Biomechanical Comparison of Four Different Fixation Techniques for Pediatric Tibial Eminence Avulsion Fractures

Mahar, Andrew; Duncan, Doug; Oka, Richard; Lowry, A.; Gillingham, Bruce L.; Chambers, Henry G.

doi:10.1097/bpo.0b013e318164ee43

Cited by 66 publications

(52 citation statements)

References 12 publications

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“…Successful results have been reported with both methods of fixation. [2][3][4][9][10][11][12][13] The results of biomechanical studies comparing suture and screw fixation are mixed, [14][15][16][17] and few clinical studies directly compare these two methods of fixation. 18,19 The purpose of this review is to provide a synthesis of the literature regarding the outcome of nonoperatively and operatively treated displaced tibial eminence fractures.…”

Section: Introductionmentioning

confidence: 98%

Treatment of Tibial Eminence Fractures: A Systematic Review

et al. 2014

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Fractures of the tibial eminence are rare, accounting for less than 1% of the injuries involving the anterior cruciate ligament (ACL). Most agree that nondisplaced fractures can be managed nonoperatively, but debate exists over the ideal treatment of displaced fractures. This systematic review evaluates the outcome of nonoperatively and operatively managed displaced tibial eminence fractures. The PubMed, Embase, and Cochrane databases were queried. Inclusion criteria included reported outcomes of displaced tibial eminence fractures, minimum 2-year follow-up, and English language. Outcomes reported were pooled and included the following: clinical instability (Lachman/anterior drawer, pivot shift, and KT 1000), patient-reported pain and/or instability, return to sport, Lysholm, Tegner, and the need for ACL reconstruction. Comparison was made in the outcomes of nonoperatively and operatively treated fractures and between suture and screw fixation techniques. Overall 16 studies met the inclusion criteria. The pooled mean age was 23 years and mean follow-up was 35 months. Clinical instability was seen in 70% of nonoperatively treated patients and 14% of operatively treated patients (p < 0.0001). Patient-reported instability was higher in nonoperatively treated patients (54 vs. 1.2%, p < 0.0001), as was the rate of ACL reconstruction (10 vs. 1.0%, p = 0.036). In comparing suture fixation to screw fixation, patient-reported instability and the rate of ACL reconstruction were equivalent. Patients treated with screw fixation had a higher incidence of clinically measured instability (Lachman and KT arthrometer) and an increased rate of hardware removal (3.9 vs. 64.9%, p < 0.05). Surgically managed patients report less instability, are higher functioning, and require fewer ACL reconstructions when compared with nonoperatively treated patients. Suture fixation was associated with improvements in clinical measures of stability and decreased need for hardware removal; however, patient perception of stability and need for ACL reconstruction was no different between the two treatment methods.

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Section: Introductionmentioning

confidence: 98%

Treatment of Tibial Eminence Fractures: A Systematic Review

et al. 2014

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“…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]. Typically some sort of visualization is required to reduce the fracture fragment as there is a high likelihood of entrapment of the intermeniscal ligament or the anterior horn of the medial or lateral meniscus [12,84].…”

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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“…7 Tibial eminence fractures Tibial eminence fractures are most commonly seen in children aged 8e17 years and represent 14% of anterior cruciate ligament injuries. 8 Classified by Meyers and McKeevers into 3 types based on degree of displacement and position of the fracture fragment, most commonly they are of the displaced type. 9 The injury is usually sustained during sporting activities, particularly football or skiing, and is associated with bone bruising typical of that occurring with an ACL rupture in 90% of cases, suggesting a similar mechanism of injury.…”

Section: Tibial Tuberosity Fracturesmentioning

confidence: 99%

“…Although both have similar biomechanical properties, suture fixation has been shown to undergo deformation with cyclical loading, which may result in postoperative ACL laxity. 8 The main disadvantage of screw fixation is the requirement to cross the physis, and the associated risk of growth arrest.…”

Section: Tibial Tuberosity Fracturesmentioning

confidence: 99%