Arthroscopic-Assisted Fixation of Tibial Spine Avulsion Fracture Using a Tensionable Suture Construct With Dual Transtibial Tunnels and Suture Buttons.

Tibial spine avulsion fractures are challenging knee injuries representing the functional equivalent of an anterior cruciate ligament) tear. Current surgical techniques face limitations including potential residual laxity and arthrofibrosis. This Technical Note describes an arthroscopic fixation technique using a tensionable suture construct with dual transtibial tunnels and suture buttons. The proposed technique involves arthroscopic-assisted fixation with 2 key features: dual transtibial tunnels and an additional suture tape passed through the anterior periosteum. By using an Adjustable Button System TightRope, and FiberTape, the method optimizes time-zero fixation biomechanics, improves fragment reduction, and allows immediate range-of-motion exercises. Surgical approach includes diagnostic arthroscopy, fracture site debridement, and tunnel creation. The construct distributes tensile forces across 2 tunnels, enhancing rotational stability and reduction. The anterior suture tape provides additional compression to the fracture fragment. This technique offers an alternative to traditional screw fixation, potentially reducing the risks of subsequent surgery, implant removal, and growth disturbances while facilitating early rehabilitation.