Arthroscopic FiberWire Fixation for Anterior Cruciate Ligament Avulsion Fractures: A Case Series Report
-
Maziar Nafisi
,
Hossein Ahmadzadeh
,
Pouya Tabatabaei Irani
,
Mohammad Ayati Firoozabadi
,
Seyed Mohammad Javad Mortazavi
Abstract
Arthroscopic fixation using FiberWire sutures with a suture disc is a reliable, cost-effective, and minimally-invasive technique for managing anterior cruciate ligament (ACL) avulsion fractures, also known as tibial spine fractures (TSFs), which are uncommon but significant knee injuries that can lead to joint instability if left untreated. This retrospective case series evaluated the clinical outcomes of this approach in six patients (four men, two women; mean age: 22 years) with fractures classified using the modified Meyers and McKeever system. All patients underwent arthroscopic fixation and were followed for 9 months with serial radiographic and clinical assessments. Fracture union was achieved in all cases within three months, and five patients demonstrated negative Lachman and pivot shift tests, while one exhibited grade 1 positivity. The mean International Knee Documentation Committee (IKDC) score was 91.16 ± 4.61, with five patients graded as excellent and one as good. No complications were observed, highlighting the efficacy and safety of this technique across different age groups.
1. Poncet A. Avulsion fracture of the tibial spine at the insertion of the anterior cruciate ligament. Bull Mem Soc Chir Paris. 1875;1(875):1. [In French].
2. Luhmann SJ. Acute traumatic knee effusions in children and adolescents. J Pediatr Orthop. 2003;23(2):199-202. [PubMed: 12604951].
3. Mortazavi SMJ, Hasani Satehi S, Vosoughi F, Rezaei Dogahe R, Besharaty S. Arthroscopic Fixation of Anterior Cruciate Ligament Avulsion Fracture Using FiberWire Suture With Suture Disc. Arthrosc Tech. 2021;10(7):e1709-e15. doi: 10.1016/j.eats.2021.03.018. [PubMed: 34336568]. [PubMed Central: PMC8322570].
4. Beaty JH, Kumar A. Fractures about the knee in children. J Bone Joint Surg Am. 1994;76(12):1870-80. doi: 10.2106/00004623- 199412000-00016. [PubMed: 7989394].
5. Grönkvist H, Hirsch G, Johansson L. Fracture of the anterior tibial spine in children. J Pediatr Orthop. 1984;4(4):465-8. doi: 10.1097/01241398-198408000-00015. [PubMed: 6470118].
6. Meyers MH, Mc KF. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am. 1959;41-a(2):209-20; discussion 20-2. [PubMed: 13630956].
7. Zaricznyj B. Avulsion fracture of the tibial eminence: treatment by open reduction and pinning. J Bone Joint Surg Am. 1977;59(8):1111-4. [PubMed: 591548].
8. Green D, Tuca M, Luderowski E, Gausden E, Goodbody C, Konin G. A new, MRI-based classification system for tibial spine fractures changes clinical treatment recommendations when compared to Myers and Mckeever. Knee Surg Sports Traumatol Arthrosc. 2019;27(1):86-92. doi: 10.1007/s00167-018- 5039-7. [PubMed: 29961096].
9. Jain S, Modi P, Dayma RL, Mishra S. Clinical outcome of arthroscopic suture versus screw fixation in tibial avulsion of the anterior cruciate ligament in skeletally mature patients. J Orthop. 2023;35:7-12. doi: 10.1016/j.jor.2022.10.006. [PubMed: 36325248]. [PubMed Central: PMC9619313].
10. Ayati Firoozabadi M, Dehghaniashkezari D, Seyedtabaei SMM, Tabatabaei Irani P, Khaledian H, Bozorgi Savodji P, et al. Arthroscopic ACL Avulsion Fixation With Adjustable Loop Length Cortical Endobutton. Arthrosc Tech. 2024;13(1):102815. doi: 10.1016/j.eats.2023.08.020. [PubMed: 38312862]. [PubMed Central: PMC10837809].
11. Chang CJ, Huang TC, Hoshino Y, Wang CH, Kuan FC, Su WR, et al. Functional Outcomes and Subsequent Surgical Procedures After Arthroscopic Suture Versus Screw Fixation for ACL Tibial Avulsion Fractures: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2022;10(4):23259671221085945. doi: 10.1177/23259671221085945. [PubMed: 35400137]. [PubMed Central: PMC8990705].
12. McLennan JG. The role of arthroscopic surgery in the treatment of fractures of the intercondylar eminence of the tibia. J Bone Joint Surg Br. 1982;64(4):477-80. doi: 10.1302/0301- 620x.64b4.6896515. [PubMed: 6896515].
13. Steiner ME, Murray MM, Rodeo SA. Strategies to improve anterior cruciate ligament healing and graft placement. Am J Sports Med. 2008;36(1):176-89. doi: 10.1177/0363546507311690. [PubMed: 18166680].
14. Seon JK, Park SJ, Lee KB, Gadikota HR, Kozanek M, Oh LS, et al. A clinical comparison of screw and suture fixation of anterior cruciate ligament tibial avulsion fractures. Am J Sports Med. 2009;37(12):2334-9. doi: 10.1177/0363546509341031. [PubMed: 19737989].
15. Bong MR, Romero A, Kubiak E, Iesaka K, Heywood CS, Kummer F, et al. Suture versus screw fixation of displaced tibial eminence fractures: a biomechanical comparison. Arthroscopy. 2005;21(10):1172-6. doi: 10.1016/j.arthro.2005.06.019. [PubMed: 16226643].
16. Bogunovic L, Tarabichi M, Harris D, Wright R. Treatment of tibial eminence fractures: a systematic review. J Knee Surg. 2015;28(3):255-62. doi: 10.1055/s-0034-1388657. [PubMed: 25162406].
17. Buckthorpe M, Gokeler A, Herrington L, Hughes M, Grassi A, Wadey R, et al. Optimising the Early-Stage Rehabilitation Process Post-ACL Reconstruction. Sports Med. 2024;54(1):49-72. doi: 10.1007/s40279-023-01934-w. [PubMed: 37787846].
18. Chouhan DK, Dhillon MS, John R, Khurana A. Management of neglected ACL avulsion fractures: a case series and systematic review. Injury. 2017;48(Suppl 2):S54-s60. doi: 10.1016/s0020- 1383(17)30495-3. [PubMed: 28802422].
2. Luhmann SJ. Acute traumatic knee effusions in children and adolescents. J Pediatr Orthop. 2003;23(2):199-202. [PubMed: 12604951].
3. Mortazavi SMJ, Hasani Satehi S, Vosoughi F, Rezaei Dogahe R, Besharaty S. Arthroscopic Fixation of Anterior Cruciate Ligament Avulsion Fracture Using FiberWire Suture With Suture Disc. Arthrosc Tech. 2021;10(7):e1709-e15. doi: 10.1016/j.eats.2021.03.018. [PubMed: 34336568]. [PubMed Central: PMC8322570].
4. Beaty JH, Kumar A. Fractures about the knee in children. J Bone Joint Surg Am. 1994;76(12):1870-80. doi: 10.2106/00004623- 199412000-00016. [PubMed: 7989394].
5. Grönkvist H, Hirsch G, Johansson L. Fracture of the anterior tibial spine in children. J Pediatr Orthop. 1984;4(4):465-8. doi: 10.1097/01241398-198408000-00015. [PubMed: 6470118].
6. Meyers MH, Mc KF. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am. 1959;41-a(2):209-20; discussion 20-2. [PubMed: 13630956].
7. Zaricznyj B. Avulsion fracture of the tibial eminence: treatment by open reduction and pinning. J Bone Joint Surg Am. 1977;59(8):1111-4. [PubMed: 591548].
8. Green D, Tuca M, Luderowski E, Gausden E, Goodbody C, Konin G. A new, MRI-based classification system for tibial spine fractures changes clinical treatment recommendations when compared to Myers and Mckeever. Knee Surg Sports Traumatol Arthrosc. 2019;27(1):86-92. doi: 10.1007/s00167-018- 5039-7. [PubMed: 29961096].
9. Jain S, Modi P, Dayma RL, Mishra S. Clinical outcome of arthroscopic suture versus screw fixation in tibial avulsion of the anterior cruciate ligament in skeletally mature patients. J Orthop. 2023;35:7-12. doi: 10.1016/j.jor.2022.10.006. [PubMed: 36325248]. [PubMed Central: PMC9619313].
10. Ayati Firoozabadi M, Dehghaniashkezari D, Seyedtabaei SMM, Tabatabaei Irani P, Khaledian H, Bozorgi Savodji P, et al. Arthroscopic ACL Avulsion Fixation With Adjustable Loop Length Cortical Endobutton. Arthrosc Tech. 2024;13(1):102815. doi: 10.1016/j.eats.2023.08.020. [PubMed: 38312862]. [PubMed Central: PMC10837809].
11. Chang CJ, Huang TC, Hoshino Y, Wang CH, Kuan FC, Su WR, et al. Functional Outcomes and Subsequent Surgical Procedures After Arthroscopic Suture Versus Screw Fixation for ACL Tibial Avulsion Fractures: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2022;10(4):23259671221085945. doi: 10.1177/23259671221085945. [PubMed: 35400137]. [PubMed Central: PMC8990705].
12. McLennan JG. The role of arthroscopic surgery in the treatment of fractures of the intercondylar eminence of the tibia. J Bone Joint Surg Br. 1982;64(4):477-80. doi: 10.1302/0301- 620x.64b4.6896515. [PubMed: 6896515].
13. Steiner ME, Murray MM, Rodeo SA. Strategies to improve anterior cruciate ligament healing and graft placement. Am J Sports Med. 2008;36(1):176-89. doi: 10.1177/0363546507311690. [PubMed: 18166680].
14. Seon JK, Park SJ, Lee KB, Gadikota HR, Kozanek M, Oh LS, et al. A clinical comparison of screw and suture fixation of anterior cruciate ligament tibial avulsion fractures. Am J Sports Med. 2009;37(12):2334-9. doi: 10.1177/0363546509341031. [PubMed: 19737989].
15. Bong MR, Romero A, Kubiak E, Iesaka K, Heywood CS, Kummer F, et al. Suture versus screw fixation of displaced tibial eminence fractures: a biomechanical comparison. Arthroscopy. 2005;21(10):1172-6. doi: 10.1016/j.arthro.2005.06.019. [PubMed: 16226643].
16. Bogunovic L, Tarabichi M, Harris D, Wright R. Treatment of tibial eminence fractures: a systematic review. J Knee Surg. 2015;28(3):255-62. doi: 10.1055/s-0034-1388657. [PubMed: 25162406].
17. Buckthorpe M, Gokeler A, Herrington L, Hughes M, Grassi A, Wadey R, et al. Optimising the Early-Stage Rehabilitation Process Post-ACL Reconstruction. Sports Med. 2024;54(1):49-72. doi: 10.1007/s40279-023-01934-w. [PubMed: 37787846].
18. Chouhan DK, Dhillon MS, John R, Khurana A. Management of neglected ACL avulsion fractures: a case series and systematic review. Injury. 2017;48(Suppl 2):S54-s60. doi: 10.1016/s0020- 1383(17)30495-3. [PubMed: 28802422].
| Files | ||
| Issue | Vol 12 No 3 (2026) | |
| Section | Research Articles | |
| Keywords | ||
| Anterior Cruciate Ligament Injuries Tibial Spine Fractures Arthroscopy Suture Techniques Knee | ||
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How to Cite
1.
Nafisi M, Ahmadzadeh H, Tabatabaei Irani P, Ayati Firoozabadi M, Mortazavi SMJ. Arthroscopic FiberWire Fixation for Anterior Cruciate Ligament Avulsion Fractures: A Case Series Report. J Orthop Spine Trauma. 2026;12(3):131-4.
