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Indian Journal of Orthopaedics Surgery

Efficacy of Arthroscopic suture fixation technique in comminuted avulsion fractures of Anterior Cruciate Ligament

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Author Details: Prashant Vilas Bhandari, Punarvasu Rajeev Jagtap, Suyog Prakash Burgute, Vijay Vasant Nemade

Volume : 2

Issue : 3

Online ISSN : 2395-1362

Print ISSN : 2395-1354

Article First Page : 231

Article End Page : 235


Background: Treatment of comminuted avulsion fractures of Anterior Cruciate Ligament (ACL) is challenging. Arthroscopic fixation techniques such as fixation with Screws, staples, k-wires and Sutures are described to achieve this. But in comminuted avulsion fractures of ACL(Meyers and McKeever Type IV), attempts at internal fixation with screws, staples or k-wires often becomes  impossible as small fragments of avulsed bone may further shatter while fixing them with implant. Hence we decided to perform arthroscopic reduction and fixation with sutures. Aim of this study is to demonstrate efficacy and benefits of fixation of ACL avulsion fractures with arthroscopic reduction and suture fixation technique.
Methods: Patients diagnosed as having comminuted avulsion fractures of ACL and treated at our institute between November 2012 to January 2015 and those who were followed up in Out Patient Department or on telephone up to January 2016 were retrospectively studied. We could trace records of 23 patients who fulfilled our inclusion, exclusion and follow up criteria. Fixation of ACL avulsion fractures was performed with arthroscopic reduction and suture fixation technique.
Results: 23 patients with comminuted avulsion fracture of Anterior Cruciate Ligament were studied retrospectively. Post-operatively 17 patients had full range of motion by 8 weeks. The remaining 6 patients had a range of 50 to 1100 at the 8 week. This was improved to 50 to 1250  till 12 weeks of follow up.19 patients had a negative Lachman test postoperatively, and 4 patients had a grade I Lachman, but with a firm end point. 2 patients had deep vein thrombosis on 3rd and 5th post-operative day. These patients were treated with low molecular weight heparin injections subcutaneously for 1 week followed by oral anticoagulants and physiotherapy. At an average of 27 months' follow-up (range, 12 to 39 months), all of the patients were satisfied with their outcome and returned to their pre-injury functional activity.
Conclusion: Arthroscopic suture fixation of comminuted avulsion fractures of ACL gives acceptable results and reduces implant related complications.

Keywords: Avulsion fracture, Anterior Cruciate Ligament, Arthroscopy