Long-term Outcomes of Tibial Spine Avulsion Fractures After Open Reduction With Osteosuturing Versus Arthroscopic Screw Fixation: A Multicenter Comparative Study

Abstract

Background: More information is needed regarding return to preinjury sport levels and patient-reported outcomes after tibial spine avulsion (TSA) fracture, which is most common in children aged 8 to 12 years. Purpose: To analyze return to play/sport (RTP), subjective knee-specific recovery, and quality of life in patients after TSA fracture treated with open reduction with osteosuturing versus arthroscopic reduction with internal screw fixation. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 61 patients <16 years old with TSA fracture treated via open reduction with osteosuturing (n = 32) or arthroscopic reduction with screw fixation (n = 29) at 4 institutions between 2000 and 2018; all patients had at least 24 months of follow-up (mean ± SD, 87.0 ± 47.1 months; range, 24-189 months). The patients completed questionnaires regarding ability to return to preinjury-level sports, subjective knee-specific recovery, and health-related quality of life, and results were compared between treatment groups. Univariate and multivariate logistic regression analyses were conducted to determine variables associated with failure to return to preinjury level of sport. Results: The mean patient age was 11 years, with a slight male predominance (57%). Open reduction with osteosuturing was associated with a quicker RTP time than arthroscopy with screw implantation (median, 8.0 vs 21.0 weeks; P < .001). Open reduction with osteosuturing was also associated with a lower risk of failure to RTP at preinjury level (adjusted odds ratio, 6.4; 95% CI, 1.1-36.0; P = .035). Postoperative displacement >3 mm increased the risk of failure to RTP at preinjury level regardless of treatment group (adjusted odds ratio, 15.2; 95% CI, 1.2-194.9; P = .037). There was no difference in knee-specific recovery or quality of life between the treatment groups. Conclusion: Open surgery with osteosuturing was a more viable option for treating TSA fractures because it resulted in a quicker RTP time and a lower rate of failure to RTP as compared with arthroscopic screw fixation. Precise reduction contributed to improved RTP.

Tibial Spine Avulsion Fractures in Paediatric Patients: A Systematic Review and Meta-Analysis of Surgical Management

“…Twelve studies reported outcomes with the use of sutures only, of which nine studies used ARIF [ 11 , 13 , 16 , 31 , 32 , 37 , 45 , 46 , 48 ], and three studies used both ARIF and ORIF [ 17 , 19 , 38 ]. Four studies directly compared the use of sutures with the use of screws [ 12 , 14 , 22 , 34 ].…”

“…A representation of this can be seen in Figure 4. After pooling the outcomes of the studies comparing screw and suture interventions [12,22], the results revealed a significantly increased risk of screw fixation over suture fixation for post-operative pain (OR [95% CI] = 28.75 [2.45, 337.10], p = 0.007). A representation of this can be seen in Figure 4.…”

“…See Figure 5. The pooled data from the studies comparing screw and suture fixation [14,22] revealed a significantly increased risk of post-operative knee instability with screw fixation over suture fixation (OR [95% CI] = 14.31 [4.09, 50.05], p < 0.0001). See Figure 5.…”

Management and Outcomes of Tibial Eminence Fractures in the Pediatric Population: A Systematic Review

“…ORIF demonstrated a higher Lysholm score compared to the ARIF technique. Indeed, as Jääskelä et al showed, children who underwent open surgery for TEF usually have a quicker return to play/sports [ 34 ].…”