Introduction: Anterior cruciate ligament (ACL) avulsion fractures, although rare, can cause significant knee instability if untreated. High-energy trauma is the primary cause, often requiring surgical intervention for neglected cases. This case report presents a neglected ACL avulsion fracture treated with Arthroscopic Reduction Internal Fixation (ARIF) using suture tape pul lthrough.
Case Presentation: A 22-year-old female presented with right knee pain and instability for three months following a motorcycle accident five months earlier. Clinical examination revealed ACL instability. Plain radiographs and MRI confirmed avulsion of the tibial eminence, confirmed by plain radiographs and MRI showing avulsion of the tibial eminence with a partial tear of the posterolateral ACL bundle. The patient underwent ARIF using a suture tape pull-through technique. The avulsed fragment was anatomically reduced and fixed with a double stranded Ethibond suture and endobutton. Postoperative radiographs confirmed stable fixation. Six weeks following surgery, active range of motion was initiated, and by the end of seven weeks, the patient was gradually progressed to full weight bearing.
Discussion: Neglected ACL avulsion fractures pose challenges due to chronic instability. The arthroscopic approach minimizes soft tissue disruption and enhances joint visualization, which is crucial in complex cases. The suture tape pull -through technique ensures robust fixation, biomechanical stability, and preserves native alignment. This technique avoids common complications associated with traditional methods, such as implant migration or failure. Postoperative rehabilitation ensured progressive recovery, and the patient demonstrated marked improvement in stability and function.
Conclusion: ARIF using the suture tape pull-through technique is an effective, minimally invasive approach for managing neglected ACL avulsion fractures. This case underscores its utility in ensuring anatomical reduction, stable fixation, and early recovery, supporting its role as a preferred treatment option for delayed presentations .