case_images: PMC10715858_01
case_images: (a) Frontal view and (b) lateral view of the plain radiograph showing Meyers type III tibial ACL avulsion fractures. (c) Coronal and (d) sagittal views of CT showing rounded bone fragments and osteosclerosis at the fracture site, suggesting that the fracture is old. ACL: anterior cruciate ligament; CT: computed tomography.
case_images: CRIOR2023-4681973.001.jpg
case_images: PMC10715858_01_CRIOR2023-4681973.001.jpg
case_images: fig1
case_images: Radiography showed Meyers' type III tibial ACL avulsion fractures (Figures 1(a) and 1(b)). CT revealed rounded bone fragments and osteosclerosis at the fracture site, suggesting that it was an old fracture (Figures 1(c) and 1(d)).
case_images: (a) Preoperative STIR image of MRI showing poor delineation of the ACL. (b) Arthroscopic image of the ununited fracture area. The bone fragment was displaced. (c) Arthroscopic image of the fracture bed. The fracture bed was freshened using a 4.5 mm arthroscopic shaver and a bipolar electrode. (d) Arthroscopic image of the fixation. The bone fragment was fixed via screw fixation. STIR: short T-inversion recovery; MRI: magnetic resonance imaging; ACL: anterior cruciate ligament; BF: bone fragment; FB: fracture bed.
case_images: CRIOR2023-4681973.002.jpg
case_images: PMC10715858_01_CRIOR2023-4681973.002.jpg
case_images: fig2
case_images: ACL (Figure 2(a)). An osteosynthesis of the fracture nonunion was performed arthroscopically. The displacement of the bone fragments of the intercondylar eminence fracture was confirmed arthroscopically (Figure 2(b)). Both the displaced bone fragments and the fracture bed were sufficiently freshened using a 4.5 mm arthroscopic shaver (Merlin; Zimmer Biomet, Warsaw, IN, USA) and a bipolar electrode (Super MULTIVAC 50 3.75 mm; Smith and Nephew, Watford, HRT, England) (Figure 2(c)); the bone fragments were repositioned and fixed with a 4.0 mm cannulated cancellous screw (ACE Titanium Cannulated Cancellus Screw System; Zimmer Biomet, Warsaw, IN, USA) (Figure 2(d)).
case_images: (a) Frontal view and (b) lateral view of plain radiography showing good repositioning was confirmed.
case_images: CRIOR2023-4681973.003.jpg
case_images: PMC10715858_01_CRIOR2023-4681973.003.jpg
case_images: fig3
case_images: Postoperative radiography revealed good repositioning (Figure 3).
case_images: (a) Coronal and (b) sagittal views of CT at 4 months postoperatively showing fusion of most of the bones. MRI at 6 months postoperatively. (c) Arthroscopic image at screw removal showing that good ACL volume and tension were maintained. (d) Arthroscopic image (acquired after deflating the tourniquet) showing that blood flow was confirmed in the ACL. CT: computed tomography; MRI: magnetic resonance imaging; ACL: anterior cruciate ligament.
case_images: CRIOR2023-4681973.004.jpg
case_images: PMC10715858_01_CRIOR2023-4681973.004.jpg
case_images: fig4
case_images: At 4 months postoperatively, CT revealed union (Figures 4(a) and 4(b)). Arthroscopically, good ACL volume and tension were maintained (Figure 4(c)). Furthermore, when the tourniquet was released, blood flow could be seen in the ACL (Figure 4(d)).