Arthroscopic Epiphyseal Plate-Sparing Fixation of ACL Tibial Avulsion Fracture in Skeletally Immature Patients

Abstract

ACL tibial avulsion fracture occurs quite often in children and adolescent. The treatment is similar in strategies but different in techniques in this group of patients compared with that in skeletally mature patients [1]. For skeletally immature patients, one principle is to avoid injury to the epiphysial plate, no matter what kind of reconstruction or repair technique is taken. If the patient is in late adolescence stage and the growth peak has passed, the entire treatment principle and methods are the same as for adults. For children or early adolescent-stage patients who have high growing potential, more conservative treatment should be taken. When fracture reduction and fixation are inevitable choices, measures should be taken to minimize or avoid injury to the epiphysial plate. The reported techniques include mainly intra-epiphysis fixation with screw, suture anchor or pullout sutures, and trans-epiphyseal plate fixation with pullout sutures [2–7]. Intra-epiphysis fixation is somewhat complicated, and sometimes fixation device is inadvertently placed into the epiphyseal plate. As for trans-epiphysial plate pullout suture fixation through bone tunnels, there is still concern of disturbance of the epiphyseal plate even if the tunnels can be made as small as possible. Thus, we developed an arthroscopic epiphyseal plate-sparing fixation to treat ACL tibial avulsion fracture in children or patients at early adolescent stage. The indication of the current technique is type II and III fracture in acute stage and unstable type III fracture in chronic stage.