ACL avulsion managed with pullout suture technique- A prospective study

Introduction: Anterior cruciate ligament (ACL) most commonly avulsed from tibial attachment. Affected mostly in young patients, mechanism of injury includes road traffic accidents, falls, and sports injuries. Various methods of fixation are used in operative treatment of these fractures varying from retrograde wires , screws , ante grade screws, sutures, suture anchors, and a recently described suture bridge and K wire and tension band wiring technique. In this study, we are assessing arthroscopic pull out suture technique in ACL tibial avulsion. Materials & Methods: This is prospective study done in two institutions by two surgeons between March 2015 to March 2017. Total number of 18 patients (12 males and 6 females) who went arthroscopic ACL tibial avulsion fixation were selected for the study. Fractures were classified according to the Meyers and McKeever fracture classification system. First diagnostic knee arthroscopy done then fracture crater exposed, washed, reduced and fixed temporarily with K- wire passed through superomedical portal. Knot taken on ACL with fiber wire no 2 and pulled through two portals, made medial and lateral to ACL footprint. Pulled fiber wires secured through suture disk on medial tibial surface. Postoperatively, the knee was maintained with long knee brace in full extension for 2 weeks. Touch weight bearing walk was allowed on day 1. Initial phase include closed kinetic chain exercise and sports activities advised after 6 months. Results: Total 18 (12 male and 6 female) patients were enrolled in the study, age ranging from 18 to 45 years (Mean 30.3 years). 7 patients with right knee and 11 patients with left knee involved. Out of 18 patients, 9 patients were of type 3, 6 patients were of type 2 and remaining 3 patients were of type 4. Average time of surgery from date of trauma was 6 days. Patients assessed at 2, 6, 12 and 24 weeks. At the end of 12 months, we lost 2 cases follow up, anterior drawer test was positive in 6 cases, one patients had instability with Lachman test positive as he had nonunion, for which ACL reconstruction done with autologous semitendinosus graft. International Knee Documentation Committee (IKDC) score done in 16 patients at 12 months follow up. Conclusion: We recommend arthroscopic suture fixation of tibial avulsion of ACL in adults with advantage of rigid fixation, good postoperative functional outcome. However our study sample and follow up duration is less, further study is required.