Observation on the therapeutic effect of arthroscopic hollow screw fixation through medial patellar approach for anterior cruciate ligament tibial avulsion fracture

Objective 　To investigate the surgical method and clinical effect of arthroscopic fixation of tibial avulsion fracture of the anterior cruciate ligament (ACL) with hollow screw via medial patellar approach. Methods 　From July 2014 to December 2017, 26 ACL patients, including 18 males and 8 females, with an average age of (26.3±3.3) years, ranging from 19 to 50 years, were treated by arthroscopic hollow screw fixation through medial patellar approach. According to Meyers-McKeever- Zaricznyj before operation, there were 10 cases of type Ⅱ fracture and 16 cases of type Ⅲ, all of which were fresh fractures. The preoperative and postoperative anterior drawer test, Lachman test, Lysholm knee function score and International Knee Documentation Committee (IKDC) score were compared. All the operations were performed by the same operation team. Results 　The follow-up period ranged from 6 to 14 months with an average of (11.2±1.5) months, and 2 patients were lost to follow-up. X-ray radiographs showed that all fractures healed 3 months after the surgery, and there was no case of screw loosening, fracture or re-fracture. At the last follow-up after surgery, the active range of the affected knee was extension 0°, flexion 130°-150° with an average of 138°. Both the anterior drawer test and Lachman test changed from positive to negative before surgery; Lysholm's knee function score improved from (46.50±3.31) points before operation to (89.13±2.52) points at the last follow-up, the difference was statistically significant (t=50.13, P<0.01). IKDC scores were significantly abnormal (grade D) at admission, but at the last follow-up, 22 patients achieved normal (grade A) (91.67%, 22/24), 2 were close to normal (grade B) (8.33%, 2/24), there was no abnormal (grade C) cases. Conclusion 　Arthroscopic hollow screw fixation through medial patellar approach in treatment of ACL has the advantages of firm bone block fixation, early healing of fracture, early functional exercise and functional recovery of knee and so on, and the clinical effect is good, and the method is applicable to Meyers-McKeever-Zaricznyj fracture types Ⅱ and Ⅲ. DOI: 10.11855/j.issn.0577-7402.2018.12.10