Arthroscopic Repair in Tibial Spine Avulsion Fractures Using Polyethylene Terephthalate Suture: Good to Excellent Results in Pediatric Patients

Abstract

Background: The objective of the arthroscopic treatment in tibial spine avulsion fractures (TSAF) is to achieve firm reduction and strong internal fixation while still having the patient undergo a minimally invasive procedure. Material and methods: The study was performed on 12 young patients with avulsion fracture of the anterior tibial spine. All 12 patients had type 3 Modified Meyers and McKeever fractures. The injury mechanism was direct anterior to posterior trauma in full leg length hyperextension with sport trauma reported in all cases. The physical examination revealed decreased range of motion, extension deficit, and pain during walking. Radiology, MRI, and CT pathologic findings described complete fracture of the anterior tibial spine with no clear signs of callus formation at the time of examination. All patients underwent arthroscopic suture surgical treatment. The Tegner, the Lysholm, and the International Knee Documentation Committee (IKDC) scores were used to evaluate subjective outcomes at three and six months after the surgery. Radiographs were used to assess callus formation and healing status of the fracture. Results: The mean IKDC score was 33.4 ± 23.3 (p = 0.032) preoperatively and 84.2 ± 14.3 at final follow-up (p = 0.0032, CI = 95%). The mean Tegner score improved from 3.8 ± 1.1 pre-operatively to 6.7 ± 2.2 at six months follow-up (p = 0.0231, CI = 95%). The Lysholm score differed significantly at baseline compared to final follow-up (53.7 ± 17.3 vs. 87.7 ± 9.9; p = 0.0066, CI = 95%). In all cases (n = 12), the radiographs taken after six months revealed the healing of the fracture in the anatomic position without secondary displacement. No functional knee instability was detected at the end of the study. Conclusions: The study provides preliminary promising results regarding fracture healing, knee stability, and functional subjective scores. Patient selection was a major factor of success prediction for this technique.

Tibial Spine Fractures in the Child and Adolescent Athlete: A Systematic Review and Meta-analysis

“…Multiple treatment methods using both open and arthroscopic approaches were encountered in our review. 7,11,13,21,22,34,40,57 Overall, generally good outcomes were seen among all patients, with similar patientreported outcomes (Lysholm, Tegner, IKDC scores) across all groups. Nonunion was uncommon in our study, with only 13 patients of a possible 1638 having difficulty with fracture healing.…”

“…With recent advances in arthroscopic surgery, more surgeons have opted for a minimally invasive approach for treatment of these fractures with varying methods of fixation. 5,11,17,40 Despite recent advances, controversy and variability remain among treating physicians with regard to fixation methods, surgical timing, and optimal imaging modalities, among other factors. Given the heterogeneity of the literature, this study was performed to systematically review the literature on TSFs to determine the current treatment approaches, outcomes, and complications.…”

Arthroscopically Assisted Cannulated Screw Fixation for Treating Type III Tibial Intercondylar Eminence Fractures: A Short-Term Retrospective Controlled Study

“…The most commonly used fixation devices for children with tibial intercondylar eminence fractures are screws, intraosseous sutures, Kirschner wires, and steel wires ( 23 ). The use of absorbable screws ( 9 , 25 ) and suture anchors ( 26 ) has also been reported. The goal of treatment for children with intercondylar eminence fractures is to obtain anatomic reduction while maintaining proper tension of the ACL to achieve sufficient strength of the fracture fragments, which can facilitate early activities and prevent serious complications, such as joint stiffness.…”