Authors of section

Authors

Matthias Hansen, Rodrigo Pesantez

Executive Editors

Joseph Schatzker, Ernst Raaymakers, Rick Buckley

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Suture anchors

1. Introduction

In fractures and soft tissue injuries around the knee, where the bony fragments are too small to fix with screws, the ligamentous and bony fragments can be reduced and fixed in order to obtain a stable knee joint. This can be done with the use of suture anchors.

This procedure may be aided arthroscopically or open.

There are number of different suture anchors on the market which vary in size and design. In this illustration we are using the simple cork screw anchor which is inserted arthroscopically.

suture anchors

2. Patient preparation

This procedure is normally performed with the patient in a lateral position.

suture anchors

3. Approaches

Safe zones for percutaneous instrumentation

Inserting percutaneous instrumentation through safe zones reduces the risk of damage to neurovascular structures.

Anterolateral approach

For open reduction an anterolateral approach is used.

mio angular stable plate liss

4. Anchor insertion

The suture anchor is inserted through the fracture line into bone. The anchors need to be placed sufficiently deep so that the metal part does not protrude above the fracture.

In repairing the soft tissue and small bony fragments, the anchor is placed as close as possible to the articular margin. Once the anchor is securely seated in bone, the handle is removed.

extraarticular fracture avulsion of fibular head

An appropriately angled suture passer is used to shuttle one suture through the labrum.

suture anchors

5. Reduction and fixation

The sutures are then tied and as the knot is tightened, the fracture is reduced.

suture anchors

The procedure is repeated for any other fragments not suitable for screw fixation.

extraarticular fracture avulsion of fibular head

At the end of the procedure, use the image intensifier to check the placement of fixation devices and the reduction of the joint.

6. Aftercare

The neurovascular status of the extremity must be carefully monitored. Impaired blood supply or developing neurological loss must be investigated as an emergency and dealt with expediently.

Functional treatment
Functional treatment shall be applied for 2 – 3 days with patient still resting in bed starting on postoperative day 1.
The goal of early active and passive range of motion is to achieve a full range of motion within the first 4 – 6 weeks. Maximum stability is achieved at the time of surgery.
In noncompliant patients consider the use of a hinged knee brace.

Weight bearing
The patient can be fully weight bearing but care must be taken not to apply a varus distracting force. For this reason, crutches are advisable as a means of protection.

Follow up
Wound healing should be assessed on a short term basis within the first two weeks. Subsequently a 8 week follow-up is usually performed.

Implant removal
Implant removal is not mandatory and should be discussed with the patient.