Arthroscopic Pull-Out Suture vs. Open Screw Fixation for ACL Tibial Avulsion Fractures: A Comparative Study

Objective: To compare the clinical outcomes of pull-out suture fixation and open screw fixation, focusing on range of motion (ROM), pain levels, and Lysholm scores at six and twelve months postoperatively.

Introduction: Anterior Cruciate Ligament (ACL) tibial avulsion fractures are a significant cause of knee instability. Two common surgical techniques for repair include pull-out suture fixation and open screw fixation. This study aimed to compare the clinical outcomes of these two methods, focusing on range of motion (ROM), pain levels, and Lysholm scores at six and twelve months postoperatively.

Methods: We conducted a retrospective cohort study involving 50 patients treated at Shahid Chamran Hospital, Shiraz University of Medical Sciences, between 2020 and 2024. Patients were divided equally into two groups: one treated with pull-out suture fixation and the other with screw fixation. Outcomes assessed at six and twelve months included ROM, pain, and Lysholm scores.

Results: Statistically significant improvements in ROM and Lysholm scores were observed in the pull-out suture group compared to the screw fixation group at both follow-up points. However, no significant difference in pain scores was detected between the groups.

Conclusion: Pull-out suture fixation demonstrated superior clinical outcomes compared to screw fixation in the treatment of ACL tibial avulsion fractures. These findings may guide surgical decision-making to optimize patient recovery.



Keywords: Tibial Spine Avulsion, ACL, ORIF, Pull-out suture, Screw Fixation

Level of Evidence: Level III, retrospective cohort study.