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

Abstract

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    Garrett WE Jr, Swiontkowski MF, Weinstein JN, Callaghan J, Rosier RN, Berry DJ, Harrast J, Derosa GP (2006) American Board of orthopaedic surgery practice of the orthopaedic surgeon: Part-II, certification examination case mix. J Bone Joint Surg Am 88(3):660–667. doi:10.2106/JBJS.E.01208

    PubMed  Article  Google Scholar 

  2. 2.

    DeHaven KE (1980) Diagnosis of acute knee injuries with hemarthrosis. Am J Sports Med 8(1):9–14

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Ahn JH, Yoo JC (2005) Clinical outcome of arthroscopic reduction and suture for displaced acute and chronic tibial spine fractures. Knee Surg Sports Traumatol Arthrosc 13(2):116–121. doi:10.1007/s00167-004-0540-6

    PubMed  Article  Google Scholar 

  4. 4.

    Engebretsen L, Benum P, Fasting O, Mølster A, Strand T (1990) A prospective, randomized study of three surgical techniques for treatment of acute ruptures of the anterior cruciate ligament. Am J Sports Med 18(6):585–590. doi:10.1177/036354659001800605

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Duquin TR, Wind WM, Fineberg MS, Smolinski RJ, Buyea CM (2009) Current trends in anterior cruciate ligament reconstruction. J Knee Surg 22(1):7–12

    PubMed  Article  Google Scholar 

  6. 6.

    Ochi M, Adachi N, Uchio Y, Deie M, Kumahashi N, Ishikawa M, Sera S (2009) A minimum 2-year follow-up after selective anteromedial or posterolateral bundle anterior cruciate ligament reconstruction. Arthroscopy 25(2):117–122. doi:10.1016/j.arthro.2008.10.011

    PubMed  Article  Google Scholar 

  7. 7.

    Ahn JH, Lee YS, Ha HC (2008) Anterior cruciate ligament reconstruction with preservation of remnant bundle using hamstring autograft: technical note. Arch Orthop Trauma Surg. doi:10.1007/s00402-008-0597-7

    Google Scholar 

  8. 8.

    Ahn JH, Lee YS, Lee DH, Ha HC (2008) Arthroscopic physeal sparing all inside repair of the tibial avulsion fracture in the anterior cruciate ligament: technical note. Arch Orthop Trauma Surg 128(11):1309–1312. doi:10.1007/s00402-007-0506-5

    PubMed  Article  Google Scholar 

  9. 9.

    Crain EH, Fithian DC, Paxton EW, Luetzow WF (2005) Variation in anterior cruciate ligament scar pattern: does the scar pattern affect anterior laxity in anterior cruciate ligament-deficient knees? Arthroscopy 21(1):19–24. doi:10.1016/j.arthro.2004.09.015

    PubMed  Article  Google Scholar 

  10. 10.

    Zantop T, Brucker PU, Vidal A, Zelle BA, Fu FH (2007) Intraarticular rupture pattern of the ACL. Clin Orthop Relat Res 454:48–53. doi:10.1097/BLO.0b013e31802ca45b

    PubMed  Article  Google Scholar 

  11. 11.

    Murray MM (2009) Current status and potential of primary ACL repair. Clin Sports Med 28(1):51–61. doi:10.1016/j.csm.2008.08.005

    PubMed  Article  Google Scholar 

  12. 12.

    Strand T, Molster A, Hordvik M, Krukhaug Y (2005) Long-term follow-up after primary repair of the anterior cruciate ligament: clinical and radiological evaluation 15–23 years postoperatively. Arch Orthop Trauma Surg 125(4):217–221. doi:10.1007/s00402-004-0766-2

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Taylor DC, Posner M, Curl WW, Feagin JA (2009) Isolated tears of the anterior cruciate ligament: over 30-year follow-up of patients treated with arthrotomy and primary repair. Am J Sports Med 37(1):65–71. doi:10.1177/0363546508325660

    PubMed  Article  Google Scholar 

Download references

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).

Author information

Affiliations

Authors

Corresponding author

Correspondence to Kyoung Hwan Koh.

Electronic supplementary material

Below is the link to the electronic supplementary material.

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)

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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). https://doi.org/10.1007/s00590-012-1114-9

Download citation

Keywords

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