Arthroscopic fixation of anterior cruciate ligament tibial avulsion fractures: the suture “bridge” pull out technique and evaluation of results

Mihir R. Patel, Ushma K. Butala, Nirlepsinh S. Thakor, Raunik R. Bansod, Rohan A. Dhotre


Background: Tibial anterior cruciate ligament (ACL) avulsion fractures are a common injury in children and adolescents. Operative treatment is indicated for type 2, 3 and 4 fractures. Arthroscopic fixation is the preferred method and numerous fixation options are described. The purpose of this study is to evaluate the results of a new technique of arthroscopic fixation.

Methods: A retrospective study was done involving twelve patients having displaced ACL tibial avulsion fractures. The arthroscopic suture “bridge” pull out technique was used to fix these fractures. Patient symptoms like knee pain, locking, clicking, sensation of giving way and clinical signs like tenderness, range of motion, Mc Murray’s test, stability test and Lysholm knee scores were evaluated pre operatively and post operatively at 3 months and 6 months. Patient satisfaction was noted at latest follow up.

Results: One patient had type 2, 7 patients had type 3 and 4 patients had type 4 tibial ACL avulsion fractures. All the fractures united and all patients achieved full knee range of motion by 2 months post-operative. The clinical symptoms and signs improved post operatively. The mean Lysholm knee score at 3 months follow up was 88.8 and at 6 months follow up were 98.8. At latest follow up, all the patients were satisfied with their knee function.

Conclusions: The arthroscopic suture “bridge” pull out technique is an effective method for fixation of ACL tibial avulsion fractures with respect to knee stability, range of motion and resumption of pre injury activity level.


Knee arthroscopy, Suture pull out, Bridge, ACL tibial avulsion

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