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    <title>Avulsion Fractures Using a Luggage-Tag FiberWire Configuration</title>

    <authors>Dr Kailash A</authors>

    <abstract>&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span style=&quot;mso-font-kerning:0pt;mso-ligatures:none;&quot; lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;&lt;strong&gt;INTRODUCTION&lt;/strong&gt;&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Anterior cruciate ligament tibial avulsion fractures involve separation of the ACL from its tibial insertion while the ligament substance remains intact¹. These injuries are relatively uncommon but are increasingly recognized following sports injuries, road-traffic accidents, and high-energy trauma².&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;The modified Meyers and McKeever classification categorizes these injuries based on the degree of displacement and comminution¹˒³. Type I injuries are minimally displaced and are typically treated conservatively. However, displaced fractures (Types II–IV) usually require surgical fixation to restore normal ACL tension and prevent residual anterior instability⁴.&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Historically, open reduction and internal fixation were used to treat these injuries. With advances in arthroscopic techniques, minimally invasive fixation methods have largely replaced open surgery due to better visualization of intra-articular structures, reduced soft-tissue trauma, and faster rehabilitation⁵.&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Several fixation techniques have been described including cannulated screw fixation, suture anchors, and transosseous suture techniques⁶˒⁷. While screw fixation provides rigid compression, it may not be suitable in comminuted fragments and sometimes requires hardware removal⁶. High-strength suture constructs using modern materials such as FiberWire have demonstrated biomechanical strength comparable to screw fixation while avoiding hardware complications⁸.&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;The present study evaluates the outcomes of arthroscopic fixation using a luggage-tag FiberWire configuration with dual tibial tunnels and suture disc fixation in adult patients with displaced ACL tibial avulsion fractures.&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span style=&quot;mso-bidi-font-family:SimSun;&quot; lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;&lt;strong&gt;MATERIALS AND METHODS&lt;/strong&gt;&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;&lt;strong&gt;Study Design&lt;/strong&gt;: A prospective case series was conducted at a tertiary orthopaedic center between November 2024 and December&amp;nbsp;&lt;/span&gt;&lt;span style=&quot;mso-spacerun:yes;&quot; lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt; &lt;/span&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;2025. Institutional approval was obtained prior to commencement of the study.&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;figure class=&quot;table&quot; style=&quot;width:100.0%;&quot;&gt;&lt;table class=&quot;MsoTableGrid&quot; style=&quot;border-collapse:collapse;mso-border-alt:solid windowtext .5pt;mso-padding-alt:0cm 5.4pt 0cm 5.4pt;mso-yfti-tbllook:1184;&quot; border=&quot;1&quot; cellspacing=&quot;0&quot; cellpadding=&quot;0&quot; width=&quot;100%&quot;&gt;&lt;tbody&gt;&lt;tr style=&quot;mso-yfti-firstrow:yes;mso-yfti-irow:0;&quot;&gt;&lt;td style=&quot;border:1.0pt solid windowtext;mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:16.98%;&quot; width=&quot;16%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Sr No.&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;td style=&quot;border-bottom-style:solid;border-color:windowtext;border-left-style:none;border-right-style:solid;border-top-style:solid;border-width:1.0pt;mso-border-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:41.18%;&quot; width=&quot;41%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Parameter&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;td style=&quot;border-bottom-style:solid;border-color:windowtext;border-left-style:none;border-right-style:solid;border-top-style:solid;border-width:1.0pt;mso-border-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:41.82%;&quot; width=&quot;41%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Value&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr style=&quot;mso-yfti-irow:1;&quot;&gt;&lt;td style=&quot;border-bottom-style:solid;border-color:windowtext;border-left-style:solid;border-right-style:solid;border-top-style:none;border-width:1.0pt;mso-border-alt:solid windowtext .5pt;mso-border-top-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:16.98%;&quot; width=&quot;16%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;1&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;td style=&quot;border-bottom:1.0pt solid windowtext;border-left-style:none;border-right:1.0pt solid windowtext;border-top-style:none;mso-border-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-top-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:41.18%;&quot; width=&quot;41%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Total patients&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;td style=&quot;border-bottom:1.0pt solid windowtext;border-left-style:none;border-right:1.0pt solid windowtext;border-top-style:none;mso-border-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-top-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:41.82%;&quot; width=&quot;41%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;10&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr style=&quot;mso-yfti-irow:2;&quot;&gt;&lt;td style=&quot;border-bottom-style:solid;border-color:windowtext;border-left-style:solid;border-right-style:solid;border-top-style:none;border-width:1.0pt;mso-border-alt:solid windowtext .5pt;mso-border-top-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:16.98%;&quot; width=&quot;16%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;2&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;td style=&quot;border-bottom:1.0pt solid windowtext;border-left-style:none;border-right:1.0pt solid windowtext;border-top-style:none;mso-border-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-top-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:41.18%;&quot; width=&quot;41%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Mean age&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;td style=&quot;border-bottom:1.0pt solid windowtext;border-left-style:none;border-right:1.0pt solid windowtext;border-top-style:none;mso-border-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-top-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:41.82%;&quot; width=&quot;41%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;23&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr style=&quot;mso-yfti-irow:3;&quot;&gt;&lt;td style=&quot;border-bottom-style:solid;border-color:windowtext;border-left-style:solid;border-right-style:solid;border-top-style:none;border-width:1.0pt;mso-border-alt:solid windowtext .5pt;mso-border-top-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:16.98%;&quot; width=&quot;16%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;3&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;td style=&quot;border-bottom:1.0pt solid windowtext;border-left-style:none;border-right:1.0pt solid windowtext;border-top-style:none;mso-border-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-top-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:41.18%;&quot; width=&quot;41%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Gender: Male/Female&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;td style=&quot;border-bottom:1.0pt solid windowtext;border-left-style:none;border-right:1.0pt solid windowtext;border-top-style:none;mso-border-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-top-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:41.82%;&quot; width=&quot;41%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;8/2&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr style=&quot;mso-yfti-irow:4;mso-yfti-lastrow:yes;&quot;&gt;&lt;td style=&quot;border-bottom-style:solid;border-color:windowtext;border-left-style:solid;border-right-style:solid;border-top-style:none;border-width:1.0pt;mso-border-alt:solid windowtext .5pt;mso-border-top-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:16.98%;&quot; width=&quot;16%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;4&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;td style=&quot;border-bottom:1.0pt solid windowtext;border-left-style:none;border-right:1.0pt solid windowtext;border-top-style:none;mso-border-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-top-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:41.18%;&quot; width=&quot;41%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Side: Left/right&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;td style=&quot;border-bottom:1.0pt solid windowtext;border-left-style:none;border-right:1.0pt solid windowtext;border-top-style:none;mso-border-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-top-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:41.82%;&quot; width=&quot;41%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;4/6&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;&lt;/figure&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;&lt;strong&gt;Patient Demographics&lt;/strong&gt;:&amp;nbsp;&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;&lt;strong&gt;Inclusion Criteria:&lt;/strong&gt;&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;ul style=&quot;list-style-type:disc;&quot;&gt;&lt;li style=&quot;list-style-type:disc;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Meyers and McKeever Type II–IV fractures&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/li&gt;&lt;li style=&quot;list-style-type:disc;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Surgery performed within 3 weeks of injury&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/li&gt;&lt;/ul&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;&lt;strong&gt;Exclusion Criteria:&lt;/strong&gt;&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;ul style=&quot;list-style-type:disc;&quot;&gt;&lt;li style=&quot;list-style-type:disc;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Multiligament knee injury&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/li&gt;&lt;li style=&quot;list-style-type:disc;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Associated tibial plateau fracture&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/li&gt;&lt;li style=&quot;list-style-type:disc;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Previous knee surgery&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/li&gt;&lt;li style=&quot;list-style-type:disc;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Chronic avulsion fractures (&amp;gt;6 weeks)&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/li&gt;&lt;/ul&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;&lt;strong&gt;Fracture Distribution&lt;/strong&gt;&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;figure class=&quot;table&quot; style=&quot;width:100.0%;&quot;&gt;&lt;table class=&quot;MsoTableGrid&quot; style=&quot;border-collapse:collapse;mso-border-alt:solid black .5pt;mso-border-insideh:.5pt solid black;mso-border-insidev:.5pt solid black;mso-padding-alt:0cm 5.4pt 0cm 5.4pt;mso-yfti-tbllook:1024;&quot; border=&quot;1&quot; cellspacing=&quot;0&quot; cellpadding=&quot;0&quot; width=&quot;100%&quot;&gt;&lt;tbody&gt;&lt;tr style=&quot;mso-yfti-firstrow:yes;mso-yfti-irow:0;&quot;&gt;&lt;td style=&quot;border:1.0pt solid windowtext;mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:46.6%;&quot; width=&quot;46%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Fracture Type&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;td style=&quot;border-bottom-style:solid;border-color:windowtext;border-left-style:none;border-right-style:solid;border-top-style:solid;border-width:1.0pt;mso-border-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:53.4%;&quot; width=&quot;53%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Number of patients&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr style=&quot;mso-yfti-irow:1;&quot;&gt;&lt;td style=&quot;border-bottom-style:solid;border-color:windowtext;border-left-style:solid;border-right-style:solid;border-top-style:none;border-width:1.0pt;mso-border-alt:solid windowtext .5pt;mso-border-top-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:46.6%;&quot; width=&quot;46%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Type 2&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;td style=&quot;border-bottom:1.0pt solid windowtext;border-left-style:none;border-right:1.0pt solid windowtext;border-top-style:none;mso-border-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-top-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:53.4%;&quot; width=&quot;53%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;3&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr style=&quot;mso-yfti-irow:2;&quot;&gt;&lt;td style=&quot;border-bottom-style:solid;border-color:windowtext;border-left-style:solid;border-right-style:solid;border-top-style:none;border-width:1.0pt;mso-border-alt:solid windowtext .5pt;mso-border-top-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:46.6%;&quot; width=&quot;46%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Type 3&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;td style=&quot;border-bottom:1.0pt solid windowtext;border-left-style:none;border-right:1.0pt solid windowtext;border-top-style:none;mso-border-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-top-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:53.4%;&quot; width=&quot;53%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;5&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr style=&quot;mso-yfti-irow:3;mso-yfti-lastrow:yes;&quot;&gt;&lt;td style=&quot;border-bottom-style:solid;border-color:windowtext;border-left-style:solid;border-right-style:solid;border-top-style:none;border-width:1.0pt;mso-border-alt:solid windowtext .5pt;mso-border-top-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:46.6%;&quot; width=&quot;46%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Type 4&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;td style=&quot;border-bottom:1.0pt solid windowtext;border-left-style:none;border-right:1.0pt solid windowtext;border-top-style:none;mso-border-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-top-alt:solid windowtext .5pt;padding:0cm 5.4pt;vertical-align:top;width:53.4%;&quot; width=&quot;53%&quot;&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:center;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;2&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;&lt;/figure&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;&lt;strong&gt;Surgical Technique:&lt;/strong&gt;&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;&lt;u&gt;Patient Positioning and Anesthesia&lt;/u&gt;: The&lt;/span&gt;&lt;span style=&quot;mso-spacerun:yes;&quot; lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;&amp;nbsp; &lt;/span&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;procedure is performed under spinal or general anesthesia. A high-thigh pneumatic tourniquet is applied but inflated only after limb exsanguination.&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;The patient is placed supine on a radiolucent operating table with the operative leg in hanging leg position or secured in a leg holder allowing approximately 90° of knee flexion. The contralateral limb is positioned in an abduction stirrup.&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;The entire lower limb is prepared and draped in a sterile manner from mid-thigh to foot.&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;&lt;u&gt;Portal Placement&lt;/u&gt;: Standard arthroscopic portals are established:&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Anterolateral portal: Used as the primary viewing portal and placed just lateral to the patellar tendon at the level of the inferior pole of the patella.&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Anteromedial portal: Created under direct visualization using a spinal needle to ensure appropriate trajectory toward the tibial eminence.&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;A Passport cannula is introduced through the anteromedial portal to facilitate suture management and prevent soft-tissue bridging.&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;&lt;u&gt;Diagnostic Arthroscopy and Fracture Bed Preparation&lt;/u&gt;&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;1. Evacuate hemarthrosis&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;2. Evaluate ACL integrity&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;3. Assess menisci and articular cartilage&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;4. Identify interposed soft tissue&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Soft-tissue structures such as the intermeniscal ligament or fibrous debris that prevent fragment reduction are removed using a shaver or radiofrequency probe.The fracture crater is gently debrided to expose fresh cancellous bone while preserving the size and morphology of the avulsed fragment.&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;&lt;u&gt;Luggage-Tag FiberWire Configuration&lt;/u&gt;: High-strength nonabsorbable FiberWire suture is used.&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;First Stitch: A suture passer is introduced through the Passport cannula and passed through the ACL substance 5–7 mm proximal to the tibial insertion.&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;The free suture end is then passed through its own loop to create a self-cinching luggage-tag configuration.&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;This construct provides:&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;ul&gt;&lt;li class=&quot;MsoListParagraphCxSpFirst&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;mso-add-space:auto;mso-list:l3 level1 lfo4;text-align:justify;text-indent:-18.0pt;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Circumferential ligament capture&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/li&gt;&lt;li class=&quot;MsoListParagraphCxSpMiddle&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;mso-add-space:auto;mso-list:l3 level1 lfo4;text-align:justify;text-indent:-18.0pt;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Even load distribution&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/li&gt;&lt;li class=&quot;MsoListParagraphCxSpMiddle&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;mso-add-space:auto;mso-list:l3 level1 lfo4;text-align:justify;text-indent:-18.0pt;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Reduced risk of suture cut-through&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/li&gt;&lt;/ul&gt;&lt;p class=&quot;MsoListParagraphCxSpLast&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;mso-add-space:auto;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Second Stitch: A second luggage-tag stitch is placed posteriorly within the ACL substance.&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;This step provides:&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;ul&gt;&lt;li class=&quot;MsoListParagraphCxSpFirst&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;mso-add-space:auto;mso-list:l1 level1 lfo2;text-align:justify;text-indent:-18.0pt;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Rotational stability&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/li&gt;&lt;li class=&quot;MsoListParagraphCxSpMiddle&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;mso-add-space:auto;mso-list:l1 level1 lfo2;text-align:justify;text-indent:-18.0pt;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Balanced force distribution&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/li&gt;&lt;li class=&quot;MsoListParagraphCxSpLast&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;mso-add-space:auto;mso-list:l1 level1 lfo2;text-align:justify;text-indent:-18.0pt;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Secure capture of both ACL bundles&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/li&gt;&lt;/ul&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;&lt;u&gt;Tibial Tunnel Preparation&lt;/u&gt;: An ACL tibial guide is introduced through the anteromedial portal and positioned at the medial margin of the fracture bed.&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;First Tunnel: A 2.7-mm guide pin is drilled from the anteromedial tibial cortex exiting at the medial aspect of the fracture crater.&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Second Tunnel: The guide is repositioned laterally and a second tunnel is drilled while maintaining a 1-cm bone bridge between tunnels.&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&amp;nbsp;&lt;/p&gt;&lt;p class=&quot;MsoNormal&quot; style=&quot;line-height:normal;margin-bottom:.0001pt;text-align:justify;&quot;&gt;&lt;span style=&quot;font-family:&amp;quot;Times New Roman&amp;quot;,&amp;quot;serif&amp;quot;;font-size:10.0pt;&quot;&gt;&lt;span lang=&quot;EN-US&quot; dir=&quot;ltr&quot;&gt;Preserving the bone bridge is essential to:&lt;/span&gt;&lt;/span&gt;&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;</abstract>

    <keywords>hhh,ggfff</keywords>

    <doi>10.5281/zenodo.17636578</doi>

    <volume>6</volume>

    <issue>Issue2</issue>

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    <published_date>2026-02-15 00:00:00</published_date>

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