Arthroscopic Dual-Tunnel Fixation of Anterior Cruciate Ligament Tibial Avulsion Fractures Using a Luggage-Tag FiberWire Configuration

Background: Anterior cruciate ligament (ACL) tibial avulsion fractures represent detachment of the ligament from its tibial insertion rather than midsubstance rupture. Although more frequently reported in pediatric populations, displaced injuries are increasingly encountered in adults following high-energy trauma and sports activities¹. Stable fixation is required to restore ACL tension and prevent residual knee instability.

Purpose: To  evaluate radiological union and functional outcomes following arthroscopic fixation of displaced ACL tibial avulsion fractures using a luggage-tag FiberWire configuration with a dual-tunnel technique.

Methods: Ten adult patients with Meyers and McKeever Type II–IV tibial avulsion fractures underwent arthroscopic fixation using high-strength FiberWire sutures in a luggage-tag configuration. Two tibial tunnels were created maintaining a 1-cm cortical bone bridge. Sutures were secured over a tibial suture disc. Functional outcomes were assessed using Lysholm and IKDC subjective knee scores preoperatively and at minimum 12-month follow-up.

Results: All fractures achieved radiographic union within 12 weeks. Mean Lysholm score improved from 48.5 ± 6.5 preoperatively to 92.5 ± 4.5 at final follow-up. Mean IKDC score improved from 44.2 ± 7.5  to 89.0 ± 5.2. No revision surgery or persistent instability was observed.

Conclusion: Arthroscopic luggage-tag FiberWire fixation with a dual-tunnel technique provides reliable fracture union and excellent functional outcomes in ACL tibial avulsion fractures.