[Arthroscopic stabilization of the fractured intercondylar eminence].

PURPOSE OF THE STUDY: The authors present the results of arthroscopic reduction of a displaced fracture of the intercondylar eminence and stabilization of the fracture with a tension band wire and absorbable, double PDS sutures.

MATERIAL: In the years 1998 to 2002, a fracture of the intercondylar eminence was arthroscopically diagnosed in 34 patients, 21 women and 13 men in the age range of 17 to 46 years. Five patients had type I fracture, 13 had type II fracture and 16 had type III fracture, as classified by the Meyers and McKeever system. Arthroscopic stabilization was used for all type II and type III fractures in a total of 29 patients. Double PDS sutures no. 1 were always applied. One double PDS loop was used in eight patients and, in the rest, two or three double PDS loops were employed.

METHODS: PDS no. 1 sutures were inserted, by means of wire loops, through bone tunnels. These were drilled with 2-mm Kirschner's wires, using an anterior cruciate ligament (ACL) reamer, medial to the tibial tuberosity. Double PDS sutures were applied to the distal portion of the ACL, which permits good stabilization even in comminuted fractures of the eminence. The strength of a double PDS loop is sufficient and facilitates speedy recovery. Before terminating surgery it is necessary to check joint mobility and fixation stability. Only good stability allows for early mobilization of the joint. The postoperative treatment involved immobilization of the knee joint with a rigid brace in a semi-flexed position at 20 degrees for 6 weeks. However, from the second postoperative day, the brace was removed during targeted rehabilitation. Exercise on a continuous passive motion device, strengthening of the thigh muscles, patellar mobilization, walking with the use of crutches, while wearing the brace, with partial weight bearing until pain were practised. A treadmill without loading was used from the fifth postoperative week.

RESULTS: Twenty-nine patients in whom stabilization with PDS sutures was used were evaluated. Of them 26 were completely free from any complaints and fully healed, always without findings of displacement on X-ray. In one patient, a fragment of the comminuted fracture was loosened and interfered with full extension. It was removed by arthroscopy and full recovery without consequences ensued. One patient underwent repeat surgery for hematoma in the wound; after wound healing and rehabilitation, he achieved a full range of motion. One patient showed signs of fibrosis of Hoffa's fat pad. All patients returned to the style of life as before injury. At follow-up of 1 to 4 years, Lysholm scores were excellent in 23 patients, very good in four patients, satisfactory in one patient (repeat surgery) and one patient was not examined.

DISCUSSION: Fracture of the intercondylar eminence is caused by a mechanism similar to that causing rupture of the anterior cruciate ligament but, in addition, the margin of the intercondylar fossa is pressed against the eminence which breaks off. Displaced fractures (types II and III according to the Meyers and McKeever classification) are indicated for surgical stabilization. Fixation of the fractured eminence by means of absorbable material is sufficient, and insertion of metal material and its subsequent removal thus can be avoided. Arthroscopic inspection permits exact reduction; this procedure is minimally invasive.

CONCLUSIONS: Arthroscopic stabilization of a fractured eminence by means of PDS sutures is a gentle surgical procedure that provides good mechanical support, facilitates early rehabilitation and achieves good outcomes. The use of absorbable sutures allows us to avoid further surgery in order to remove fixation material.