Avulsion Fracture of Anterior Cruciate Ligament Zhijie Xi HistoryHistory18751875 PoncetPoncet1970Avulsion fracture of the ACL was 1970Avulsion fracture of the ACL was classified byclassified by Meyers MHMeyers MH1996Veselko M performed1996Veselko M performed arthroscopic arthroscopic placement and removal of cannulated screw placement and removal of cannulated screw for fixationfor fixation2008Jinzhong Zhao reported2008Jinzhong Zhao reported arthroscopic arthroscopic Figure-of-8 suture fixation technique Figure-of-8 suture fixation technique MorbidityMorbidity3/1000003/1000001414 ofof ACLACL injuryinjuryDistributionDistribution ofof ageage childrenchildren8 81414 yearsyears oldold oldold womenoverwomenover 4040 yearsyears oldoldAccid E-merg Nurs，2004，12(3)：1 73-1 75International Journal of Pediatrics, 2012, Article ID 932702, 6 pages epidemiologyepidemiologyFall injury and traffic accident51Fall injury and traffic accident51Sports injuriesSkiing and football-14%Sports injuriesSkiing and football-14%The Knee，2008，15(3)：164-167Associated with Associated with capsule tearcapsule tear ofof meniscusmeniscus oror articular capsulearticular capsule, sometimes, sometimes includingincluding medial medial and and lateral collateral ligament injury lateral collateral ligament injury or or injury of injury of articular cartilagearticular cartilageArthroscopy: The Journal of Arthroscopic and Related Surgery, 2005,21(1):86-92.RelevantRelevant anatomical structureanatomical structureResident ridgeResident ridgeResident ridgeResident ridgeBranching ridgeBranching ridgeFootprintsFootprintsFootprintsThe The anterior medial bundle anterior medial bundle is tight in flexion is tight in flexion the the posterior lateral bundle posterior lateral bundle is tight in the is tight in the straight positionstraight position12损伤机制损伤机制Young people - knee flexion, Young people - knee flexion, tibial internal rotationtibial internal rotationAdults - hyperextension of the Adults - hyperextension of the kneekneeACL limits anterior displacement, ACL limits anterior displacement, hyperextension, and internal rotationhyperextension, and internal rotationDiagnosisDiagnosisInjuryInjury historyhistory ofof hyperextension of kneehyperextension of kneeBruiseBruise andand hyphemahyphemaThe extension was limitedThe extension was limitedAnteriorAnterior drawer test and Lachman sign aredrawer test and Lachman sign are positivepositiveX-ray X-ray andand CTCT areare conducive to understanding conducive to understanding of fracture of fracture MRI is helpful to understand injuryMRI is helpful to understand injury ofof ACL, and ACL, and othersothers combined injury.combined injury.AnteriorAnterior drawer test and drawer test and Lachman sign Lachman sign X-rayX-rayCTCTMRIMRIMeyers-McKeever classificationMeyers-McKeever classificationArthroscopy 2005;211:86-92How to identify fresh or old fractures How to identify fresh or old fractures in imagingin imagingTreatmentTreatmentI type - Conservative treatmentI type - Conservative treatment toto keepkeep thethe kneeknee inin a a functional positionfunctional position forfor 6 weeks6 weeks andand typestypes - Manipulation- Manipulation，i if failf fail，selected surgery selected surgery typetype - Surgery- SurgeryReductionReduction The drawer test after extensionThe drawer test after extensionP - R - I - C EP - R - I - C E program ProtectionProtectionRestRestIceIceCompressionCompressionElevateElevateIt It used to be the most commonly used to be the most commonly treatment program to open reduction treatment program to open reduction and fixed with wireand fixed with wireA failed caseA failed caseCase 1Single tunnel fixation with steel wire and Single tunnel fixation with steel wire and extrusion screwextrusion screwnNo extrusion nailwas found beforeoperationimpingeIf the fracture mass is small, using Ethibond If the fracture mass is small, using Ethibond suture suture Old fracture of avulsion fracture of ACLOld fracture of avulsion fracture of ACLCase 2Case 2Wound freshnessWound freshnessTo clean and remove all dead, damaged tissue around of the fracture massTo introduce the To introduce the wire by wire by a lumbar a lumbar puncture puncture needle needle To thread To thread through No. 5 Ethibond, No. 5 Ethibond, and fix fracture with 8 tension band and fix fracture with 8 tension band To inspect carefullyTo inspect carefullyThe patients were followed up for 1 month after surgeryCase 3Case 3nTo use PDSii as the threadTo use PDSii as the threadTo use PDSii as the threadTo use PDSii as the threadTo use PDSii as the threadTo use PDSii as the threadCase 4Case 4Old avulsion fracture of ACLOld avulsion fracture of ACLWith bone sclerosis, and ACL stretch With bone sclerosis, and ACL stretch and tearand tearThe bone block The bone block cannot be removed cannot be removed with the nucleus with the nucleus pulposus clamppulposus clampmicro-grinding drillto drill To remove bone massTo remove bone masswith nucleus pulposus with nucleus pulposus forcepsforcepsEnlargement of the Enlargement of the condylar fossa condylar fossaThe picture was taken after reconstruction of anterior cruciate ligamentPostoperative X-rayPostoperative X-rayfollowed up for 1 month after surgeryFor a bigger fracture block, hollow For a bigger fracture block, hollow screw is a good choicescrew is a good choiceLateral meniscus (LM) is being pulled and Lateral meniscus (LM) is being pulled and displaceddisplacedIf the fracture of the tibial plateau is combined, first of all, the fracture should be fixedX-ray showed ACL avulsion fracture X-ray showed ACL avulsion fracture combined with tibial plateau fracturecombined with tibial plateau fractureCase 4MRIMRITo check the stability of knee joint To check the stability of knee joint before operationbefore operationTo carefully examine the collapse of the To carefully examine the collapse of the lateral tibial plateaulateral tibial plateauTo reduce and fix tibial plateau fracturesTo reduce and fix tibial plateau fracturesTo remove the synovial To remove the synovial tissue of the femoral tissue of the femoral condylecondyleArthroscopic image of Arthroscopic image of the reduce fracture the reduce fractureTo cut the transverse To cut the transverse ligament of meniscus ligament of meniscus The reduction of the The reduction of the fracture mass is blockedfracture mass is blockedby the transverse ligament by the transverse ligament of the meniscus of the meniscus To reduce fractureTo fixed fracture with k-wire temporarily ToTo drilldrill into secondinto secondK-wire K-wire A guide pin is insertedToTo screw into thescrew into the hollow screw hollow screwToTo inspectinspect afterafter fixationfixationPostoperative X-rayPostoperative X-rayPostoperative functional Postoperative functional rehabilitationrehabilitationTo take positive exercise of knee flexion and extension in 2 to 4 weeks To load limitedly within 9 weeksphysical exercise can be take 12 weeks laterThanks for your attention