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Background <p>Tibial avulsion of the anterior cruciate ligament (ACL) is common in growing children, often resulting from sports injuries or accidental trauma. While minor injuries may heal conservatively, more severe fractures typically require surgical intervention to restore knee stability. Traditional fixation techniques—often involving metallic implants or transphyseal tunnels—pose risks such as growth disturbances, physeal damage, and hardware-related complications.</p> Objective <p>To describe and evaluate an arthroscopic, physeal-sparing, pull-through suture technique for the treatment of type III tibial eminence avulsion fractures in paediatric patients.</p> Methods <p>The technique involves arthroscopic debridement of the fracture site, followed by passage of No. 5 FibreWire sutures through the ACL. Small (2.7 mm) tibial tunnels are drilled in a manner that avoids the physis, and the sutures are tied over a bony bridge outside the joint, eliminating the need for intra-articular hardware. This method ensures precise reduction and stable fixation while preserving the growth plate.</p> Results <p>Two male patients (aged 8 and 12) with MRI-confirmed type III tibial eminence fractures and associated ligament and meniscal strains were treated using this technique. Both underwent four weeks of immobilisation followed by a guided rehabilitation programme. At two months, both had regained full range of motion; by four months, they returned to daily activities. No clinical instability was observed at six months follow-up.</p> Conclusion <p>The arthroscopic physeal-sparing pull-through suture technique is a safe, effective, and affordable method for managing paediatric tibial eminence fractures. It provides stable fixation while minimising the risk of growth plate injury, offering an ideal solution for skeletally immature patients.</p>

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Arthroscopic Repair of Tibial Avulsion of Anterior Cruciate Ligament in Paediatric Patients Using a Novel Physeal Sparing Pull Through Technique

  • 期刊论文

  • 发表日期：

    2025年11月11日

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  • Jigar Desai,
  • Siddhant Pol,
  • Shaligram Purohit,
  • Aditya Meena,
  • Rahul Nahata,
  • Saiprasad Madavi

摘要

Background

Tibial avulsion of the anterior cruciate ligament (ACL) is common in growing children, often resulting from sports injuries or accidental trauma. While minor injuries may heal conservatively, more severe fractures typically require surgical intervention to restore knee stability. Traditional fixation techniques—often involving metallic implants or transphyseal tunnels—pose risks such as growth disturbances, physeal damage, and hardware-related complications.

Objective

To describe and evaluate an arthroscopic, physeal-sparing, pull-through suture technique for the treatment of type III tibial eminence avulsion fractures in paediatric patients.

Methods

The technique involves arthroscopic debridement of the fracture site, followed by passage of No. 5 FibreWire sutures through the ACL. Small (2.7 mm) tibial tunnels are drilled in a manner that avoids the physis, and the sutures are tied over a bony bridge outside the joint, eliminating the need for intra-articular hardware. This method ensures precise reduction and stable fixation while preserving the growth plate.

Results

Two male patients (aged 8 and 12) with MRI-confirmed type III tibial eminence fractures and associated ligament and meniscal strains were treated using this technique. Both underwent four weeks of immobilisation followed by a guided rehabilitation programme. At two months, both had regained full range of motion; by four months, they returned to daily activities. No clinical instability was observed at six months follow-up.

Conclusion

The arthroscopic physeal-sparing pull-through suture technique is a safe, effective, and affordable method for managing paediatric tibial eminence fractures. It provides stable fixation while minimising the risk of growth plate injury, offering an ideal solution for skeletally immature patients.