Early Knee Range of Motion Following Operative Treatment for Tibial Tubercle Avulsion Fractures Is Safe

Abstract

Background: Tibial tubercle avulsion fractures (TTAF) often require surgical reduction and stabilization. Traditional teachings recommend postoperative knee immobilization for 4 to 6 weeks; however, the necessity of these restrictions is unclear and the actual practice varies. This study's purpose was to: (1) retrospectively review operatively managed TTAFs at a single center to examine the spectrum of postoperative rehabilitation guidelines, and (2) compare the outcomes of patients based on the timing of initiation of postoperative knee range of motion (ROM). Methods: Operatively managed TTAFs treated at a single center from 2011-2020 were identified. Patients with polytrauma, associated lower extremity compartment syndrome, or treatment other than screw fixation were excluded. Patient demographics, mechanism of injury, Ogden Classification, associated injuries, operative technique, postoperative ROM progression, and time to release to unrestricted activities were collected. Patients were grouped based on the initiation of postoperative ROM as Early (< 4 wk, EROM) or Late ( ≥ 4 wk, LROM). Bivariate analysis was used to compare characteristics between these 2 groups. Results: Study criteria identified 134 patients, 93.3% (n = 125) of whom were male. The mean age of the cohort was 14.77 years [95% confidence interval (CI: 14.5 to 15.0]. Forty-nine patients were designated EROM; 85 patients were categorized as LROM. The groups did not differ significantly with regards to age, race, injury characteristics, or surgical technique. Both groups progressed similarly with regards to postoperative range of motion. Ultimate activity clearance was achieved at ~20 weeks postoperatively without differences between groups (P > 0.05). Four instances of postoperative complication were identified, all of which occurred in the LROM group. Conclusion: A broad range of postoperative immobilization protocols exists following the screw fixation of TTAFs. Across otherwise similar cohorts of patients undergoing operative treatment, initiation of knee range of motion before 4 weeks was without complication and provided equivalent outcomes to traditional immobilization practices. Given the clear benefits to patients and caregivers provided by the permission of early knee motion and the avoidance of casting, providers should consider more progressive postoperative rehab protocols following operatively treated TTAFs.

Does Skeletal Maturity Predict the Pattern of Tibial Tubercle Avulsion Fracture?

“…Our patient sample, on average, resembled the prototypical TTAF patient that has been extensively described in the literature-a well-nourished, adolescent male engaged in explosive sporting activities. [28][29][30][31] However, unlike the cohort that Pandya used in 2012 to develop their classification system, our mean age did not increase between successive Pandya subtypes-there was a decrease in mean age from type B to C fractures. Although our analysis identified statistically significant differences across Pandya subtypes with respect to age, GRP, and stage of epiphyseal union, this significance was primarily driven by our Pandya A subcohort.…”

“…Our patient sample, on average, resembled the prototypical TTAF patient that has been extensively described in the literature—a well-nourished, adolescent male engaged in explosive sporting activities 28–31 . However, unlike the cohort that Pandya used in 2012 to develop their classification system, our mean age did not increase between successive Pandya subtypes—there was a decrease in mean age from type B to C fractures.…”

Tibial tubercle fractures are sports injuries in male adolescents with a considerable risk of complications and reoperations: a systematic review

“…Nine studies [1, 4, 7, 15, 20, 24, 30, 37, 41] included both surgically and conservatively treated fractures while 16 studies [2, 5, 6, 10, 12, 14, 16–19, 25, 27, 28, 32, 36, 40] included solely surgically treated patients. Surgical technical details can be found in (Table 5).…”

“…Symptomatic hardware was the most common complication, reported in 51 (5% total or 6% of surgical) cases. Growth arrest was reported in 15 (2% of total) cases [2, 4, 10, 15, 17, 20, 28]. Six cases of genu recurvatum, 3 cases of leg length discrepancy, 1 case of genu valgum and 5 cases of non‐specified growth disturbance were reported.…”

“…In total, 161(19% of surgical management) patients had further surgical procedures. The vast majority of the reoperations were hardware removals [149 cases, (18% of surgical management)] [2, 6, 12, 14–17, 19, 24, 27, 28, 40]. Time of hardware removal was reported only in 3 studies, standing at an average of 12.4 months after the fixation [2, 12, 40].…”