Surgical treatment of anterior cruciate ligament avulsion injuries in skeletally immature patients by cerclage wire loop technique

Abstract

Introduction Tibial eminence avulsion fracture is the pediatric equivalent to a midsubstance anterior cruciate ligament (ACL) injury. It is most common between the ages of 8 and 19 years. Patients and methods From June 2009 to December 2012, 26 patients with ACL avulsion fractures were submitted to surgical treatment by means of a cerclage stainless steel wire loop. Seventeen patients were male and nine were female. Their ages ranged from 8 to 15 (mean: 12) years, and they were followed up for 6–22 (mean: 16) months. Results The Meyers & McKeever and Zaricznyj classifications were used for evaluating fractures for surgery. Radiographs in two views are often sufficient to establish a diagnosis. Cases were evaluated clinically by means of the anterior drawer test, which was negative in 21 patients, whereas four patients had residual laxity of about 2–3 mm increased manual anteroposterior tibial translation compared with the contralateral knee, without subjective feeling of instability. According to the Lyslholm scoring system excellent and good results were achieved in 24 (92%) cases, two patients showed fair results, and there were no poor results. Conclusion The use of a stainless steel wire loop cerclage by open technique gives excellent results, with benefits such as capture and control tension on ACL on each side of the avulsed fragment proper and adequate mechanical strength.