Modified suture bridge technique with tension-reducing suture for adolescent tibial tubercle avulsion fractures: a retrospective analysis

The incidence of tibial tubercle avulsion fractures (TTAFs) has increased in recent years. To date, however, no standardized treatment strategy has been established for this type of injury. The suture bridge technique has been reported to generate a tension band–like biomechanical effect through crossed sutures, which may enhance fixation strength while eliminating the need for secondary implant removal. Nevertheless, clinical evidence supporting the application of this technique in adolescent patients with TTAFs remains limited. Moreover, achieving a more uniform distribution of mechanical stress across the fracture interface continues to represent a critical and unresolved challenge in the surgical fixation of tibial tubercle avulsion fractures. Sixteen adolescent patients diagnosed with tibial tubercle avulsion fractures and treated with a modified suture-bridge fixation technique combined with tension-relieving sutures between 2019 and 2023 were retrospectively enrolled in this study. All participants satisfied the predefined inclusion criteria and completed a minimum follow-up duration of 2 years. Radiographic examinations were used to assess postoperative bone union. Knee function was examined before surgery, and at one year and two years after surgery, through measurements of joint range of motion (ROM), as well as the International Knee Documentation Committee (IKDC) subjective score, Lysholm score, and Tegner activity level. All 16 surgically treated patients were included in the final analysis, with no loss to follow-up. The mean follow-up duration was 26.3 months. Radiographic examinations demonstrated satisfactory anatomical reduction with successful fracture union, and no apparent clinical complications were observed during the follow-up period. Compared with preoperative baseline values, ROM, IKDC score, Lysholm score, and Tegner activity level were significantly improved at both the 1-year and 2-year follow-ups ( p < 0.05). This retrospective case series suggests that the modified suture-bridge technique combined with tension-reducing sutures is a feasible and safe surgical option for adolescent TTAFs, with favorable short-term radiographic healing and clinical recovery. The construct was designed to provide a tension band–like compressive effect and more evenly distribute mechanical load across the fracture site; however, these proposed biomechanical advantages remain theoretical. Further biomechanical studies and well-designed comparative clinical investigations are needed to validate these assumptions and clarify the potential advantages of this fixation strategy. Level IV; retrospective case series. This study was retrospectively registered in the Chinese Clinical Trial Registry (ChiCTR2500113025) on November 24, 2025. The registration was completed after the treatment period and follow-up of the included patients.