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Fig. 4 | BMC Musculoskeletal Disorders

Fig. 4

From: Outcomes and second-look arthroscopic evaluation after combined arthroscopic treatment of tibial plateau and tibial eminence avulsion fractures: a 5-year minimal follow-up

Fig. 4

Arthroscopically assisted fixation of a tibial eminence avulsion fracture using the pullout suture technique. a The fragment was reduced using an anterior cruciate ligament (ACL) tibial guide. b A 26-gauge wire loop was inserted into the knee joint via the medial and lateral tibial bone tunnels, and the diameter of the wire loop was dilated using a probe. c The suture hook, loaded with No. 2 polydioxanone sutures (PDSs) as guide sutures, was passed twice—one loop went through the posterior aspect of the ACL, and the second went through the anterior aspect. d The actual shuttling of the Ethibond was done using the PDS. The medial ends of each PDS were tied with No. 5 Ethibond loops and retrieved through the medial tibial bone tunnel, passed through the anterior and posterior part of the ACL, and then shuttled into the lateral tibial bone tunnel. Tension was applied to all sutures using a probe to achieve anatomic reduction, restore the ACL to its normal position, and restore the ACL’s normal tension. e The four No. 5 Ethibond sutures were individually identified and tied over bone tunnels on the anterior tibial cortex. f A good reduction of an ACL avulsion fracture (visualized using arthroscopy)

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