Arthroscopic Fixation of Displaced Tibial Eminence Fractures: A New Growth Plate–Sparing Method

Vega, Jorge Rubén; Irribarra, Luis; Baar, Alejandro; Iñiguez, Magaly; Salgado, Martín; Gana, Natalia

doi:10.1016/j.arthro.2008.07.007

Cited by 77 publications

(73 citation statements)

References 27 publications

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“…Fixation can be performed with sutures [77][78][79][80][81], (Fig. 5) metal screws [82][83][84][85], bioabsorbable nails [86], Kirschner wires [36,41,43,76], or suture anchors [87,88]. Several reports have found that screws can actually weaken the small fragment or cause comminution [78] and thus recommend suture fixation, which has demonstrated similar or improved strength profiles [89][90][91].…”

Section: Tibial Eminence Fracturementioning

confidence: 99%

Pediatric ACL injuries: evaluation and management

Mall¹,

Paletta

2013

Curr Rev Musculoskelet Med

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The anterior cruciate ligament (ACL) is a stabilizing structure to both anterior translation of the tibia with respect to the femur as well as rotation of the knee joint. Children and adolescents are susceptible to these injuries, and there are some who believe the incidence of ACL injuries in this population is increasing due to year round single sport participation. Pediatric ACL injuries are typically seen in several forms: tibial avulsion fractures, partial ACL tears, and full thickness ligament tears. There were and still are some who feel that ACL injuries should be treated non-operatively in the pediatric and adolescent population; however, recent literature refutes this notion. Several factors must be considered during pediatric and adolescent ACL reconstruction, each of which will be examined in this manuscript, including: status of the physis, reconstruction technique, and graft source.

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Section: Tibial Eminence Fracturementioning

confidence: 99%

Pediatric ACL injuries: evaluation and management

Mall¹,

Paletta

2013

Curr Rev Musculoskelet Med

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“…3 Arthroscopically assisted methods include both retrograde and antegrade techniques and incorporate metal, absorbable, and nonabsorbable materials. [4][5][6][7][8] Many case reports and techniques have been described, and concerns regarding fracture fragment comminution and stability, fixation pullout strength, and the need for hardware removal have arisen. Retrograde and antegrade screws have been commonly used for fixation, but several potential problems exist: screw purchase with fragment comminution, as well as the potential need for hardware removal and transphyseal fixation in the skeletally immature patient.…”

mentioning

confidence: 99%

“…Retrograde and antegrade screws have been commonly used for fixation, but several potential problems exist: screw purchase with fragment comminution, as well as the potential need for hardware removal and transphyseal fixation in the skeletally immature patient. [4][5][6][7][8] Arthroscopic suture fixation has also evolved over the years, including suture loop transporters, multiple drill tunnels, retrograde guides, and various tissue penetrators for suture passage. [9][10][11][12][13] Recently published literature has proposed that fixation with the EndoButton (Smith & Nephew, Andover, MA) may provide greater initial fixation strength than that with sutures or suture anchor fixation, but potential implant impingement and the need for hardware removal may supersede the initial strength benefits.…”

mentioning

confidence: 99%

ORV Arthroscopic Reduction and Internal Fixation of Tibial Eminence Fractures

Myer

Purnell

Caldwell

et al. 2013

Arthroscopy Techniques

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Tibial eminence fractures are an uncommon but well-described avulsion of the anterior cruciate ligament. Treatment principles are based on the amount and pattern of fracture displacement. Management has evolved from closed reduction and immobilization to arthroscopic reduction and internal fixation followed by early rehabilitation. Various fixation methods have evolved, ranging from arthroscopic reduction and percutaneous screw fixation to arthroscopic suture repair. We present a technique for arthroscopic reduction and internal fixation using a cannulated drill bit and high-strength suture. This technique facilitates anatomic reduction with uncomplicated tunnel placement and suture passing in an effort to allow strong fixation and early rehabilitation.

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“…10,11 Several arthroscopic techniques have been reported, such as metal screw fixation, [12][13][14][15][16][17] staple fixation, 18 K-wire fixation, 6,19,20 suture fixation, 18,[21][22][23][24][25][26][27] and anchor fixation. 28,29 However, a number of these techniques violate the growth plate, and in the case of metal screw fixation, retained hardware can result in the need to reoperate to remove hardware. Within the orthopaedic community, questions about which is the strongest method of fixation with the greatest stability remain, 28,30,31 with some surgeons favoring suture fixation 26 and others preferring screw fixation.…”

mentioning

confidence: 99%

“…28,29 However, a number of these techniques violate the growth plate, and in the case of metal screw fixation, retained hardware can result in the need to reoperate to remove hardware. Within the orthopaedic community, questions about which is the strongest method of fixation with the greatest stability remain, 28,30,31 with some surgeons favoring suture fixation 26 and others preferring screw fixation. [32][33][34] In this article we present arthroscopic techniques for growth plateesparing tibial eminence fracture fixation in skeletally immature patients using both resorbable headless screws and sutures.…”

mentioning

confidence: 99%

Hybrid Fixation of Tibial Eminence Fractures in Skeletally Immature Patients

Gans

Babatunde

Ganley

2013

Arthroscopy Techniques

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Tibial eminence fractures most commonly occur in children and adolescents. When treating displaced fractures of the tibial eminence, some surgeons prefer screw fixation whereas others prefer suture fixation. The ultimate goal is to limit morbidity through early return to range of motion and activity. In this technical note, we describe 2 hybrid fixation techniques for fixing tibial eminence fractures, one for type III and the other for type IV fractures. The first technique (variation A) is used to treat type III fractures and combines use of both a bioabsorbable compression screw and suture for fixation. The second technique (variation B) is used to treat type IV fractures and combines use of both a bioabsorbable compression screw and shoulder anchor fixation. We have found that these methods provide efficient, secure, and reliable fixation using standard techniques common to arthroscopic surgery. In addition, the growth plates are spared in children and adolescents, and the need for reoperation to remove hardware is eliminated.

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Arthroscopic Fixation of Displaced Tibial Eminence Fractures: A New Growth Plate–Sparing Method

Cited by 77 publications

References 27 publications

Pediatric ACL injuries: evaluation and management

Pediatric ACL injuries: evaluation and management

ORV Arthroscopic Reduction and Internal Fixation of Tibial Eminence Fractures

Hybrid Fixation of Tibial Eminence Fractures in Skeletally Immature Patients

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