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The American Journal of Sports Medicine

Year: 2009  |  Volume: 37  |  Issue: 12  |  Page No.: 2334 - 2339

A Clinical Comparison of Screw and Suture Fixation of Anterior Cruciate Ligament Tibial Avulsion Fractures

J. K Seon, S. J Park, K. B Lee, H. R Gadikota, M Kozanek, L. S Oh, S Hariri and E. K. Song



Screw and suture fixations are the most commonly used methods of fixation in treatment of anterior cruciate ligament tibial avulsion fractures. Even though a few biomechanical studies have compared the stability of the 2 fixation techniques, a clinical comparison has not yet been reported.


The authors hypothesized that both fixations would be identical in all studied clinical outcome measures at a minimum 2-year follow-up.

Study Design

Cohort study; Level of evidence, 3.

Materials and Methods

Thirty-three patients treated with either screw fixation (16 patients) or suture fixation (17 patients) within 1 month of the anterior cruciate ligament tibial avulsion fracture (type II or III) without associated ligamentous injury were included. All patients were evaluated at a minimum 2-year follow-up in terms of Lysholm knee scores and return to preinjury activities. Knee stability was compared based on the Lachman test and stress radiography.


No significant differences were found between the 2 groups in terms of average Lysholm knee scores (91.7 in the screw group and 92.7 in the suture group, P = .413) at follow-up. All patients except 2 (1 in each group) returned to preinjury activity levels. However, flexion contractures (5° to 10°) were found in 3 patients in the screw group and 2 patients in the suture group without significant intergroup difference. Stabilities based on the Lachman test and instrumented stress radiography were also similar between the 2 groups at follow-up. However, 2 patients in the screw group and 1 in the suture group showed more than 5 mm laxity compared with the contralateral knee on stress radiographs.


Both the screw and suture fixation techniques for the anterior cruciate ligament tibial avulsion fracture produced relatively good results in terms of functional outcomes and stability without any significant differences. However, some patients in both groups showed residual laxity or flexion contractures.

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