Arthroscopic reduction of adult comminuted tibial eminence avulsion with single tunnel pull-through suture fixation: A case report of technical note

INTRODUCTION AND IMPORTANCE: Tibial eminence avulsion is an exceptional knee injury in the adult population. The treatment of this injury is generally based on the pattern of the fragment fracture displacement and operative treatment is recommended for comminuted eminence fracture to prevent nonunion and knee instability. CASE PRESENTATION: We reported a 30-years-old female with severe left knee pain after falling from a motorcycle. Physical examination showed moderate left knee effusion with restricted knee joint range of motion from 0 to 90°. Anterior drawer test was positive without opening varus or valgus stress. A preliminary radiograph and CT scan of the left knee denoted displaced and comminuted tibial eminence avulsion. CLINICAL DISCUSSION: Anatomical reduction of the displaced fragment and adequate tension of the ACL bundle are the surgical goal to promote fracture healing, maintain knee stability, and restore range of motion. Various reduction and fixation techniques have been devised for comminuted tibial eminence avulsion ranging from arthroscopic screw to suture fixation. Although arthroscopic reduction and suture fixation become the prominent treatment for this injury, the ideal technique remains unclear. CONCLUSION: We propose a modified arthroscopic reduction and suture fixation technique by using a single tibial tunnel and knotless distal anchoring screw fixation. Despite some limitations, this technique simplifies anatomic reduction and fixation with single tunnel placement which has shown to be effective in reducing surgical time.