Arthroscopic Reduction and Fixation of Tibial Spine Avulsion Fractures by a Stainless Steel Wiring Technique Mohamed M. Abdelhamid, M.D., Maysara Abdelhalim.

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Arthroscopic Reduction and Fixation of Tibial Spine Avulsion Fractures by a Stainless Steel Wiring Technique Mohamed M. Abdelhamid, M.D., Maysara Abdelhalim Bayoumy, M.D., Hesham A. Elkady, M.D., Ayman Farouk Abdelkawi, M.D. Arthroscopy Techniques Volume 6, Issue 6, Pages e2289-e2294 (December 2017) DOI: 10.1016/j.eats.2017.08.042 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 1 Instruments used in the technique: anterior cruciate ligament tibial guide, guide pin, and 26- and 30-gauge wire. Arthroscopy Techniques 2017 6, e2289-e2294DOI: (10.1016/j.eats.2017.08.042) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 2 Arthroscopic view of the right knee through the anterolateral portal showing the fracture reduced and provisionally fixed with a percutaneous Kirschner wire placed with the knee at 90° of flexion through either a medial or lateral parapatellar location. Arthroscopy Techniques 2017 6, e2289-e2294DOI: (10.1016/j.eats.2017.08.042) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 3 Photograph of the right knee showing the arthroscope in the anterolateral portal and the anterior cruciate ligament tibial guide in the anteromedial portal and secured to the proximal anteromedial cortex with one of the guide wires advanced through it. Arthroscopy Techniques 2017 6, e2289-e2294DOI: (10.1016/j.eats.2017.08.042) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 4 Arthroscopic view of the right knee through the anterolateral portal showing the appropriate guide pin (drill bit) that is used to penetrate just medial to the fracture site. Arthroscopy Techniques 2017 6, e2289-e2294DOI: (10.1016/j.eats.2017.08.042) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 5 Photograph of the right knee showing the arthroscope in the anterolateral portal, and the 4.5-mm cannulated drill bit is used to create the medial tunnel. Arthroscopy Techniques 2017 6, e2289-e2294DOI: (10.1016/j.eats.2017.08.042) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 6 Photograph of the right knee showing the arthroscope in the anterolateral portal and the thin cerclage wire loop passed through the tunnel and into the knee. Arthroscopy Techniques 2017 6, e2289-e2294DOI: (10.1016/j.eats.2017.08.042) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 7 Arthroscopic view of the right knee through the anterolateral portal showing the guide wire (black arrow) lateral to the fracture site and the anterior cruciate ligament (red arrowhead). Arthroscopy Techniques 2017 6, e2289-e2294DOI: (10.1016/j.eats.2017.08.042) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 8 Arthroscopic view of the right knee through the anterolateral portal showing a thin cerclage wire loop (black arrow) lateral to the fracture site and the anterior cruciate ligament (red arrowhead). Arthroscopy Techniques 2017 6, e2289-e2294DOI: (10.1016/j.eats.2017.08.042) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 9 Arthroscopic view of the right knee through the anterolateral portal showing 1 of the wire loop that is shuttled through the wire loop of the second one. Arthroscopy Techniques 2017 6, e2289-e2294DOI: (10.1016/j.eats.2017.08.042) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 10 Photograph of the right knee showing retrieval of the loop from 1 tunnel through the other one to outside the knee. Arthroscopy Techniques 2017 6, e2289-e2294DOI: (10.1016/j.eats.2017.08.042) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 11 Arthroscopic view of the right knee through the anterolateral portal showing a horizontal mattress suture-like wire incorporating bone-ligament-bone. Arthroscopy Techniques 2017 6, e2289-e2294DOI: (10.1016/j.eats.2017.08.042) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 12 The wire is twisted on the anterior tibial cortex by using pliers and cut short. Arthroscopy Techniques 2017 6, e2289-e2294DOI: (10.1016/j.eats.2017.08.042) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions