Clinical Outcome of Arthroscopic Reduction and Fixation by Pull Through Suture Technique in Tibial Spine Fractures

TL;DR

This study shows that arthroscopic pull-through suture fixation is effective for treating tibial spine fractures, offering good recovery and fewer complications.

Contribution

The study provides clinical evidence supporting the use of arthroscopic pull-through suture fixation over traditional methods for tibial spine fractures.

Findings

90% of patients achieved normal or nearly normal knee function at 12 months.

95% of patients showed no instability in knee tests post-surgery.

Only minor complications were reported, such as transient stiffness and a superficial infection.

Abstract

Background: Tibial spine fractures involving the avulsion of the anterior cruciate ligament (ACL) insertion compromise knee stability and often result in functional limitations if inadequately treated. These fractures are commonly categorized using the Meyers and McKeever classification, and treatment approaches have shifted from open reduction techniques to minimally invasive arthroscopic methods, such as the pull-through suture fixation technique. This study evaluates clinical outcomes of tibial spine fractures treated using arthroscopic pull-through suture fixation.

Methodology: A prospective study was conducted at a tertiary care hospital, including 20 patients (ages 15-55) with type III and IV tibial spine fractures. All patients underwent arthroscopic pull-through suture fixation. Preoperative and postoperative assessments included radiographs, Lachman, anterior drawer, pivot shift tests, and functional evaluations using Lysholm Knee and International Knee Documentation Committee (IKDC) scores. Follow-up assessments were performed at 6 weeks, 3, 6, and 12 months.

Results: The mean age of participants was 30.4 ± 9.8 years, with males constituting 75% of the cohort. Road traffic accidents (85%) were the predominant injury mechanism. The average time from injury to surgery was 10.25 ± 3.9 days, and union was achieved within 10.15 weeks on average. Functional outcomes showed significant improvement, with Lysholm scores increasing to 94.8 ± 1.7 and IKDC ratings achieving "normal" or "nearly normal" in 90% of patients at 12 months. Stability tests demonstrated marked improvements, with 95% of patients achieving Grade 0 on Lachman, anterior drawer, and pivot shift tests. Postoperative complications were minimal, with only one case of transient joint stiffness and one superficial wound infection.

Conclusion: Arthroscopic pull-through suture fixation effectively restores stability, function, and range of motion in type III and IV tibial spine fractures. The technique offers a reliable alternative to screw fixation, with fewer complications and a quicker recovery. These findings support its broader adoption as a preferred treatment method for displaced tibial spine fractures.