Arthroscopic repair of tibial spine avulsion fracture in adults with pull out sutures: A prospective study

Background: Surgical fixation is indicated for displaced tibial spine avulsion fractures (Meyers-McKeever types II-IV). Arthroscopic suture techniques are favored for reducing morbidity and avoiding hardware complications. Objective: This study evaluated outcomes of arthroscopic reduction and internal fixation using a pull-out suture technique tied over a tibial bone bridge. Methods: A prospective study included 25 patients (21 males, 4 females; mean age 19-25 years) with types II (n=5), III (n=16), and IV (n=4) fractures. A standardized arthroscopic technique used a 90° suture lasso to pass #5 Ethibond or #2 FiberWire through the ACL, shuttled through tibial tunnels and secured over a bone bridge. The Lysholm score was assessed preoperatively and postoperatively at 6 weeks, 3 months, and 12 months. Results: Mean Lysholm scores improved significantly from 11.86 (poor) preoperatively to 93.54 (good-to-excellent) at final follow-up (p < 0.001). At 6 months, 80% of patients achieved good-to-excellent results. Complications included two cases of minor extension deficit (resolved with arthrolysis) and one case of instability (4%) requiring ACL reconstruction. There were no infections or nonunions. Conclusion: Arthroscopic suture fixation for tibial spine avulsions provides stable, implant-free fixation, enables early mobilization, and yields excellent functional outcomes with a low complication rate.