Arthroscopy - 2026-03-18 - Journal Article
Primary Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft in the Setting of Adult Irreducible Tibial Eminence Fracture Renders Comparable Outcomes to Suture Fixation in Reducible Cases.
Gao YT, Wang YX, Yang YP, Wang J, Gong X, Wang C, Wang JQ, Shi WL
Topics
Key Takeaway
Primary hamstring autograft ACLR for irreducible tibial eminence fractures achieves equivalent Tegner, Lysholm, and IKDC scores and 85.1% patient-acceptable symptomatic state compared to suture fixation in reducible cases at mean 77-month follow-up.
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Summary
This retrospective comparative study asked whether primary hamstring autograft ACLR for irreducible tibial eminence fractures produces outcomes equivalent to suture fixation for reducible fractures, with treatment allocation determined intraoperatively. At mean 77 months, no significant intergroup differences were found in Tegner, Lysholm, or IKDC scores, ipsilateral reinjury, arthrofibrosis, return to sport, or patient satisfaction on multivariable regression. Patient-acceptable symptomatic state was achieved in 85.1% overall with no difference between groups (26/31 ACLR vs 37/43 SF, P > .999).
Key Limitation
The ACLR group had a mean time-to-surgery nearly 10 months longer than the SF group, reflecting a fundamentally different clinical presentation (chronic vs acute) that likely confounds outcome comparisons despite multivariable adjustment.
Original Abstract
PURPOSE
To investigate whether primary anterior cruciate ligament reconstruction (ACLR) in the setting of adult irreducible tibial eminence fracture could achieve comparable clinical outcomes to suture fixation (SF) in reducible cases.
METHODS
Patients who were diagnosed with displaced tibial eminence fracture and underwent either ACLR or SF were retrospectively analyzed. The treatment modalities were determined intra-operatively based on the intra-operative evaluation of the osseous and ligamentous status, according to which native ACL preservation by SF was applied in reducible cases and ACLR for irreducible cases. The primary outcome was patient-reported outcome measures at a minimum 2-year follow-up. Secondary outcomes include ipsilateral reinjury at the ACL-injured limb, contralateral injury, range of motion loss, arthrofibrosis, return to sport, and patient satisfaction at the most recent follow-up. Patient-acceptable symptomatic state was determined by the anchor question: "Taking into account your daily activities and functional performance, do you find your current condition satisfactory?".
RESULTS
A total of 31 patients in the ACLR group and 43 patients in the SF group were included. Patients' characteristics were comparable between groups, except for time from injury to surgery (ACLR vs SF: mean [range], 11.8 [0.1, 84.0] months vs 1.2 [0.0, 12.0] months, P < .001) and lateral meniscal injury (ACLR vs SF: 45.2% vs 16.3%, P = .023). The mean follow-up was 77 months. Univariate comparison revealed no significant intergroup difference for the primary and secondary outcomes (all P > .05). Multivariable linear regressions revealed no significant association between treatment modalities and clinical outcomes in terms of the Tegner, Lysholm, and International Knee Documentation Committee scores (all P > .05). Subgroup analyses based on fracture types and sex also suggested similar results. Multivariable logistic regressions revealed no difference in ipsilateral reinjury, contralateral injury, range of motion loss, arthrofibrosis, return to sport, and patient satisfaction between groups (all P > .05). A total of 63 (85.1%) participants reported achieving patient-acceptable symptomatic state, with no significant difference between the ACLR and SF groups (26/31 vs 37/43, P > .999).
CONCLUSIONS
Primary ACLR using hamstring autograft in the setting of adult irreducible tibial eminence fracture achieved clinical outcomes comparable to SF in reducible cases. The percentage of patients reported achieving patient-acceptable symptomatic state was similar between the 2 groups.
LEVEL OF EVIDENCE
Level III, retrospective comparative case series.