Anterior cruciate ligament tibial insertion avulsion fractures managed with a single tunnel using a double-loaded suture anchor under arthroscopy: a retrospective case series

Evidence regarding arthroscopic single-tunnel fixation using a double-loaded suture anchor for anterior cruciate ligament (ACL) tibial insertion avulsion fractures remains limited. This study evaluated the short-term clinical outcomes of this technique. We retrospectively analyzed 50 patients with ACL tibial insertion avulsion fractures managed with this arthroscopic technique between January 2014 and June 2022. All patients were followed up for 12 months with complete required clinical data. The primary outcome was the paired change in Lysholm score from baseline to the 12-month follow-up. Radiographs were obtained intermittently to determine fracture reduction and healing. Lachman and anterior drawer tests were performed by the same physician to determine knee joint stability. The Lysholm score was used to evaluate knee function. All patients successfully completed the surgery and postoperative follow-up. The median Lysholm score increased from 50.00 (48.00, 52.25) preoperatively to 93.00 (92.00, 94.00) postoperatively. The Hodges–Lehmann estimate was 43.50 (95% CI, 42.00–46.00; P < 0.001; Wilcoxon effect size r = 0.871). No major complications occurred and all the patients recovered without infection, fracture nonunion, instability, or neurovascular injury. Arthroscopic single-tunnel fixation using a double-loaded suture anchor appeared feasible and was associated with favorable short-term clinical outcomes in this cohort. These findings require validation in prospective comparative studies with larger sample sizes and longer follow-up.