BACKGROUND
There is debate within current literature as to the best treatment of displaced tibial spine fractures.1,2 We suggest a simple and effective arthroscopic approach to this injury. The Twinfix Ti Quick-T soft tissue anchor (Smith and Nephew; Warwick Technology Park, Gallows Hill, Warwick CV34 6WG, UK) has a 3.5-mm screw on a pre-tied suture attaching a high strength ‘T’-bar. The system allows a secure, adjustable fixation of uncomminuted tibial spine fractures.
TECHNIQUE
The patient is positioned for a standard arthroscopic anterior cruciate ligament (ACL) reconstruction using anterolateral and anteromedial portals. The tibial spine is reduced. The acufex ACL drill guide (Smith and Nephew) is used to hold the reduced tibial spine throughout the procedure. Over the guidewire, a 4-mm bit is used to drill the track, terminating the tunnel at the fracture site. The fracture fragment is fixed using the anchor (Fig. 1). The suture is deployed and the ‘T’-bar aligned at the distal entrance to the drill track. The pre-tied suture is advanced, thereby securing the tibial spine and ACL (Fig. 2). The incisions are closed in the surgeon's preferred manner, with standard follow-up protocol.
Figure 1.
Screw fixation of the secured fragment.
Figure 2.
Deployment of suture and secure fixation.
DISCUSSION
Arthroscopic screw or suture fixation of tibial spine fractures proves difficult, with a steep learning curve.3–5 We suggest a technique, which is quick, effective and simple. Although we identified no such problems, previous reports of suture anchor failure must be noted and caution taken with this approach. A series of patients must undergo this procedure before the long-term results are known.
References
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