Executive Editor: Ernst Raaymakers, Joseph Schatzker

Authors: Matthias Hansen, Rodrigo Pesantez

Proximal tibia 41-A1.3 Direct reduction

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Glossary

1 Principles top

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Choice of fixation technique

Suturing is the best alternative to screw fixation if the avulsion fragment is small or comminuted.

Avulsion of anterior cruciate ligament
The A1.3-type injury represents an avulsion of the anterior cruciate ligament.

This intraarticular avulsion fracture is most often seen in the younger patient.

2 Reduction top

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Ball-spiked pusher

The fracture is visualized with the arthroscope and reduction is attempted with a hook or another instrument inserted through another portal.


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Clamps

In open procedures, the avulsed bony fragment of the intercondylar eminence is addressed directly and may be reduced with the help of clamps or wires.

3 Fixation top

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Drill holes

Drill two holes from the ACL base, one medial and one lateral.


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Apply suture

Place the sutures around the base of the anterior cruciate ligament (ACL), pass them through the holes, make a knot and tighten it.

v2.0 2016-11-21