Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Gu, Seoul 135-710, South Korea.
Injury. 2013 Aug;44(8):1028-32. doi: 10.1016/j.injury.2012.12.008. Epub 2013 Jan 8.
The purpose of this study is to present and evaluate a new arthroscopic technique using three-point suture fixation for anterior cruciate ligament (ACL) tibial avulsion fracture with accompanying detachment of the anterior horn of the lateral meniscus.
Eleven patients with a diagnosis of ACL tibial avulsion fracture underwent arthroscopic suture fixation from January 2007 to December 2009. Out of the 11 patients, six had cases of ACL tibial avulsion fractures (four were type III and two were type IV) with accompanying detachment of the anterior horn of the lateral meniscus and were treated using three-point suture fixation. The patients were followed up and evaluated according to Lysholm scores, International Knee Documentation Committee (IKDC) subjective scores, Tegner activity level scales, anterior drawer testing and KT-2000 arthrometer testing.
All patients were followed up for more than 2 years (range 25-40 months). The fracture fragments were united at a mean of 10.3 weeks (range 8-13). All patients were negative for the Lachman test and the anterior drawer test and had < 3 mm side-to-side difference with the KT-2000 arthrometer. The postoperative mean Lysholm score improved to 98 (range 96-100, P < 0.05). The postoperative mean IKDC subjective score was 93.3 (range 91-98, P < 0.05). The median Tegner score improved from 2.5 (range 2-3) to 8.5 (range 8-9) postoperatively (P < 0.05). The type of avulsion fracture (III or IV) did not significantly impact clinical results (Lysholm score, IKDC score, Tegner activity level, P > 0.05).
ACL avulsion fractures with accompanying detachment of the anterior horn of the lateral meniscus should be treated as another type of ACL avulsion fracture. Arthroscopic treatment using the three-point suture fixation technique is effective for this type of ACL avulsion fracture and can restore the function and stability of the knee joint.
本研究旨在介绍并评估一种新的关节镜下三点缝合固定技术，用于治疗前交叉韧带（ACL）胫骨撕脱骨折伴外侧半月板前角撕脱。
2007 年 1 月至 2009 年 12 月，11 例 ACL 胫骨撕脱骨折患者接受了关节镜下缝合固定。11 例患者中，6 例 ACL 胫骨撕脱骨折（4 型 3 度，2 型 4 度）伴外侧半月板前角撕脱，采用三点缝合固定。根据 Lysholm 评分、国际膝关节文献委员会（IKDC）主观评分、Tegner 活动水平评分、前抽屉试验和 KT-2000 关节测量仪检查对患者进行随访和评估。
所有患者均随访 2 年以上（25-40 个月）。骨折块平均在 10.3 周（8-13 周）时愈合。所有患者 Lachman 试验和前抽屉试验均为阴性，KT-2000 关节测量仪检查侧移差值均小于 3mm。术后 Lysholm 评分平均为 98 分（96-100 分，P<0.05）。术后 IKDC 主观评分平均为 93.3 分（91-98 分，P<0.05）。术后 Tegner 评分中位数从 2.5 分（2-3 分）提高到 8.5 分（8-9 分）（P<0.05）。撕脱骨折类型（3 度或 4 度）对临床结果（Lysholm 评分、IKDC 评分、Tegner 活动水平，P>0.05）无显著影响。
伴有外侧半月板前角撕脱的 ACL 胫骨撕脱骨折应视为另一种类型的 ACL 撕脱骨折。关节镜下三点缝合固定技术治疗此类 ACL 撕脱骨折有效，可恢复膝关节的功能和稳定性。
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