ACL Avulsion Fixation

• Complete ACL avulsion, often with a bone fragment.
• Persistent knee instability despite conservative treatment.
• Associated injuries to cartilage or meniscus that may worsen without repair.
• Athletes or active individuals require strong, stable knees for performance.

ACL avulsion fixation can be performed through arthroscopic surgery (minimally invasive) or open surgery (direct exposure). The choice depends on the complexity of the injury and  the size of the bone fragment..

1. Arthroscopic ACL Avulsion Fixation (Keyhole Surgery)

This is the preferred modern technique for many avulsion injuries. Small incisions (keyholes) are made, and an arthroscope (a camera-assisted tool) allows the surgeon to view the knee on a monitor.

Key Steps:

• Visualization: The avulsed fragment is identified using the arthroscope.
• Preparation: The bone bed is cleaned to promote strong healing.
• Repositioning: The torn ACL and bone fragment are aligned to their original position.
• Fixation: Special screws, sutures, or anchors secure the fragment to the tibia.
• Closure: Tiny incisions are closed with sutures or strips.

Advantages:

• Minimally invasive, with smaller incisions and less tissue damage.
• Faster recovery and reduced scarring.
• Ability to treat associated injuries (like meniscus tears) in the same procedure.

2. Open ACL Avulsion Fixation

In some cases—especially with large bone fragments or complex avulsion patterns—an open approach may be chosen. A larger incision provides direct access to the injury site, allowing precise manipulation and fixation.

Key Steps:

• Exposure: Soft tissues are carefully separated to access the ACL’s tibial attachment.
• Preparation: The bone bed is cleaned to create a stable healing surface.
• Repositioning: The fragment and ligament are accurately placed back into position.
• Fixation: Screws, pins, or sutures firmly secure the fragment.
• Closure: The incision is closed in layers, and the knee is dressed.

Advantages:

• Direct visualization of the injury.
• Useful for complex cases where arthroscopy may not allow adequate fixation.
• Precise handling of large or multiple fragments.

Rehabilitation is essential for both arthroscopic and open fixation:

• Immobilization: A knee brace or splint protects the repair in the early weeks.
• Gradual Weight-Bearing: Introduced under medical supervision.
• Physiotherapy: Focused on restoring range of motion, strengthening quadriceps and hamstrings, and improving balance.
• Return to Sports: Typically after 4–6 months, depending on healing and compliance with rehabilitation.

• Restores knee stability and normal biomechanics.
• Reduces risk of secondary injuries (meniscus or cartilage damage).
• Enables athletes and active individuals to return to pre-injury activity levels.
• Prevents long-term complications such as chronic instability or early arthritis.

With timely surgical repair—whether arthroscopic or open—and consistent rehabilitation, most patients achieve excellent functional outcomes. Early intervention offers the best chance for restoring stability, protecting joint health, and maintaining an active lifestyle.

Both arthroscopic and open ACL avulsion fixation are effective techniques for reattaching the ligament and restoring stability. Arthroscopy is minimally invasive and ideal for most cases, while open surgery is reserved for complex injuries requiring direct access. The right choice depends on the injury pattern, but both approaches, combined with structured rehab, can return patients to active, pain-free living.