Arthroscopic Fixation of Minimally Displaced Avulsion Fracture of Ischial Tuberosity Using a "Double-Pulley" Suture Anchor Technique.

Avulsion fracture of the ischial tuberosity is an uncommon injury caused by a sudden, forceful eccentric contraction of the hamstrings that avulses the unfused secondary ossification center from the pelvis. Although open reduction and internal fixation are recommended when fragment displacement exceeds 2 cm, reports describing minimally invasive solutions are still lacking. In addition, for those patients who are engaged in high-intensity sports or physical activities, conservative treatment can compromise hamstring power, delay return to sport, and occasionally result in chronic ischial pain. To address these limitations, we describe an arthroscopic "double-pulley" suture anchor fixation technique for avulsion fracture of the ischial tuberosity with 6-mm displacement. This approach reduces soft tissue trauma through minimally invasive access and avoids secondary surgeries for implant removal, potentially reducing recovery time and improving patient outcomes.