Arthroscopic treatment for tibial “Peel off” tears in anterior cruciate ligament-case report


Anterior cruciate ligament (ACL) injury was very common, and its reconstruction is one of the most commonly performed orthopaedic surgeries. A standard treatment option for ACL complete rupture in active young patients is debridement of remnant tissue and reconstruction with various types of tendon graft. However, “A tibial peel off tear” of ACL without bony avulsion can be treated using preservation of original ACL and trans-osseous pullout suture repair. The IKDC subjective score was 90, the objective score was A, and the Lysholm score was 95 at 24 months after surgery. KT-2000 arthrometer showed 2 mm side-to-side difference. Pivot shift test and Lachman test were negative, and there was no limitation in range of motion. Patient returned to full activities including sports and satisfied with the surgical results. In the postoperative MRI at 6 months after the surgery, the continuity of ACL was well maintained without any Cyclops lesion. We believe that trans-osseous pullout suture repair could be included as an alternative method in this “tibial peel off” type ACL injury instead of the usual removal of remnant tissue and reconstruction with a graft.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

This study was approved by Institutional Review Board of Samsung Medical Center (IRB No. 2010-04-073).

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Corresponding author

Correspondence to Kyoung Hwan Koh.

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Video 1 ACL was peeled off from the tibial bone without any bony fragment, and there was no remnant soft tissue at tibial bone footprint. The tibial side of ACL was only connected to the torn lateral meniscus anterior horn (MPG 23518 kb)

Video 2 After formation of three bone tunnels at the ACL tibial footprint, suture materials, which pierced ACL, were retrieved through the tunnel, and a sliding knot tying and augmentation suture with the surrounding soft tissue were made (MPG 23528 kb)

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Ahn, J.H., Han, K.Y., Yu, I.S. et al. Arthroscopic treatment for tibial “Peel off” tears in anterior cruciate ligament-case report. Eur J Orthop Surg Traumatol 23, 251–255 (2013).

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  • Anterior cruciate ligament rupture
  • Reconstruction
  • Tear pattern
  • Peel off tear
  • Pullout suture repair