Ligament Avulsion Research Articles

Outcomes following arthroscopic repair of humeral avulsion of the glenohumeral ligament (HAGL) lesion: A systematic review

PurposeThe purpose of this systematic review was to evaluate patient outcomes following arthroscopic surgical management for a humeral avulsion of the glenohumeral ligament (HAGL) lesion. MethodsBased on PRISMA guidelines, two independent reviewers performed a literature search to isolate studies on arthroscopic HAGL repair. The functional outcomes, return to play (RTP), and recurrent instability from each study were extracted and analyzed. ResultsOverall, 7 manuscripts were included with 49 patients. The patient population was 61.4% male with a mean age of 24.8 years (15–42 years), and 41.9 months of follow-up on average (12–104 months). The Rowe score was the most frequently reported outcome measure with a weighted mean of 89. In total, 81.2% of patients reported being able to RTP post-operatively, with 70.5% reported being able to play at an equal or higher level. There was 1 recurrent dislocation (2%). ConclusionThe current study found successful clinical outcomes following the arthroscopic management of HAGL lesions. Recurrent dislocation requiring revision was rare, with high rates of return to play including those who could return to the same level of play. However, the paucity of evidence does not permit a statement of best-practice to be made.

A Bibliometric Analysis of the Most Cited Research on Humeral Avulsions of the Glenohumeral Ligament: A Paucity of High-Level Evidence

To identify the 25 most-cited articles on humeral avulsion of the glenohumeral ligament (HAGL) lesions and characterize them based on number of citations, citation density, source journal, year of publication, geographic origin, article type, and level of evidence. The Science Citation Index Expanded database was queried for all possible publications regarding HAGL lesions. The 25 most-cited articles from 1976 to 2021 relevant to the topic were selected for further analysis. Articles were characterized based on the number of citations, citation density, year of publication, source journal, country of origin, article type, article subtype, and level of evidence. The number of citations for individual articles ranged from 21 to 182 (mean ± standard deviation: 44.72 ± 36.87). Ten countries contributed to the 25 most cited articles, with 14 of the 25 (56%) articles published in the United States. Furthermore, the top 25 cited articles were published in 9 journals, with the majority in Arthroscopy-The Journal of Arthroscopic and Related Surgery (n= 15, 60%). There were 15 (60%) articles classified as "Clinical," 9 (36%) as "Review/Expert Opinion," and 1 (4%) as "Basic Science." All clinical studies met the standard for level IV evidence. This bibliometric analysis provides a list of the 25 most cited articles related to HAGL lesions, providing a reference of impactful articles for medical educators. The lack of high level of evidence "Clinical" studies demonstrates that higher-quality research is needed to establish guidelines for the treatment and management of HAGL lesions. A list of the 25 most-cited articles regarding recurrent glenohumeral instability can serve as a comprehensive reference for practitioners, educators, researchers, and orthopaedic trainees.

Atypical Shoulder Instability Patterns in Adolescents Following Traumatic Anterior Shoulder Dislocation

Background: Traumatic anterior shoulder instability is common in the adolescent athlete, and when it is untreated, the recurrence rate is high. Atypical lesions—such as anterior glenoid periosteal sleeve, humeral glenohumeral ligament, and insertional tendon avulsions—may occur within this population, and accurate diagnosis and appropriate lesion management are key to treatment success. Purpose: To evaluate the age, skeletal immaturity, bone loss, and uncommon soft tissue lesions as correlates of posttraumatic anterior shoulder instability lesion patterns in an adolescent population. Study Design: Cross-sectional study, Level of evidence, 3. Methods: Consecutive patients ≤18 years of age (160 shoulders) treated within a single institution for traumatic anterior shoulder instability between June 2013 and June 2021 were reviewed. Demographics, injury mechanism, radiographic and magnetic resonance imaging of lesions, the presence of any bone loss, operative findings, and physeal status were recorded. An overall 131 shoulders met the inclusion criteria. Instability lesion type was analyzed categorically by age <15 or ≥15 years; individual age was assessed for correlation with any bone loss present. Atypical lesions—anterior labral periosteal sleeve avulsion, humeral avulsion of the glenohumeral ligament, subscapularis avulsion—were assessed for correlations with age, open physeal status, and the presence of any bone loss. Results: An overall 131 shoulders (mean, 15.3 years; range, 10.5-18.3) were identified for this study: 55 in patients <15 years old and 76 in patients ≥15 years old. Bony injuries such as Bankart and Hill-Sachs lesions were more common in the ≥15-year-old group (P = .044 and P = .024, respectively). Bony Bankart injuries were found at a rate of 18.2% in the <15-year-old group, as compared with 34.2% in the ≥15-year-old group (P < .05). Anterior labral periosteal sleeve avulsions were more common in the <15-year-old group (n = 13 [23.6%] vs n = 8 [10.5%]; P < .044), as were all atypical lesions combined (n = 23 [41.8%] vs n = 13 [17.1%]; P < .0018]. Conclusion: In this series of anterior shoulder instability in children and adolescents, instability lesions varied significantly by age. Bone loss was associated with older age at presentation, and atypical lesions were more common in patients <15 years of age. Treatment teams should be aware of less common soft tissue injuries in this young age group and ensure careful review of adequate imaging for proper diagnosis and treatment in these younger patients.

Treatment of unstable C1 semi-ring fractures with direct C1 pedicle screw fixation using a navigational template: A case report and literature review.

Because of the risk of C1 to C2 instability, which would reduce the mobility of the occipito-atlanto-axis articulation, unstable C1 semi-ring fractures are typically treated with C1 to C2 or C0 to C2 fusion. The vertebral artery and spinal cord are at risk of harm during the installation of C1 pedicle screws. There is a need for a method that can maintain the occipito-atlanto-axis articulation's mobility and increase the safety of C1 pedicle screw fixation, particularly for surgeons who have less experience inserting C1 pedicle screws freehand. A 45-year-old man who had suffered a severe fall from a height of 2.5 m presented with pain in his cervical spine. Magnetic resonance imaging and computed tomography were used to diagnose unstable atlas fractures. According to radiographic studies, the patient had a unilateral anterior and posterior arch fracture (semi-ring fracture, Landells type II), as well as fractures and transverse ligament avulsion at the attachment site. We fixed the C1 directly with a pedicle screw using a navigational template. Both during and after the operation, there were no connected complications. Imaging at 12 months after surgery demonstrated that the fracture had united. The average visual analog scale score decreased from 8 before surgery to 2. In particular for surgeons with less experience placing freehand C1 pedicle screws, direct C1 pedicle screw fixation with the aid of a navigational template was a good option because it can preserve the mobility of the occipito-atlanto-axis articulation and improve the safety of C1 pedicle screw.

In-Season Management of Shoulder Instability: How to Evaluate, Treat, and Safely Return to Sport.

Anterior glenohumeral instability is a common injury in contact and collision athletes, and in-season management remains a controversial topic. Several recent studies have examined non-operative and operative management of in-season athletes after instability events. Non-operative treatment is associated with faster return to play and higher rates of recurrent instability. Dislocations and subluxations have similar rates of recurrent instability but non-operatively treated subluxations have a quicker return to play than dislocations. Operative treatment is often a season ending decision but is associated with high rates of return to sport and significantly lower rates of recurrent instability. Indications for in-season operative intervention may include critical glenoid bone loss (>15%), an off-track Hill-Sachs lesion, an acutely reparable bony Bankart lesion, high-risk soft tissue injures such as a humeral avulsion of the glenohumeral ligament or displaced anterior labral periosteal sleeve avulsion, recurrent instability, insufficient time remaining in season to rehabilitate from injury, and inability to successfully return to sport with rehabilitation. It is the role of the team physician to appropriately educate athletes on risks and benefits of operative and non-operative treatment strategies and guide athletes through the shared decision-making process that balances these risks against their long-term health and athletic career goals.

A comparative study of absorbable screw fixation and absorbable screw combined with suture anchor fixation in treatment of avulsion fracture of posterior cruciate ligament at tibial insertion of knee joint

To compare the effectiveness of open reduction of posterior cruciate ligament (PCL) avulsion fracture at tibial insertion of knee joint with absorbable screws fixation and absorbable screw combined with suture anchor fixation. The clinical data of 26 patients with PCL avulsion fracture at tibial insertion who met the selection criteria between March 2015 and October 2021 were retrospectively analyzed. Among them, 14 patients were fixed with simple absorbable screw (group A), and 12 patients were fixed with absorbable screw combined with suture anchors (group B). All patients were confirmed by X-ray film, CT, or MRI preoperatively, and got positive results in preoperative posterior drawer tests. There was no significant difference in gender, age, side of affected limb, time from injury to operation, comorbidities, and preoperative Meyers & McKeever classification, Lysholm score, and International Knee Documentation Committee (IKDC) score between the two groups ( P>0.05). The operation time and postoperative complications were recorded and compared between the two groups. At last follow-up, Lysholm score and IKDC score were used to evaluate the improvement of knee function. There was no significant difference in operation time between the two groups ( P>0.05). All incisions healed by first intention, and no complication such as vascular and nerve injury or venous thrombosis occurred. All 26 patients were followed up 9-89 months, with an average of 55.3 months. The follow-up time of group A and group B was (55.7±23.2) and (56.8±29.3) months, respectively, with no significant difference ( t=-0.106, P=0.916). Radiographs showed bone healing in both groups at 3 months after operation, and no complication such as infection and traumatic arthritis occurred. At last follow-up, the posterior drawer test was negative in both groups, and the Lysholm score and IKDC score significantly improved when compared with the pre-operative values ( P<0.05). However, there was no significant difference in the improvement value between the two groups ( P>0.05). For PCL avulsion fracture at tibial insertion of the knee joint, the open reduction and absorbable screw combined with suture anchor fixation can achieve reliable fracture reduction and fixation, which is conducive to the early rehabilitation and functional exercise, and the postoperative functional recovery of the knee joint is satisfactory.

OSSEOUS FEMORAL AVULSION OF THE ACL ORIGIN, WITH AN OTHERWISE INTACT ACL – A CASE REPORT

Anterior cruciate ligament (ACL) avulsion fracture is commonly associated with knee injuries and its management is controversial ranging from conservative treatment to arthroscopic xation. (1) They occur due to sporting or high-velocity trauma. Tears of the anterior cruciate ligament supersede osseous avulsion in the adult demographic. In adults, ACL tears commonly occur in the mid-substance and less commonly avulses from its tibial attachment. Femoral avulsions of the ACL occur less frequently (2). Most of the cases reported in the clinical literature occurred in the skeletally immature patients because of relatively elastic connective tissue and correspondingly weaker bony structures (2). Avulsion fractures of the cruciate ligaments are important, as they can be identied on radiographs, allowing a specic diagnosis. The treatment of cruciate ligament avulsion fractures is different than the treatment of intrasubstance tears of the cruciate ligaments. These injuries can be treated conservatively or surgically with good outcomes. Recently arthroscopic xation of these injuries with various xation devices has become more frequent. Treatment largely depends on the type of fracture, particularly, the size, displacement, comminution, and orientation of the avulsed fracture fragment, in addition to the integrity of the attached cruciate ligament. (3)

Positive Pivot Shift Test among Patients with Displaced Anterior Tibial Spine Fractures Undergoing Arthroscopic Fixation in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Understanding of displaced anterior tibial spine fractures has evolved over the years and is now considered to be anterior cruciate ligament avulsion injuries rather than intra-articular fractures. However, there are very few studies available evaluating the presence or absence of a pivot shift test, which is specific in diagnosing anterior cruciate ligament insufficiency, in patients with anterior tibial spine fractures. This study aimed to find out the prevalence of the positive pivot shift test among patients with displaced anterior tibial spine fractures undergoing arthroscopic fixation in a tertiary care centre. A descriptive cross-sectional study was conducted among patients presented with displaced anterior tibial spine fractures undergoing arthroscopic fixation. The data were collected between 1 January 2020 and 30 May 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: IRC_2019_11_09_1). All patients who presented with displaced anterior tibial spine fractures undergoing arthroscopic fixation were included in the study and those who did not provide consent were excluded. The pivot test was performed under anaesthesia. Point estimate and 90% Confidence Interval were calculated. Among 48 patients, pivot shift was positive in 36 (75%) (64.75-85.25, 90% Confidence Interval). The mean age of the participants was 28.97±11.16 years, 21 (58.33%) were males and 15 (41.66%) were females. The prevalence of positive pivot shift test under anaesthesia in patients with displaced anterior tibial spine fractures undergoing arthroscopic fixation was higher than other studies done in similar settings. anterior cruciate ligament; arthroscopy; knee fractures; physical examination.

CLINICAL EFFECT OF ARTHROSCOPIC TREATMENT OF ANTERIOR CRUCIATE LIGAMENT AVULSION FRACTURE WITH GATE-SHAPED KIRSCHNER WIRE

BACKGROUND: The anterior cruciate ligament (ACL) is an important ligament of the knee joint. Avulsion fracture of the tibial insertion point of the ACL accounts for 14% of all ACL injuries. However, no gold standard approach for treating ACL avulsion fractures exists. OBJECTIVE: This study aimed to evaluate the clinical effect of the treatment of ACL avulsion fracture with gate-shaped Kirschner wire fixation via arthroscopy. METHODS: Clinical data of 46 patients (male:female, 1:1.3; age, [Formula: see text] years) with ACL avulsion fracture who were treated with gate-shaped Kirschner wire fixation via arthroscopy in the People’s Hospital of Zhongjiang County from February 2018 to March 2021 were collected. The clinical effect was retrospectively analyzed using preoperative and postoperative joint range of motion (ROM), Lysholm score, and International Knee Documentation Committee (IKDC) score. RESULTS: After the operation, the ROM ([Formula: see text] deviation, [Formula: see text] and [Formula: see text], [Formula: see text]), Lysholm score ([Formula: see text] and [Formula: see text], [Formula: see text]), and IKDC score ([Formula: see text] and [Formula: see text] at the last follow-up, [Formula: see text]) significantly increased. CONCLUSIONS: The Kirschner wire fixation technique via arthroscopy displayed good therapeutic efficacy, was simple and effective, and is worth recommending for treating ACL avulsion fractures.

Intraoperative Periprosthetic Fractures during primary Total knee arthroplasty: Experience from an Asian high-volume arthroplasty centre

BackgroundIntraoperative periprosthetic fracture (IF) is an under-reported complication in primary total knee arthroplasty (TKA). This study aimed to audit the outcomes and complication rates in patients encountering IF during primary TKA and propose a new classification for its management. MethodsA nested case–control study was performed at a tertiary referral hospital where 50 patients encountering IF during primary TKA operated by a single surgeon team between January 2016 to May 2021, were compared with 150 (3:1) age-, gender- and implant-matched patients not encountering IF. Demographic data, risk factors, outcomes and complications of both groups were compared at a minimum follow up of 1 year. ResultsThe incidence of IF was 0.45%, with 44 fractures in the femur (88%), six (12%) in the tibia and none in the patella. Medial collateral ligament avulsion fracture (54.54%) in the femur and medial plateau fracture (66.66%) in the tibia were the most common fracture types. At final follow up, the fracture group had higher rates of 90-day re-admissions (8% vs. 2.66%, P = 0.095), deep infection (4% vs. 0.66%, P = 0.15) and revisions (6% vs. 1.33%, P = 0.06). The mean Knee Society Score was not significantly different between the two groups (152.22 ± 9.25 vs. 161.68 ± 11.22, P = 0.642) with union being achieved in all but one patient at a mean duration of 9.6 weeks. ConclusionsPatients with severe and fixed deformities have a higher risk for IF. The occurrence of fracture and the complexity of surgery equally contribute to the higher complication rates. Appropriately managed fractures have comparable functional outcomes.

Adjustable-Loop Cortical Button Fixation Results in Good Clinical Outcomes for Acute Tibial Avulsion Fracture of the Posterior Cruciate Ligament

To evaluate the clinical outcomes for arthroscopic treatment of acute posterior cruciate ligament (PCL) avulsion fractures with adjustable-loop cortical button fixation device. Patients with PCL tibial avulsion fractures treated with an adjustable-loop cortical button fixation device between October 2019 and October 2020 were retrospectively identified. Patients with type 1 were treated using plaster fixation as a conservative treatment, whereas patients with type 2 and 3 with displacement were treated using an arthroscopic adjustable-loop cortical button. Operating time, incision recovery, complications, and postoperative fracture healing time were monitored. All patient follow-up was done at 12 months' postoperatively. Lysholm Knee Score and the International Knee Documentation Committee score were used to assess knee function. A total of 30 patients were included in the study (20 male/10 female; mean age 45.5 years, range 35-68 years). The mean operative time was 67.5 minutes (range: 50-90 minutes). The postoperative incision healed at stage A without complications, such as medically induced vascular nerve injury, intra-articular hematoma, or infection. All 30 patients were tracked postoperatively for 12 to 14 months, with a mean follow-up period of 12.6 months. The Lysholm knee function score was 45.93 ± 6.15 before surgery and 87.10 ± 3.71 at 12 months after surgery, and the International Knee Documentation Committee score was 19.27 ± 4.40 before surgery and 95.47 ± 1.87 at 12 months after surgery, with a statistically significant difference. The treatment of PCL avulsion fractures with arthroscopic adjustable-loop cortical button fixation is easy to perform and shows good clinical results in our study. IV, therapeutic case series.

Diagnostic Value of DECT-Based Collagen Mapping for Assessing the Distal Tibiofibular Syndesmosis in Patients with Acute Trauma.

Background: Injury to the distal tibiofibular syndesmosis (DTFS) is common in patients with trauma to the ankle, but diagnostic accuracy of conventional X-ray and CT is insufficient. A novel dual energy CT (DECT) post-processing algorithm enables color-coded mapping of collagenous structures, which can be utilized to assess the integrity of the DTFS. Methods: Patients were included in this retrospective study if they underwent third-generation dual-source DECT followed by 3T-MRI or ankle joint surgery within 14 days between January 2016 and December 2021. Three radiologists blinded to all patient data independently evaluated grayscale images and, after 8 weeks, grayscale and collagen mapping images for the presence of ligamentous injury or avulsion fractures of the DTFS. MRI and surgery provided the reference standard. Diagnostic accuracy parameters were calculated for all ratings, and a comparison of ROC curve analysis was performed to evaluate the incremental diagnostic value of color-coded images over grayscale images. Results: A total of 49 patients (median age 49 years; 32 males) were evaluated. Application of collagen mapping significantly increased sensitivity (25/30 [83%] vs. 20/30 [67%]), specificity (110/118 [93%] vs. 70/118 [60%]), positive predictive value (25/33 [76%] vs. 20/67 [30%]), negative predictive value (110/115 [96%] vs. 70/80 [88%]), and accuracy (134/147 [91%] vs. 90/147 [61%]) for the detection of injury to the DTFS (all parameters, p < 0.001). Collagen mapping achieved higher diagnostic confidence, image quality, and noise scores compared to grayscale CT (all parameters, p < 0.001). Conclusions: Collagen mapping yields substantially higher diagnostic accuracy and confidence for assessing the integrity of the distal tibiofibular syndesmosis compared to grayscale CT in patients with acute trauma. The application of this algorithm can accelerate the adequate diagnosis and treatment of DTFS injury in clinical routine.

Anterior Longitudinal Ligament Avulsion Fracture when Changing the Patient's Position from Lateral to Prone during Extreme Lateral Interbody Fusion: A Case Report.

Anterior Longitudinal Ligament Avulsion Fracture when Changing the Patient's Position from Lateral to Prone during Extreme Lateral Interbody Fusion: A Case Report.

Glenoid Avulsion of the Glenohumeral Ligament Repair Through a Single Working Portal

Glenoid avulsion of the glenohumeral ligament (GAGL) is a traumatic cause of shoulder instability. GAGL lesions are a rare shoulder pathology most commonly reported as a source of anterior shoulder instability, with no current reports implicating this pathology as a cause of posterior instability. Satisfactory surgical repairs of GAGL lesions with anterior shoulder instability have been well documented; however, this Technical Note highlights the successful repair of a posterior GAGL lesion through a single working portal with suture anchor fixation of the posterior capsule.

Study of double button plate and cannulated screw fixation for posterior cruciate ligament avulsion fracture.

The posterior cruciate ligament (PCL) plays an important role in maintaining the stability of the knee joint. To date, researchers have not reached agreement on which type of fixation material should be used to treat PCL tibial avulsion fractures. The aim of this study was to investigate the effects of double button plate and cannulated screw fixation in the treatment of PCL avulsion fractures. We retrospectively reviewed our database, which was collected prospectively. From January 2019 to January 2020, 46 patients with posterior cruciate ligament avulsion fractures who were treated with double button plate and cannulated screw fixation. The primary outcomes of this study were surgical complications (fixation failure/displacement, implant breakage, nonunion, infection), radiological parameters, and knee function and secondary outcomes included reoperation rates for the fixation methods and the prevalence of symptomatic hardware causing soft tissue irritation outcomes were included. Values were analysed using multiple comparisons, where P-values of 0.05 or less were considered significant. Double button plate fixation had significantly higher values than cannulated screw fixation. The results showed that double button plate fixation was related to greater decreases in the length of surgery, intraoperative blood loss, hospital days, full weight bearing time, and incidence of complications, as well as greater increases in postoperative range of motion and Knee Society Score function and Lysholm scores. Compared with cannulated screw fixation, the use of double button plate fixation technology has the following advantages: less trauma, shorter operation time, convenient use of instruments and fixtures, and it does not need to be removed, thus avoiding secondary trauma. Moreover, double button plate fixation under direct vision is safe and reliable without the need for additional equipment.

Arthroscopic Fixation of Posterior Cruciate Ligament Avulsion Fracture with Combined Suture Tape and Internal Bracing by Suture-bridge Technique

Background: Tibial-sided avulsion fracture of the posterior cruciate ligament (PCL) almost always require surgical intervention. Multiple techniques of reduction and fixation have been described in the literature from open/mini-open conventional screw fixation to the all-arthroscopic fixation techniques. Recent evidence shows that the all-arthroscopic fixation techniques had higher subjective and objective knee outcome scores with the advantage of addressing concomitant intra-articular injuries such as osteochondral injuries or meniscal problems. Objectives: We propose an arthroscopic fixation technique using suture tapes placed in a suture-bridge technique and combined it with internal bracing to fix tibial-sided avulsion fracture of the PCL. Surgical Technique: After routine diagnostic knee arthroscopy in supine position via standard anterolateral and anteromedial portal, two standard posteromedial and posterolateral portal was created. A standard PCL aiming guide was used to create the tibial tunnel. PCL was secured using two single-looped suture tapes around it with both limbs brought to the posterior compartment through either side of the PCL (medial and lateral). Internal bracing was done with suture tape secured to the femoral side using fixed suspensory device and brought to the posterior compartment through the lateral side of the PCL. All tapes are then passed through the tibial tunnel in a suture-bridge manner and fixed to a button in 30° flexion while reduction quality was constantly checked under direct visualization. Results: The suture bridge configuration provides direct bone-to-bone healing and secure enough fixation for early range of motion and power exercises. All-arthroscopic approach avoids posterior element related complications such as fragment comminution and neurovascular injuries. Conclusions: This technique can be considered as a safe and effective method for fixation of tibial-sided PCL avulsion fracture, which allows active mobilization with lowered risk of complications.

A Novel and Open Classification Emphasizing on Osteoligamentous Complex for Distal Clavicle Fractures.

Current X-ray-based classification methods cannot describe all distal clavicle fracture (DCF) patterns, especially the osteoligamentous injury pattern of DCFs. We aimed to develop a novel classification based on the osteoligamentous injury pattern of the DCFs and investigated its reliability. All DCFs from January 2017 to January 2022 were respectively screened and 45 cases (mean age 20-78; male 31, female 14) met the including criteria and were enrolled. Based on their Zanca view X-ray radiograph and three-dimensional CT construction images, we analyzed the osteoligamentous injury pattern of each case, particularly the acromioclavicular (AC) and coracoclavicular ligaments and their bone attachment. Then we developed a novel classification method, five types in total, sorting all DCFs according to their lesion manifestations of osteoligamentous complex. Also, we investigated the inter- and intra-observer reliability using kappa value. A novel classification method for DCF was developed, manifesting the avulsion or rupture of conoid and trapezoid ligaments, and involvement of AC joint. Forty-five cases of DCFs were included in this study. Among them, 11 (24.4%) were Type 1 fracture, three (6.7%) cases were Type 2, six cases (13.3%) were Type 3, 21 (46.7%) were Type 4, four (8.9%) were Type 5. Kappa values for inter-observer agreement were 0.57 after first evaluation and 0.61 after second evaluation. Intra-observer agreement was 0.72 for experienced shoulder specialist and 0.63 for radiologist. This new classification method is reliable to use, supplementary to current classification systems, and emphasizes on the osteoligamentous complex injury when opting for the treatment.

Results of Anterior Cruciate Ligament Avulsion Fracture by Treatment Using Bioabsorbable Nails in Children and Adolescents.

(1) Background: Anterior cruciate ligament avulsion fractures are characteristic for skeletally immature patients, and appropriate treatment is currently debated in the literature. The study aimed to evaluate the clinical and functional outcomes in patients with tibial eminence fractures treated with bioabsorbable nails in one orthopedic clinic. (2) Methods: After retrospective evaluation, we found 17 patients with tibial eminence fractures treated in orthopedic departments between January 2013 and July 2022 using bioabsorbable fixation nails. The study group comprised 12 boys and five girls aged 5 to 15.2 (average 10.1). The mean follow-up was 28 months. We diagnosed five type II fractures, ten type III fractures, and two type IV fractures according to Meyers-McKeever classification. (3) Results: We obtained a high healing rate-17 patients with the complete union on the control radiographs. We diagnosed two cases of malunion, of which one required revision surgery. Only one patient showed a slight anterior knee laxity. The treatment effect at follow-up was assessed using the Lysholm Knee Score and IKDC Score. The median Lysholm Score was 96.64 (SD 4.54), and the median IKDC Score was 84.64 (SD 3.10), which were both excellent results. (4) Conclusions: Based on our results, surgery using bioabsorbable devices for type II, III, and IV tibial eminence fractures in young individuals is an effective alternative, allowing good outcomes and restoring proper knee stability. The crucial factor for a good effect is a stable fracture fixation. Arthroscopic surgery gives good outcomes with minimal invasion. It is important not to prolong the attempts of arthroscopic reduction and to perform the open reduction to shorten the procedure's time and avoid complications.

The safety, efficacy, and functional outcomes on arthroscopic fixation of posterior cruciate ligament avulsion fracture by a bio-absorbable anchor or traditional pull-out technique: A prospective cohort study.

Background: The posterior cruciate ligament avulsion fracture (PCLAF) is a special type of PCL rupture, and arthroscopic fixation for PCLAF has been recommended currently. The bio-absorbable suture anchor is a novel internal fixation for PCLAF. This study aims to estimate and compare the safety, efficacy, and functional outcomes between the bio-absorbable anchor and the traditional suture pull-out technique for arthroscopic fixation of PCLAF. Methods: This was a prospective cohort study. PCLAF patients were included from 1 January 2020, to 31 August 2021, in our department, and randomly divided into the absorbable anchor group and control group (pull-out suture fixation). Clinical assessments included: post drawer test, gravity test, anterior-posterior laxity (KT-2000), range of motion, Lysholm and International Knee Documentation Committee (IKDC) scores, total failure rate, and returning to sports rate. The minimum follow-up was 1year (y). Results: 31 patients had accomplished the 1year follow-up (missing rate: 13.9%). We did not face any complications such as neurovascular injury, fever, infection, un-union, or re-rupture during the follow-up. CT scan showed that all of the patients in the two groups had a well bone union at 3months in post-operation. At 1year follow-up, the total failure rate of the bio-absorbable anchor group (1/17, p = 0.036) was lower than the control group (5/14), and the IKDC (86.24 ± 4.35, p = 0.008) and return to sports rate (11/17, p = 0.045) of the bio-absorbable anchor group were higher than that of the control group (81.43 ± 5.06) (4/14). Conclusion: Both the bio-absorbable anchor and suture pull-out technique for arthroscopic fixation of PCLAF have acquired a well bone union and superior safety, but the bio-absorbable anchor group had better efficacy and functional outcomes than the traditional pull-out technique.

Styloid Ulna Window Approach for Repair of Avulsed Foveal Attachment of Triangular Fibrocartilage Complex

To describe a surgical approach for open repair of the triangular fibrocartilage complex foveal avulsion via ulnar styloid osteotomy, and to assess its clinical results. We reviewed 12 patients with distal radioulnar joint (DRUJ) instability due to isolated foveal avulsion of DRUJ ligaments. Wrist arthroscopy was conducted for all patients to exclude the presence of concomitant tear of the superficial part of the triangular fibrocartilage complex and to corroborate the diagnosis with a positive hook test. Through an ulnar approach between flexor and extensor carpi ulnaris, an ulnar styloid osteotomy was performed under image intensifier control just ulnar to the fovea of the head of the ulna. The avulsed foveal attachment was anchored through transosseous sutures passing from the fovea to the neck of the ulna. The ulnar styloid was fixed by means of screws or tension band wires. Outcome measures included clinical assessment of pain (visual analog scale), grip strength, DRUJ instability, range of motion of the wrist, and modified Mayo wrist score. Radiographic assessment was done to determine union of the ulnar styloid osteotomy, DRUJ subluxation, and any hardware-related problems. Outcome measures were evaluated after a mean follow-up of 21 months. Healing of the osteotomy was obtained in all cases by 11 weeks. The DRUJ laxity, visual analog scale, and modified Mayo wrist score improved, while grip strength and range of motion remained unchanged. One patient had prominent hardware necessitating removal after union of the osteotomy. There were no reported cases of injury or neuropraxia of the dorsal cutaneous branch of the ulnar nerve. Open repair of an avulsed foveal attachment of the triangular fibrocartilage complex using an ulnar styloid osteotomy is an alternative to either open or arthroscopic repair approaches. Therapeutic IV.