Arthroscopic ACL Tibial Spine Avulsion Fixation Using Suture Pull-Through Double-Tunnel Technique.

Introduction: Avulsion fractures of the tibial spine are uncommon injuries that primarily affect children and adolescents but are increasingly recognized in adults after high-energy trauma. Displaced Meyers and McKeever Type II-IV fractures require fixation to restore anterior cruciate ligament (ACL) function, obtain anatomical reduction, and prevent residual knee instability. Arthroscopic suture pull-through fixation using a double-tibial-tunnel technique avoids intra-articular hardware while providing stable fixation. Objectives: The objective of the study was to assess the radiological and clinical outcomes of arthroscopic ACL tibial spine avulsion fixation in skeletally mature patients using the suture pull-through double-tunnel technique. Materials and Methods: This prospective observational study included 26 skeletally mature patients with displaced tibial spine avulsion fractures treated using the arthroscopic suture pull-through double-tunnel technique. Functional outcomes were assessed with the Lysholm Knee Score and Tegner Activity Scale, while radiological union, clinically assessed post-operative stability, complications, and return to pre-injury activity were recorded. The study had no control group, and the available follow-up was limited to the early post-operative period. Results: All 26 patients completed the available follow-up and achieved radiological union by 3 months. The mean pre-operative Lysholm score derived from the patient-level table was 40.8 ± 2.2; the reported post-operative mean was 97, although individual post-operative Lysholm values were unavailable and a paired significance test could not be performed. The Tegner score improved from 2.88 ± 0.77 preoperatively to 5.96 ± 0.77 postoperatively (P < 0.001). Twenty-two patients (approximately 85%) returned to their pre-injury activity level within 4-6 months. Two patients developed a mild extension lag that resolved with supervised physiotherapy. No non-union, fixation failure, clinically significant residual instability, or revision surgery was reported; however, the sample was too small to determine the true incidence of uncommon complications. Conclusion: In this small observational cohort, arthroscopic suture pull-through double-tunnel fixation was associated with radiological union and favorable early functional recovery while avoiding intra-articular hardware. Because the study was single-Centre, uncontrolled, short-term, and lacked instrumented stability and detailed imaging-based reduction measures, these findings should be interpreted as preliminary rather than evidence of superiority or long-term reliability.