Clinical outcome of arthroscopic fixation of anterior tibial eminence avulsion fractures in skeletally mature patients

Pan, Ru-Yu; Yang, Jui-Jung; Chang, Jen-Huei; Shen, Hsain-Chung; Lin, Leou-Chyr; Lian, Yu-Tung

doi:10.1097/ta.0b013e3182319d5a

Cited by 38 publications

(50 citation statements)

References 24 publications

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“…The remaining 13 studies assessed the outcomes of operatively treated fractures only (►Table 1). 2,3,9,10,13,18,19,[21][22][23][24][25][26][27][28][29] A total of 308 knees were included in the analysis, 20 nonoperatively treated and 288 operatively treated. The minimum follow-up ranged from 2 to 12 years (pooled mean follow-up 35 months).…”

Section: Operative Versus Nonoperative Treatmentmentioning

confidence: 99%

“…[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. The available literature is limited to small cohorts of patients with low levels of evidence.…”

Section: Introductionmentioning

confidence: 99%

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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: Operative Versus Nonoperative Treatmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment of Tibial Eminence Fractures: A Systematic Review

et al. 2014

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“…16 To date, ACL treatments for many displaced tibial avulsion fractures are reported to yield unpleasant clinical results either with limited knee extension or slight anterior knee instability. 20,21 The main causes of these unfavorable results are related to improper reduction and unstable fixation in reducing the ACL tension. 20 Long-term postoperative restrictions are also considered as a risk factor for loss of knee motion.…”

Section: Discussionmentioning

confidence: 99%

Tension Band Wire Fixation Technique for Anterior Cruciate Ligament Tibial Avulsion Fracture: A New Fixation Technique

et al. 2018

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This study evaluated clinical results of tension band wire fixation technique in the arthroscopic treatment of anterior cruciate ligament (ACL) tibial avulsion fracture. This study included 148 cases of ACL tibial avulsion fracture treated using arthroscopic tension band wire fixation technique. Patients were followed up for 25 to 36 months with an average of 27 months and evaluated in accordance with the International Knee Documentation Committee (IKDC) and Lysholm knee scoring scale. Fractures were united within 3 months after surgery in all cases. During the last follow-up, the anterior drawer, Lachman, and pivot shift tests showed negative, except for eight patients who had a 1-degree positive anterior drawer test. KT-1000 knee stability test showed no anterior instability exceeding 2 mm in 132 patients and 4 mm in 8 patients. In accordance with the IKDC scale, the knees of 132 patients were graded normal, whereas 8 other patients were nearly normal. Lysholm scores before surgery and during the last follow-up were 72.4 ± 3.2 and 97.5 ± 2.2, respectively. Statistically significant differences were observed among the Lysholm scores ( < 0.05). The Tegner scores were 6.5 ± 0.9 before injury and 6.4 ± 0.7 at the last follow-up ( > 0.05). No statistically significant differences between the preinjury and postoperative activity level were observed. All patients were satisfied with the outcomes of operation. Arthroscopic treatment of ACL tibial avulsion fracture by using tension band wire fixation technique ensures fracture healing and restores the stability and function of the joint in most patients. The level of evidence for this study is III.

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“…Avulsion fractures of the ACL are uncommon injuries that occur mainly in adolescents or young adults during sporting activities or even bicycle or car accidents. 1,11 As mentioned earlier, their management has evolved from traditional open or mini-open techniques to completely arthroscopic techniques using sutures, screws, wires, anchors, or even buttons. 4,[6][7][8][9][10] When all previous methods are compared, screw fixation seems to have the most equivocal outcomes.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic 4-Point Suture Fixation of Anterior Cruciate Ligament Tibial Avulsion Fractures

Boutsiadis

Karataglis

Agathangelidis

et al. 2014

Arthroscopy Techniques

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Tibial eminence avulsion fractures are rare injuries occurring mainly in adolescents and young adults. When necessary, regardless of patient age, anatomic reduction and stable internal fixation are mandatory for fracture healing and accurate restoration of normal knee biomechanics. Various arthroscopically assisted fixation methods with sutures, anchors, wires, or screws have been described but can be technically demanding, thus elongating operative times. The purpose of this article is to present a technical variation of arthroscopic suture fixation of anterior cruciate ligament avulsion fractures. Using thoracic drain needles over 2.4-mm anterior cruciate ligament tibial guidewires, we recommend the safe and easy creation of four 2.9-mm tibial tunnels at different angles and at specific points. This technique uses thoracic drain needles as suture passage cannulas and offers 4-point fixation stability, avoiding potential complications of bony bridge fracture and tunnel connection.

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Clinical outcome of arthroscopic fixation of anterior tibial eminence avulsion fractures in skeletally mature patients

Cited by 38 publications

References 24 publications

Treatment of Tibial Eminence Fractures: A Systematic Review

Treatment of Tibial Eminence Fractures: A Systematic Review

Tension Band Wire Fixation Technique for Anterior Cruciate Ligament Tibial Avulsion Fracture: A New Fixation Technique

Arthroscopic 4-Point Suture Fixation of Anterior Cruciate Ligament Tibial Avulsion Fractures

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