J Korean Orthop Assoc JKOA Journal of the Korean Orthopaedic Association 1226-2102 2005-8918 The Korean Orthopaedic Association 10.4055/jkoa.2011.46.6.512 Case Report Arthroscopic Bio-Absorbable Suture Anchor Fixation of Tibial Eminence Avulsion Fracture in Children Choi Eui-Sung M.D. Park Kyoung-Jin M.D. Kim Yong-Min M.D. Kim Dong-Soo M.D. Shon Hyun-Chul M.D. Cho Byung-Ki M.D. Kim Dong-Hwan M.D. Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea. Correspondence to: Kyoung-Jin Park, M.D. Department of Orthopaedic Surgery, Chungbuk National University Hospital, 62, Gaesin-dong, Cheongju 360-711, Korea. TEL: +82-43-269-6077, FAX: +82-43-274-8719, oslion@chungbuk.ac.kr 12 2011 29 12 2011 46 6 512 517 18 09 2010 24 07 2011 Copyright © 2011 by The Korean Orthopaedic Association 2011

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Surgical treatment for the pediatric anterior cruciate ligament (ACL) avulsion fracture consists of arthroscopic treatment and open surgery. Recently, arthroscopic treatment has been commonly performed rather than open surgery because of less post-operative pain and faster rehabilitation. In arthroscopic treatment, K-wire and cannulated cancellous screws are the main instruments used for fixation of avulsion fracture, but these instruments have the risk of causing damage to the growth plate and an additional surgery to remove the fixation is needed. In spite of the technical difficulty, the suture anchor is used to overcome the risk of damage to the growth plate and the need for an additional surgery. The authors report good results using bio-absorbable suture anchor in arthroscopic treatment for pediatric ACL avulsion fracture.

 knee joint anterior cruciate ligament fracture fixation arthroscopy suture anchor Wiley JJ Baxter MP Tibial spine fractures in children Clin Orthop Relat Res 1990 255 54 60 Ahn JH Yoo JC Clinical outcome of arthroscopic reduction and suture for displaced acute and chronic tibial spine fractures Knee Surg Sports Traumatol Arthrosc 2005 13 116 121 Uggen C Wei A Glousman RE Biomechanical comparison of knotless anchor repair versus simple suture repair for type II SLAP lesions Arthroscopy 2009 25 1085 1092 Seon JK Park SJ Lee KB A clinical comparison of screw and suture fixation of anterior cruciate ligament tibial avulsion fractures Am J Sports Med 2009 37 2334 2339 Meyers MH McKeever FM Fracture of the intercondylar eminence of the tibia J Bone Joint Surg Am 1970 52 1677 1684 McLennan JG The role of arthroscopic surgery in the treatment of fractures of the intercondylar eminence of the tibia J Bone Joint Surg Br 1982 64 477 480 Veselko M Senekovic V Tonin M Simple and safe arthroscopic placement and removal of cannulated screw and washer for fixation of tibial avulsion fracture of the anterior cruciate ligament Arthroscopy 1996 12 259 262 Tsukada H Ishibashi Y Tsuda E Hiraga Y Toh S A biomechanical comparison of repair techniques for anterior cruciate ligament tibial avulsion fracture under cyclic loading Arthroscopy 2005 21 1197 1201 Bong MR Romero A Kubiak E Suture versus screw fixation of displaced tibial eminence fractures: a biomechanical comparison Arthroscopy 2005 21 1172 1176 Kim JM Kim YS Ha KY Cho HM Arthroscopic stabilization for traumatic anterior dislocation of the shoulder: suture anchor fixation versus transglenoid technique J Orthop Sci 2008 13 318 323

Preoperative plain radiographs show avulsion fracture of the anterior cruciate ligament.

Preoperative magnetic resonance imaging shows avulsion fracture of the anterior cruciate ligament.

Arthroscopic findings show avulsion fracture of the anterior cruciate ligament and hematoma at fracture site.

Illustration shows the anchor insertion method by using the suprapatellar portal. The trocar is inserted under the patella through the suprapatellar portal, then the patella is lifted while the knee joint is flexed. This makes it possible to approach the area 1-2 mm anterior to the tibial attachment site of the anterior cruciate ligament (ACL), and the suture anchor can be inserted perpendicular to the articular surface. Then, the ACL is fixed with the suture.

Arthroscopic findings show accurate fixation of avulsion fracture of the anterior cruciate ligament with a suture anchor.

Post-operative radiographs show reduction of the anterior cruciate ligament avulsion fracture.

Post-operative radiographs show com plete bony union of the anterior cruciate ligament avulsion fracture at 20 weeks after operation.