Suture versus screw fixation technique for tibial eminence fracture: A meta-analysis of laboratory studies

Ye, Mao; Chen, Jun; Hu, Feng; Liu, Yanxi; Tan, Yang

doi:10.1177/2309499020907977

Cited by 3 publications

(4 citation statements)

References 42 publications

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“…5,33 Because soft tissue cut-through—or cheese-wiring—was the primary mode of suture fixation failure in our study, future studies could investigate whether suture tape constructs reduce this mode of failure and improve biomechanical outcomes. Regarding screw fixations, Ye et al 36 recently conducted a meta-analysis of studies comparing single-screw fixation versus the FiberWire suture fixation described in our study, concluding that suture fixation was superior across the spectrum of biomechanical properties. 6,9,11,20,26,29 Eggers et al 9 and Thome et al, 34 who studied skeletally mature porcine knees, concluded that the ultimate failure load of 2-screw fixation was approximately half that of FiberWire suture fixation.…”

Section: Discussionmentioning

confidence: 59%

“…These low failure loads seen in pediatric specimens throughout this study have potential implications for postoperative rehabilitation protocols. For example, biomechanical studies in adults have found that in situ forces on the ACL-tibial spine complex can reach up kk References 2,3,6,9,15,20,[27][28][29]34,36. {{ to 303 N during early rehabilitation activities, such as contralateral toe-off during walking. 30 Because no reports of biomechanical forces on the pediatric ACL-tibial spine complex during early rehabilitation are available, we are unable to provide quantitative recommendations about the specific rehabilitation protocols that pediatric patients with TSFs should undergo.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies, as well as a recent systematic review of repair using 1 screw versus repair using 1 high–tensile strength suture in porcine or adult human bone, suggest that suture fixation is superior to screw fixation. 36 However, pediatric bone has different biomechanical properties than porcine or adult human bone, including lower density and decreased ultimate stress before failure, which could influence the success of different TSF fixation techniques. 8,12,32 A recent study in skeletally immature porcine bone found no difference between 2-screw and 2-suture fixation.…”

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confidence: 99%

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Screws or Sutures? A Pediatric Cadaveric Study of Tibial Spine Fracture Repairs

Johnstone,

Baird,

Cuellar-Montes

et al. 2023

Am J Sports Med

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Background: Tibial spine fractures are common in the pediatric population because of the biomechanical properties of children’s subchondral epiphyseal bone. Most studies in porcine or adult human bone suggest that suture fixation performs better than screw fixation, but these tissues may be poor surrogates for pediatric bone. No previous study has evaluated fixation methods in human pediatric knees. Purpose: To quantify the biomechanical properties of 2-screw and 2-suture repair of tibial spine fracture in human pediatric knees. Study Design: Controlled laboratory study. Methods: Cadaveric specimens were randomly assigned to either 2-screw or 2-suture fixation. A standardized Meyers-Mckeever type 3 tibial spine fracture was induced. Screw-fixation fractures were reduced with two 4.0-mm cannulated screws and washers. Suture-fixation fractures were reduced by passing 2 No. 2 FiberWire sutures through the fracture fragment and the base of the anterior cruciate ligament. Sutures were secured through bony tunnels over a 1-cm tibial cortical bridge. Each specimen was mounted at 30° of flexion. A cyclic loading protocol was applied to each specimen, followed by a load-to-failure test. Outcome measures were ultimate failure load, stiffness, and fixation elongation. Results: Twelve matched pediatric cadaveric knees were tested. Repair groups had identical mean (8.3 years) and median (8.5 years) ages and an identical number of samples of each laterality. Ultimate failure load did not significantly differ between screw (mean ± SD, 143.52 ± 41.9 7 N) and suture (135.35 ± 47.94 N) fixations ( P = .760). Screws demonstrated increased stiffness and decreased elongation, although neither result was statistically significant at the .05 level (21.79 vs 13.83 N/mm and 5.02 vs 8.46 mm; P = .076 and P = .069, respectively). Conclusion: Screw fixation and suture fixation of tibial spine fractures in human pediatric tissue were biomechanically comparable. Clinical Relevance: Suture fixations are not biomechanically superior to screw fixations in pediatric bone. Pediatric bone fails at lower loads, and in different modes, compared with adult cadaveric bone and porcine bone. Further investigation into optimal repair is warranted, including techniques that may reduce suture pullout and “cheese-wiring” through softer pediatric bone. This study provides new biomechanical data regarding the properties of different fixation types in pediatric tibial spine fractures to inform clinical management of these injuries.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Screws or Sutures? A Pediatric Cadaveric Study of Tibial Spine Fracture Repairs

Johnstone,

Baird,

Cuellar-Montes

et al. 2023

Am J Sports Med

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“…In a biomechanical meta-analysis, no significant difference was found between suture and screw fixations in terms of stiffness and displacement after cyclic testing in adults. 33 In the only biomechanical study conducted for children, Johnstone et al 10 recently showed that suture and screw fixations of TEFs in pediatric human cadavers were biomechanically similar. Additionally, those authors found that pediatric bone fails at lower loads compared with adult cadaveric bone and porcine bone.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Functional Outcomes of Suture Versus Headless Screw Fixation for Tibial Eminence Fractures in Children

Ercan,

Arıcan,

Şibar

et al. 2024

Am J Sports Med

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Background: Suture and screw fixations are widely used to treat tibial eminence fractures (TEFs). Although a few biomechanical and clinical studies have compared suture fixation (SF) and screw fixation in the treatment of TEFs in children, no comparative clinical studies are available regarding headless screw fixation (HSF). Purpose: To evaluate the clinical and functional outcomes of children with TEF who underwent SF and HSF. Study Design: Cohort study; Level of evidence, 3. Methods: The study included 24 patients treated with either SF (11 patients) or HSF (13 patients) within 1 month of TEF (type 2 or 3) without associated ligamentous and bone injury between 2015 and 2020. All patients were evaluated at a minimum 2-year follow-up in terms of Lysholm score, Tegner activity level, International Knee Documentation Committee subjective score, and isometric strength test. Knee stability was compared based on the Lachman test, pivot-shift test, and KT-1000 arthrometer side-to-side difference. Results: No significant differences were found between the 2 groups in terms of Lysholm score, Tegner activity level, and International Knee Documentation Committee subjective score at follow-up. All patients were able to resume their daily activities within 6 months after the injury. However, flexion deficits (6°-10°) were found in 2 patients in the SF group and 1 patient in the HSF group, and extension deficits (3°-5°) were found in 3 patients in the SF group and 1 patient in the HSF group, without significant intergroup difference. Stability based on the Lachman test, pivot-shift test, and KT-1000 arthrometer side-to-side difference was also similar between the 2 groups at follow-up. No statistically significant difference was found between the 2 groups in isometric tests performed. Conclusion: The present study is the first to compare the clinical and functional results of SF and HSF techniques. The HSF technique demonstrated comparable clinical and functional outcomes, suggesting its potential as an alternative to the SF technique.

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