Medial Tibia Cortex Transosseous Sling Fixation for Various Arthroscopic Procedures in the Knee: A Technical Note

Abstract

The ideal fixation method in the tibia for various arthroscopic procedures in the knee remains questionable, and the authors recommend another fixation in addition to the primary. The numerous implants available have their limitations with cost, inadequate tightening, implant slippage, breakage, and pain due to prominence. In this consideration, implant-free fixations by transosseous suturing methods have been described by various authors; however, the procedural complexity, difficulty to replicate, and risk of fractures with described techniques have been the demerits in the current practice. A novel technique of transosseous fixation in the medial third of the tibia between the medial collateral ligament and tibial tuberosity is created using a 2.5-mm drill hole perpendicular to the anterior medial and posterior surfaces of the tibia. One limb of fiber wire sutures from the graft or structure repaired is shuttled through the hole around the medial border of the tibia and tied to the other limb of sutures over the medial surface of the tibia creating a sling around the medial border of the tibia. There were no neurovascular events or fractures noted. This method is safe, replicable, and adjustable to the length of grafts/tunnels, provides a stable fixation in line of pull of grafts/repaired structures, and can be used as a supplemental fixation or primary fixation for various arthroscopic/open procedures in the knee.