折26例，受伤至手术时间 3～20 d，平均 6.7 d。骨折根据 Meyers-McKeever 分型：Ⅱ型4例，Ⅲ型11例，Ⅳ型13例。术前Lysholm膝关节功能评分为（42.1±9.0）分、国际膝关节文献委员会（IKDC）评分为（40.0±7.3）分、Tegner评分为（0.7±0.7）分。. 结果: 患者均顺利完成手术，术后切口均Ⅰ期愈合。28例患者均获随访，随访时间5～60个月，平均20.4个月。随访期间未发生感染、血管及神经损伤、内固定物松动及断裂、膝关节僵硬等并发症。术后X线片检查示骨折复位满意、固定牢靠；骨折均达临床愈合，愈合时间8～16周，平均10.3周。末次随访时Lachman试验及前抽屉试验均呈阴性。末次随访时Lysholm膝关节功能评分为（92.4±5.5）分、IKDC评分为（91.6±4.4）分、Tegner评分为（5.2±1.1）分，均较术前显著改善（ t=−22.899， P<0.001； t=−29.870， P<0.001； t=−19.979， P<0.001）。. 结论: 带线锚钉结合缝线多点固定治疗累及LM前根的ACL胫骨止点撕脱骨折，既固定了LM，又可有效复位及固定撕脱骨折，可获得较好临床疗效。.

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