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Objective: To investigate the clinical efficacy of the anchor suture bridge technique in treating avulsion fractures at the tibial insertion point of the posterior cruciate ligament (PCL) in the knee joint., Methods: In this study, we reviewed 80 patients with PCL tibial avulsion fractures treated using the anchor suture bridge technique in our department from February 2010 to December 2023. Follow-ups were conducted starting at 3 months post-surgery, then every 3 months until 12 months post-surgery. Clinical and follow-up data of each patient were analyzed. The Lysholm and Hospital for Special Surgery Knee-Rating Scale (HSS) scores of knee function before surgery and at the last follow-up were compared to assess the surgical treatment outcome., Results: The 80 patients were followed up for an average of (12.16±1.08) months post-surgery. Re-examination X-rays showed that all fractures had healed, with an average healing time of (3.66±0.51) months. All patients recovered well, with primary healing of surgical incisions and no complications such as neurovascular injury, skin necrosis, incision infection, fracture displacement, or ligament laxity. Postoperative knee Lysholm and HSS scores were significantly higher than preoperative scores. At the last follow-up, the Lysholm score increased from (46.30±6.10) preoperatively to (90.85±3.27), and the HSS score increased from (45.30±5.80) to (91.15±2.66), with statistically significant differences ( P <0.025)., Conclusion: The anchor suture bridge technique is effective in treating avulsion fractures of the PCL tibial insertion point in the knee joint. It has a high safety profile and leads to good postoperative knee function recovery, with no serious postoperative complications, demonstrating excellent clinical efficacy., Competing Interests: 利益冲突　所有作者均声明不存在利益冲突, (© 2024《四川大学学报（医学版）》编辑部 版权所有Copyright ©2024 Editorial Office of Journal of Sichuan University (Medical Sciences).)

Objective: To compare clinical effect between open reduction and fixation with cannulated screw and threaded rivet via posteromedial approach versus arthroscopic Endobutton plate fixation in treating posterior cruciate ligament avulsion fractures., Methods: Clinical data of 38 patients with posterior cruciate ligament avulsion fractures from July 2020 to December 2021 were analyzed retrospectively, and divided into open reduction and internal fixation group (posterior medial approach hollow anchor system fixation) and arthroscopic fixation group (Endobutton with loop plate fixation under arthroscopy). There were 20 patients in open reduction and internal fixation group, including 16 males and 4 females, aged from 26 to 74 years old with an average of (42.9±18.8) years old;13 patients on the left side and 7 patients on the right side;12 patients were classified to typeⅡand 8 patiens with type Ⅲ according to Meyers-McKeever fractures classification;14 patients were gradeⅡand 6 patients were grade Ⅲ in back drawer test. There were 18 patients in arthroscopic fixation group, including 11 males and 7 females;aged from 24 to 70 years old with an average of (53.5±13.4) years old;11 patients on the left side and 7 patients on the right side;10 patients were classified to typeⅡand 8 patiens with type Ⅲ according to Meyers-McKeever fractures classification;11 patients were gradeⅡand 7 patients were grade Ⅲ in back drawer test. Operation time, blood loss, and quality of immediate reduction were compared between two groups. Knee range of motion, knee back drawer test, and International Knee Documentation Committee(IKDC) grading, KT2000 stability evaluation and Lysholm function score of knee joint were compared at 6 months after operation., Results: All patients were followed up for 8 to 16 months with an average of (12.3±1.9) months. There were no complications such as incision infection, fracture malunion or non-union, and internal fixation loosening occurred. The avulsion fractures of knee joint were reached to imaging healing standard at 6 months after operation. Operation time and blood loss in open reduction and internal fixation group were (56.4±7.1) min and (63.2±10.2) ml, while (89.9±7.4) min and (27.7±8.7) ml in arthroscopic fixation group, respectively, and had significant difference between two groups ( P <0.05). There were no differences in immediate reduction quality ( χ 2 =0.257, P =0.612), knee joint range of motion at 6 months after opertaion ( t =0.492, P =0.626), knee joint rear drawer test ( χ 2 =0.320, P =0.572), IKDC classification of knee joint ( χ 2 =0.127, P =0.938), KT2000 stability evaluation ( χ 2 =0.070, P =0.791), and knee Lysholm function score ( t =0.092, P =0.282) between two groups., Conclusion: Posterior medial approach with hollow anchoring system fixation and arthroscopic Endobutton with loop plate fixation for the treatment of posterior cruciate ligament tibial occlusion avulsion fracture could achieve satisfactory clinical results, and arthroscopic surgery has less bleeding, but also has a longer learning curve and longer operation time than traditional incision surgery. The surgeon needs to make a choice according to clinical situation of patient and their own surgical inclination.

Objective: To explore the mechanism, surgical method, and effectiveness of proximal phalangeal bone avulsion fracture caused by A2 circular trochlea injury of the flexor digitorum tendon., Methods: A retrospective analysis was conducted on the clinical data of 4 patients with proximal phalangeal bone avulsion fracture caused by A2 circular trochlea injury of flexor digitorum tendon admitted between May 2018 and September 2022. The patients were all male, the age ranged from 26 to 52 years, with an average of 33 years. The injured fingers included 1 case of middle finger and 3 cases of ring finger. The causes of injury were rock climbing of 2 cases and carrying heavy objects of 2 cases. Preoperative anteroposterior and lateral X-ray films and CT examination of the fingers showed a lateral avulsion fracture of the proximal phalanx, with a fracture block length of 15-22 mm and a width of 3-5 mm. The total active range of motion (TAM) of the injured finger before operation was (148.75±10.11)°. The grip strength of the middle and ring fingers was (15.50±2.88) kg, which was significantly lower than that of the healthy side (50.50±7.93) kg ( t =-8.280, P <0.001). The time from injury to operation was 2-7 days, with an average of 3.5 days. One Kirschner wire with a diameter of 1.0 mm was used for direct fixation through the fracture block, while two Kirschner wires with a diameter of 1.0 mm were used for compression fixation against the fracture block. The fracture healing was observed, and the TAM of the injured finger and the grip strength of the middle and ring fingers were measured. The finger function was evaluated according to the upper limb functional assessment trial standards of the Chinese Medical Association Hand Surgery Society., Results: The incisions all healed by first intention after operation. All patients were followed up 6-28 months, with an average of 19 months. X-ray films showed that all avulsion fractures of proximal phalanx reached bony union, and the healing time ranged from 4 to 8 weeks, with an average of 4.6 weeks. At last follow-up, the grip strength of the middle and ring fingers was (50.50±7.76) kg, which significantly improved when compared with preoperative one ( t =-8.440, P <0.001). The TAM of the injured finger reached (265.50±2.08)°, and there was a significant difference when compared with preoperative one ( t =-21.235, P <0.001). According to the upper limb functional assessment trial standards of the Chinese Medical Association Hand Surgery Society, the finger function was all evaluated as excellent in 4 cases., Conclusion: Using Kirschner wire fixation through bone blocks and external compression fixation of bone blocks for treating proximal phalangeal bone avulsion fracture caused by A2 circular trochlear injury of the flexor digitorum tendon can achieve good effectiveness.

Objective: To investigate the effectiveness of arthroscopic suspension fixation with Endobutton in the treatment of tibial insertion avulsion fractures of posterior cruciate ligament (PCL)., Methods: A retrospective analysis was conducted on the clinical data of 52 patients (52 knees) with tibial insertion avulsion fractures of PCL, who were treated by arthroscopic suspension fixation with Endobutton between June 2017 and October 2022. There were 29 males and 23 females, with an average age of 40.6 years (range, 19-66 years). There were 24 cases of traffic accident injuries, 17 cases of sports injuries, and 11 cases of fall injuries. The time from injury to operation ranged from 6 to 19 days (mean, 13.3 days). According to the Meyers-McKeever classification, there were 30 cases of type Ⅱ and 22 cases of type Ⅲ fractures. All patients exhibited positive posterior drawer test results. Preoperative knee joint function was assessed with Lysholm score (21.3±6.7), International Knee Documentation Committee (IKDC) score (20.7±5.8), and visual analogue scale (VAS) score (5.3±0.7); and knee joint range of motion was (41.73±3.17)°. Based on preoperative CT three-dimensional reconstruction measurements, the longitudinal diameter of the avulsed bone fragment ranged from 13 to 25 mm (mean, 18.1 mm). Operation time and occurrence of complications were recorded, and postoperative imaging was used to assess fracture healing. Knee joint function and pain severity were evaluated using knee joint range of motion, Lysholm score, IKDC score, and VAS score., Results: The operation time ranged from 46 to 81 minutes (mean, 56.2 minutes). All patients were followed up 12-28 months (mean, 20.1 months). The iatrogenic fractures of bone fragments occurred during operation in 4 cases; and knee effusion occurred in 2 cases and anterior knee pain in 1 case after operation. All incisions healed by first intention. Imaging evaluations at 3 months after operation showed the fracture healing and no internal fixation failure. All patients demonstrated good knee function and had returned to normal activities at 12 months after operation. At last follow-up, the knee joint range of motion was (133.44±4.17)°, Lysholm score 93.6±3.1, IKDC score 93.4±2.5, and VAS score 1.0±0.6, with significant differences compared to preoperative scores ( P <0.05)., Conclusion: Arthroscopic suspension fixation with Endobutton in the treatment of tibial insertion avulsion fractures of PCL is simple to operate, and the knee joint function recovers well.

Objective: To investigate the effectiveness of arthroscopic multi-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of anterior cruciate ligament (ACL) involving the anterior root of lateral meniscus (LM)., Methods: A retrospective analysis was conducted on the clinical data of 28 patients with tibial insertion avulsion fracture of ACL involving the anterior root of LM who were treated with arthroscopic multi-point fixation with anchor and suture between October 2017 and January 2023. There were 12 males and 16 females with the mean age of 26 years (range, 13-57 years). There were 20 cases of sports injury and 8 cases of traffic accident injury. In 2 cases of old fracture, the time from injury to operation was 45 days and 90 days, respectively; in 26 cases of fresh fracture, the time from injury to operation was 3-20 days (mean, 6.7 days). According to the Meyers-McKeever classification, there were 4 cases of type Ⅱ, 11 cases of type Ⅲ, and 13 cases of type Ⅳ. The preoperative Lysholm knee function score was 42.1±9.0, the International Knee Documentation Committee (IKDC) score was 40.0±7.3, and the Tegner score was 0.7±0.7., Results: All operations were successfully completed, and the incisions healed by first intention. All the 28 patients were followed up 5-60 months (mean, 20.4 months). During the follow-up, there was nocomplication such as infection, vascular or nerve injury, loosening or breakage of internal fixator, or stiffness of knee joint. Postoperative X-ray films showed satisfactory fracture reduction and firm fixation. All fractures healed clinically, and the healing time was 8-16 weeks (mean, 10.3 weeks). At last follow-up, Lachman test and anterior drawer test were negative. At last follow-up, Lysholm knee function score was 92.4±5.5, IKDC score was 91.6±4.4, and Tegner score was 5.2±1.1, which significantly improved when compared with preoperative scores ( t =-22.899, P <0.001; t =-29.870, P <0.001; t =-19.979, P <0.001)., Conclusion: Multi-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of ACL involving the anterior root of LM can not only fix the LM, but also effectively reduce and fix the avulsion fracture, which can obtain good effectiveness.

Objective: To summarize the effectiveness of Kirschner wire buckling combined with bone fixation in the treatment of metacarpal avulsion fracture., Methods: The clinical data of 35 patients of metacarpal avulsion fracture admitted between March 2017 and June 2022 were retrospectively analyzed. There were 22 males and 13 females; the age ranged from 20 to 55 years, with an average of 31.6 years. There were 17 cases of the second metacarpal avulsion fracture, 6 cases of the fourth metacarpal avulsion fracture, and 12 cases of the fifth metacarpal avulsion fracture. The causes of injury included 21 cases of strangulation, 8 cases of sprain, and 6 cases of sports injury. X-ray film examination showed that the size of the avulsion fracture of metacarpal bone ranged from 0.30 cm×0.20 cm to 0.55 cm×0.45 cm. The total active motion (TAM) of the injured finger before operation was (154.00±17.38)°. The time from injury to operation was 3-10 days, with an average of 5.8 days. Follow-up regularly after operation, X-ray film and CT examination were performed to evaluate fracture healing and TAM of injured finger was measured. The finger function was evaluated by the trial standard of upper limb function evaluation of Hand Surgery Society of Chinese Medical Association., Results: All the incisions healed by first intention. All 35 patients were followed up 9-36 months, with an average of 28 months. All metacarpal avulsion fractures achieved bony healing, and the healing time was 4-6 weeks, with an average of 4.8 weeks. The metacarpophalangeal joint of the patient was stable, without stiffness, and the flexion and extension activities were good. At last follow-up, the TAM of the injured finger reached (261.88±6.23)°, which was significantly different from that before operation ( t =-35.351, P <0.001). The finger function was evaluated according to the trial standard of upper limb function evaluation of the Society of Hand Surgery of Chinese Medical Association, and 33 cases were excellent and 2 cases were good, with an excellent and good rate of 100%., Conclusion: The treatment of metacarpal avulsion fracture with Kirschner wire buckling combined with bone fixation has the advantages of less trauma, firm fixation, and less interference to the soft tissue around metacarpophalangeal joints, which is a good alternative method for the metacarpal avulsion fracture.

Objective: To compare the effectiveness of open reduction of posterior cruciate ligament (PCL) avulsion fracture at tibial insertion of knee joint with absorbable screws fixation and absorbable screw combined with suture anchor fixation., Methods: The clinical data of 26 patients with PCL avulsion fracture at tibial insertion who met the selection criteria between March 2015 and October 2021 were retrospectively analyzed. Among them, 14 patients were fixed with simple absorbable screw (group A), and 12 patients were fixed with absorbable screw combined with suture anchors (group B). All patients were confirmed by X-ray film, CT, or MRI preoperatively, and got positive results in preoperative posterior drawer tests. There was no significant difference in gender, age, side of affected limb, time from injury to operation, comorbidities, and preoperative Meyers & McKeever classification, Lysholm score, and International Knee Documentation Committee (IKDC) score between the two groups ( P >0.05). The operation time and postoperative complications were recorded and compared between the two groups. At last follow-up, Lysholm score and IKDC score were used to evaluate the improvement of knee function., Results: There was no significant difference in operation time between the two groups ( P >0.05). All incisions healed by first intention, and no complication such as vascular and nerve injury or venous thrombosis occurred. All 26 patients were followed up 9-89 months, with an average of 55.3 months. The follow-up time of group A and group B was (55.7±23.2) and (56.8±29.3) months, respectively, with no significant difference ( t =-0.106, P =0.916). Radiographs showed bone healing in both groups at 3 months after operation, and no complication such as infection and traumatic arthritis occurred. At last follow-up, the posterior drawer test was negative in both groups, and the Lysholm score and IKDC score significantly improved when compared with the pre-operative values ( P <0.05). However, there was no significant difference in the improvement value between the two groups ( P >0.05)., Conclusion: For PCL avulsion fracture at tibial insertion of the knee joint, the open reduction and absorbable screw combined with suture anchor fixation can achieve reliable fracture reduction and fixation, which is conducive to the early rehabilitation and functional exercise, and the postoperative functional recovery of the knee joint is satisfactory.

Objective: To evaluate the angle of modified anchor nail placement and the curative effect of double pulley technology for the treatment of extreme avulsion fracture of lower patella., Methods: From December 2015 to December 2018, a total of 22 patients(10 males and 12 females) with avulsion fracture of the inferior pole of patella were retrospectively analyzed. The average age was (44.00±15.24) years old(range, 19 to 70 years). All patients were treated with modified anchor angle and double pulley technique. The range of motion(ROM) and Bostman score system were used to evaluate the functional recovery of knee joint., Results: All 22 cases were followed up with an average of (30.86±8.00) weeks (18 to 46 weeks). At the last follow-up, ROM of the affected knee was (130.82±4.69) °, and the contralateral knee was (133.23 ± 3.15) °, there was no significant difference between two groups ( P >0.05). The average Bostman score was (28.45±1.41) scores, 18 cases were excellent results, 4 cases were good., Conclusion: Improved anchor placement angle and double pulley technique for treatment of extreme avulsion fracture of lower patella is easy to operate, with satisfactory curative effect and good recovery of knee joint function.

Objective: To compare difference in clnical efficacy between arthroscopic double posterior internal approach and incisional surgery for acute simple posterior cruciate ligament tibial avulsion fractures., Methods: Totally 52 patients with acute simple posterior cruciate ligament tibial avulsion fractures treated from June 2016 to June 2020 were retrospectively analyzed and divided into two groups according to different surgical protocols, 27 patients in arthroscopic group were treated with arthroscopic double posterior internal approach, including 16 males and 11 females, aged from 19 to 52 years old, with an average age of (34.9±9.2) years old;25 patients in open reduction group were treated with posterior medial knee incision, including 14 males and 11 females, aged from 18 to 54 years old , with an average age of(33.7±8.4) years old. Operation time, incision length, intraoperative bleeding, hospitalization days, hospitalization cost, fracture healing, complications, postoperative Lysholm score and IKDC score at 12 months were observed and compared between two groups., Results: All patients in both groups were completed opertaion successfully without vascular or nerve injury, and 52 patients were followed up from 6 to 24 months with an average of (15.0±1.7) months. Operation time and hospitalization cost in arthroscopic group were significantly greater than those in open reduction group( P <0.05);intraoperative bleeding, incision length, and hospitalization days in arthroscopic group were less than those in open reduction group( P <0.05);preoperative Lysholm score in arthroscopic group and open reduction group were 49.1±2.3 and 48.9±1.1 respectively, and improved to 95.9±1.7 and 86.4±1.2 at 12 months after operation respectively( P <0.05);preoperative IKDC scores in arthroscopic group and open reduction group were 47.6±4.1 and 48.1±3.9 respectively, and improved to 96.9±1.5 and 87.1±1.4 at 12 months after operation( P <0.05)., Conclusion: Arthroscopic double posterior internal approach for acute simple posterior cruciate ligament tibial stop avulsion fracture has satisfactory early results and better efficacy than traditional open surgery, which has advantages of less trauma, faster recovery and easier operation.

Objective: To systematically evaluate the clinical efficacy of arthroscopy and traditional incision in the treatment of tibial avulsion fracture of anterior cruciate ligament (ACL)., Methods: From July 2010 to July 2020, clinical comparative trial about arthroscopy and traditional incision in the treatment of ACL tibial avulsion fracture was conducted by using computer-based databases, including Embase, Pubmed, Central, Cinahl, PQDT, CNKI, Weipu, Wanfang, Cochrane Library, CBM. Literature screening and data extraction were carried out according to the inclusion and exclusion criteria, and the quality of the included literature was evaluated by improved Jadad score and Ottawa Newcastle scale (NOS). The operation time, hospital stay, fracture healing time, knee range of motion, postoperative excellent and good rate, complication rate, Lysholm score, International Knee Documentation Committee (IKDC) score and Tegner score were statistically analyzed by Review Manager 5.3 software., Results: Finally, 16 literatures were included, including 1 randomized controlled trial and 15 non randomized controlled trials, with a total of 822 patients (405 in arthroscopy group and 417 in traditional incision group). Meta analysis showed that the operation time [MD=-9.03, 95% CI(-14.36, -3.70), P <0.001], hospital stay [ MD =-5.81, 95% CI (-9.32, -2.31), P =0.001] and fracture healing time [ MD =-14.61, 95% CI (-17.93, -11.28), P <0.001] in the arthroscopy group were better than those in the traditional incision group. The incidence of complications in arthroscopy group was lower than that in traditional incision group[ OR =0.15, 95% CI (0.07, 0.33), P <0.001]. The postoperative excellent and good rate[ OR =4.39, 95% CI (1.96, 9.82), P <0.001], knee mobility[ MD =6.78, 95% CI (2.79, 10.77), P <0.001], Lysholm score[ MD =11.63, 95% CI (4.91, 18.36), P <0.001], IKDC score[ MD =7.83, 95% CI (6.09, 9.57), P <0.001] and Tegner score[ MD =0.60, 95% CI (0.31, 0.89), P <0.001] in the arthroscopic group were higher than those in the traditional incision group., Conclusion: Compared with the traditional open reduction and internal fixation, arthroscopic surgery in patients with ACL tibial avulsion fracture can shorten the operation time, hospital stay and fracture healing time, reduce the incidence of postoperative complications, and obtain good postoperative knee function. It can be recommended as one of the first choice for patients with ACL tibial avulsion fracture.

Objective: To investigate the clinical effect of arthroscopic fixation of tibial avulsion fracture of posterior cruciate ligament with a knot-free anchor and Endobuton titanium plate., Methods: From October 2019 to October 2020, 12 patients with tibial avulsion fracture of posterior cruciate ligament were treated with the arthroscopic knot-free anchor and Endobuton titanium plate, including 9 males and 3 females. The age ranged from 23 to 58 years old. The time from injury to operation ranged from 2 to 9 days. There were 2 cases of Meyers typeⅡand 10 cases of Meyers type Ⅲ. There were 2 cases of meniscus injury and 1 case of partial injury of medial collateral ligament. The fracture healing and knee range of motion were evaluated after operation, and the clinicalefficacy was evaluated by Lysholm function score., Results: All patients were followed up for 12 months. All patients healed within 6 months, and there were no complications such as incision infection, lower extremity deep venous thrombosis and internal fixation falling off. The knee flexion range of motion recovered from 50°-90° before operation to 115°-130° 6 months after operation, and no patient had straightening disorder. Lysholm functional score recovered from preoperative 29-54 scores to 86-100 scores 12 months after operation., Conclusion: Arthroscopic reduction and fixation of tibial avulsion fracture of posterior cruciate ligament with the knot-free anchor and Endobuton titanium plate has less complications, high fracture healing rate, good extension and flexion angle and early function recovery of knee joint.

Objective: To explore clinical effect of high strength wire under arthroscopy combined with outside anchor nail in treating Meyers McKeever II, III anterior cruciate ligament tibial check point., Methods: From March 2014 to June 2016, 21 patients with Meyers McKeever II, III avulsion fracture of anterior cruciate ligament tibial check point were treated by high strength wire under arthroscopy combined outside anchor nail. There were 13 males and 8 females aged from 18 to 48 years old with an average of (26.40±5.42) years old. There were 9 cases injured on the left side, and 12 cases on the right side. The courses of disease included sports injuries of 12 cases, falling down injuries of 6 cases, and accident injuries of 3 cases. According to Meyers-McKeever classification, 16 patients were type II and 5 patients were type III. All fractures were fresh, closed and simple injury. The time from injury to operation ranged from 2 to 15 days with an average of (6.20±2.63) d. Lysholm score, IKDC score and the changes of knee mobility were observed and compared before operation and 6 months after operation., Results: Twenty-one patients were followed up for 12 to 24 months with an average of (14.30±3.01) months. Operation time ranged from 40 to 65 min with an average of (45.10±4.82) min, Blood loss ranged from 5 to 15 ml with an average of (10.05±2.75) ml. Lysholm score was improved from 50.29±6.67 before operation to 92.48±2.18 at 6 months after operation. IKDC scores was increased from 47.19±4.57 before operation to 90.71±2.22 at 6 months after operation. Knee joint activity was respectively (83.05±5.33)° and (132.05±7.15)° before operation and 6 months after operation., Conclusions: High strength wire under arthroscopy combined outside anchor nail in treating Meyers McKeever II, III ACL tibial check point has the advantages of less trauma, firm fixation, and satisfactory clinical effect., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2019 by the China Journal of Orthopaedics and Traumatology Press.)

Objective: To explore effectiveness of suture-bridge fixation under arthroscopy in treatment of tibial eminence avulsion fracture of anterior cruciate ligament in adolescents., Methods: Between June 2013 and October 2016, 18 adolescent patients suffered tibial eminence avulsion fracture of anterior cruciate ligament were treated by suture-bridge fixation under arthroscopy. There were 11 males and 7 females with an average age of 12.5 years (range, 5-17 years). The injury caused by bruise in 6 cases, by sprain in 4 cases, and by sport injury in 8 cases. The interval between injury and admission ranged from 2 hours to 10 months (mean, 2 months). The results of preoperative Lachman and anterior drawer tests were positive. There were 10 cases of knee pain, 4 cases of knee extension limitation, and 4 cases of knee extension without strength. According to the Meyer-McKeever classification criteria, 12 cases were type Ⅱ and 6 cases were type Ⅲ., Results: All incisions healed by first intention. All 18 patients were followed up 10-18 months after operation, with an average of 12 months. Postoperative X-ray films showed that all fractures healed after 6-12 weeks (mean, 8 weeks). The results of postoperative Lachman and anterior drawer tests were negative. At last follow-up, the Lysholm knee score was 90.1±5.0 and 93.1±6.2 for affected and unaffected sides, respectively, showing no significant difference between affected and unaffected sides( t =0.669, P =3.184［?］). There was no premature closure of skeleton or leg length discrepancy and deformity., Conclusion: For tibial eminence avulsion fracture of anterior cruciate ligament in adolescents, the suture-bridge fixation under arthroscopy is an effective method with many advantages, such as minimal invasion, reliable fixation, good fracture healing, and no need for second operation to remove implants.

Objective: To investigate the characteristics and clinical treatment of avulsion fracture of the lateral edge of tibial plateau(segond fracture) in knee joint injuries., Methods: From January 2011 and December 2015, 29 patients with Segond fracture were treated with minimally invasive arthroscopy technology in intra-articular injuries combined with double anchor nail fixation in avulsion fracture of the lateral edge of tibial plateau, including 17 males and 12 females with an average age of 41 years old ranging from 27 to 62 years old. Among them, there were 20 cases of anterior cruciate ligament rupture (ACL rupture) involving the anterior cruciate ligament tibial eminence avulsion fracture included, 3 cases of posterior cruciate ligament rupture (PCL rupture), 1 case of ACL rupture combined with PCL rupture, 3 cases of medial collateral ligament tear, and 2 cases combined fractures of tibial plateau (1 case of the medial platform fractures and 1 cases of lateral fracture). All the patients were confirmed by X-rays, CT and MRI. The procedures were performed at 5 to 14 days after the injury(means 7 days). Lysholm scores were used to assess the knee function before and after the operation., Results: The operation time was 40 to 125 minutes (means 85 minutes), the intraoperative blood loss was 10 to 30 ml (means 15 ml). All paients were followed up for 12 to 18 months(means 14 months). The Lysholm scores were significantly improved from preoperative 52.0±4.2 to 91.9±1.4( t =-49.24, P <0.05). The results of drawer test, Lachman test and lateral stress test were negative in all 29 cases, all the fractures of 29 patients were bony union., Conclusions: The avulsion fracture of the lateral tibial plateau suggests that there are knee joint static and stable structures(joint ligament, joint capsule, meniscus, et al) and even intra articular fractures. Therefore, besides conventional imaging examinations, arthroscopic exploration was also necessary to avoid misdiagnose and provide comprehensive assessments and treatment. This can create favorable conditions for the knee joint function restore maximum., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.)

Objective: To evaluate the early clinical effects of suture anchor fixation for the treatment of avulsion fracture of tibial intercondylar eminence under arthroscopy., Methods: From July 2012 to January 2015, 22 patients with the avulsion fracture of tibial intercondylar eminence were treated with arthroscopic suture anchor fixation. There were 12 males and 10 females, with an average age of 22.8 years old(ranged, 18 to 33 years old). Nine patients had the fractures in the right knee and 13 patients had the fractures in the left knee. The mean duration from injury to surgery was 6.8 days(ranged, 3 to 11 days). According to the improved Meyers-McKeever classification, 13 cases were type II, 7 cases were type III, and 2 cases were type IV. The clinical outcomes were evaluated by the range of motion, the Lysholm score, the IKDC 2000 subjective knee score, the axial shift test, and the anterior drawer test., Results: All the incisions healed by first intention, and no complications occurred. All the patients were followed up, and the mean duration was 32.8 months (ranged, 18 to 42 months). The knee range of motion was improved from preoperative (49.37±7.69) ° to (126.38±5.58) °at the latest follow-up( P <0.01). Lysholm score was improved from preoperative 43.4±5.6 to 79.2±6.2 at the latest follow-up( P <0.01). And the IKDC 2000 score was improved from preoperative 52.6±6.2 to 81.4±5.7 at the latest follow-up( P <0.01). At the latest follow-up, the patient underwent physical examination. One patient had a positive result of axial shift test at the 18th month after operation with grade II laxity of anterior cruciate ligament. One patient had a weakly positive result of anterior drawer test at the 24th month after operation., Conclusions: Absorbable suture anchor fixation for the treatment of avulsion fracture of tibial intercondylar eminence under arthroscopy can provide accurate reduction and stable fixation, which can be applied to treat all types of fractures including comminuted fracture, and it is not necessary to remove the implant in the second operation., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Objective: To evaluate the early clinical effects of treating the avulsed fracture of humerus greater tuberosity using the double-row suture anchor fixation technique., Methods: Total 20 patients with the avulsed fracture of the greater tuberosity of the humerus were treated from September 2009 to January 2013. There were 12 males and 7 females, with an average age of 46.8 years old(24 to 69 years old). Eleven patients had injuries on right shoulder joint and 8 patients had injuries on left side. The injury mechanism included 10 cases of traffic accident, 6 cases of sports injury, and 3 cases of falls. The mean interval from injury to surgery was 34.9 d (ranged, 3 to 72 d). The affacted arm was suspended and fixed within 3 weeks after operation. The swing exercise of shoulder joint was performed from the 2nd day after operation. The strap was removed 3 weeks after operation, and painless active exercise was performed 6 weeks after operation. The patients were followed up in the outpatient department 6, 12 and 24 weeks after operation, and then every 6 months. AP and lateral X-ray films were taken at each follow-up time. At the latest follow-up, protractor was used to measure activity of patients; and VAS pain score, California University of Losangeles(UCLA) standard, American Shoulder and Elbow Surgeons (ASES) score were used to evaluate therapeutic effects., Results: All the patients were followed up, with a mean duration of 35.2 months (ranged, 24 to 48 months). All the incisions were healed on the first stage without secondary acromion impingement and other complications. All the patients had bony union within 12 weeks. The movements of shoulder joints including flexion, abduction, external rotation, internal rotation were increased obviously( P <0.05). The UCLA score was increased from preoperative 15.2±5.3 to 35.6±6.1 at the latest follow-up. The ASES score was increased from preoperative 31.2±5.4 to 91.2±6.8 at the latest follow-up ( P <0.05)., Conclusions: It has satisfactory curative effects for the avulsed fracture of humerus greater tuberosity using the double-row suture anchor fixation technique, especially the cases of small or comminuted fractures. It has several advantages such as firm fixation, simple and secure operation as well as quick postoperative recovery. Finally, patient should take exercises actively after operations., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Objective: To retrospectively investigate the clinical effect of the rivet-assisted hollow screw in the treatment of posterior cruciate ligament avulsion fracture., Methods: Total 49 patients with knee cruciate ligament avulsion fracture in the ending point of the ligament from January 2010 to December 2014 were divided into the treatment group and the control group. Thirty-one patients in treatment group were treated with rivet-assisted double cannulate nail, including 13 males and 18 females, ranging in age from 38 to 51 years old, with a mean of (40.6±5.1) years old; according to Meyers classification, 23 cases of type 2, 8 cases of type 3; 5 patients were caused by the low energy injury and 26 patients were caused by the high energy injury. Eighteen patients in control group were treated with double gold hollow screw fixation, including 5 males and 13 females, ranging in age from 36 to 52 years old, with an average age of (4.16±4.7) years old; according to Meyers classification, 14 cases of type 2 and 4 cases of type 3;2 patients were caused by the low energy injury and 16 patients were caused by the high energy injury. The operation time, postoperative complications, fracture healing time and the last AKS scoring system were compared between the two groups., Results: All the patients were followed up, and the duration ranged from 12 to 24 months, with an average of 14.2 months. The patients in treatment group had no displacement of fracture fragments and internal fixation failure. The results of AKS score:pain was 48.1±1.5, activity was 21.3±2.7, stability was 20.9±2.5, walking ability was 47.3±1.9, under the stairs ability was 43.4±2.1, the total score was 190.7±2.9. There were 2 cases in control group had fracture fragment displacement and 1 patient had nail withdraw. The results of AKS score:pain was 40.1±2.2, activity was 20.1±0.2, stability was 18.1±3.2, walking ability was 46.3±1.7, under the stairs ability was 40.2 ±1.3, the total score was 180.2±1.4. Therefore, the comparison of the above indicators, the results of the treatment group were better than those of the control group., Conclusions: Rivet-assisted hollow screw fixation in the treatment of cruciate ligament avulsion fracture in the ending, has some advantages such as follows:accurate reduction, less postoperative complications and better postoperative knee function recovery, therefore it is an effective way to treat posterior cruciate ligament avulsion fracture., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Objective: To conclude the effectiveness of arthroscopy combined with Burks and SchaVer's approach in the treatment of posterior cruciate ligament (PCL) avulsion fractures in a floppy lateral position., Methods: Between May 2010 and March 2014, 21 patients with PCL avulsion fractures were treated. There were 13 males and 8 females, aged 21 to 62 years (mean, 39.1 years). The causes included traffic accident injury in 10 cases, sports injury in 5 cases, and falling injury from height in 6 cases. The time from injury to hospital was 1-6 days (mean, 2.5 days). The results of posterior drawer test were all positive, and the results of anterior drawer test and lateral stress test were all negative. The Lysholm score was 28.0±5.5 before operation. And the American Orthopaedic Foot and Ankle Society (IKDC) score was 46.2±7.6 before operation. According to Meyer standards for fractures classification, 11 cases were rated as type II and 10 cases as type III. Arthroscopy was used to inspect and treat the intra-articular lesions, then avulsion fracture was fixed by Burks and SchaVer's approach in lateral position. Postoperative functional exercises were performed., Results: Primary healing of incision was obtained, without nerve and vascular injury or joint infection. All patients were followed up 18-36 months (mean, 27.2 months). The X-ray films of the knee joint showed good fractures reduction and healing at 3 months after operation. The results of posterior drawer test and reverse Lachman test were negative. The knee range of motion was recovered to normal level. At last follow-up, the Lysholm score of the knee joint was significantly improved to 90.9±1.4 from preoperative one ( t =54.584, P =0.000), and the IKDC score was significantly increased to 90.5±5.3 from preoperative one ( t =15.638, P =0.000), including 19 cases of grade A and 2 cases of grade B., Conclusions: A combination of arthroscopy and Burks and SchaVer's approach for the treatment of PCL avulsion fractures in a floppy lateral position has the advantages of minimal invasion and safe approach, short operative time, and early postoperative rehabilitation exercises, so it can provide satisfactory function recovery of the knee joint.