Executive Editor: Ernst Raaymakers, Joseph Schatzker, Rick Buckley

Authors: Matthias Hansen, Rodrigo Pesantez

Proximal tibia Extraarticular fracture, avulsion of tibial tubercle

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1 Introduction top


In fractures and soft tissue injuries around the knee, where the bony fragments are too small to fix with screws, the ligamentous and bony fragments can be reduced and fixed in order to obtain a stable knee joint. This can be done with the use of suture anchors.

This procedure may be aided arthroscopically or open.

There are number of different suture anchors on the market which vary in size and design. In this illustration we are using the simple cork screw anchor which is inserted arthroscopically.

2 Patient preparation and approach top


Patient preparation

This procedure is normally performed with the patient in a lateral position.



For this procedure an anterolateral approach is used.

3 Anchor insertion top


The suture anchor is inserted through the fracture line into bone. The anchors need to be placed sufficiently deep so that the metal part does not protrude above the fracture.

In repairing the soft tissue and small bony fragments, the anchor is placed as close as possible to the articular margin. Once the anchor is securely seated in bone, the handle is removed.


An appropriately angled suture passer is used to shuttle one suture through the labrum.

4 Reduction and fixation top


The sutures are then tied and as the knot is tightened, the fracture is reduced.


The procedure is repeated for any other fragments not suitable for screw fixation.

At the end of the procedure, use the image intensifier to check the placement of fixation devices and the reduction of the joint.

v2.0 2010-05-15