Arthroscopic Transosseous Suture Bridge for Repairing Avulsion Fractures of the Tibial Insertion of the Anterior Cruciate Ligament：A Mini Tunnel Technique

The study presents a novel arthroscopic transosseous suture bridge technique for repairing avulsion fractures of the tibial insertion of the anterior cruciate ligament (ACL), specifically tailored for adolescent patients. This minimally invasive surgical approach combines elements of both the transosseous tunneling and suture bridge techniques, aiming to reduce impact on the bone bed while ensuring stable fixation. Over a seven-year period, 39 patients with Meyers-Mckeever types II, III, and IV tibial avulsion fractures underwent this procedure. The surgery had an average duration of 52.7 minutes and resulted in decreased swelling and pain within two months postoperatively. All patients achieved full knee extension and over 120° of flexion. X-rays confirmed complete fracture healing within six to 12 months, and negative anterior drawer and Lachman tests indicated stable fixation. Significant improvements were seen in Lysholm and IKDC scores, reflecting enhanced knee function. This technique offers several advantages: it is effective, stable, minimally invasive to growth and development, and particularly suitable for adolescents due to the reduced impact on the bone bed and successful avoidance of epiphyseal plate injury.