Tibial eminence fractures in the paediatric population: A systematic review

Coyle, Christy; Jagernauth, Simond; Ramachandran, Manoj

doi:10.1007/s11832-014-0571-6

Cited by 70 publications

(70 citation statements)

References 37 publications

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“…In the absence of pertinent guidelines, the management of this injury in children and adolescents is influenced by the management of such injuries of ACL, which occur in adult patients. If the avulsed fragment of PCL attachment is not displaced or is minimally displaced, non-operative treatment can be suggested with good outcomes [19].…”

Section: Discussionmentioning

confidence: 99%

An Unusual Complex Posterolateral Osteoligamentous Injury of the Knee in an Adolescent

Sodavarapu

Kumar

Guduru

et al. 2020

Cureus

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We present an unusual and complex case of a 16-year-old adolescent male who injured his right knee and sustained combined avulsion injuries of posterior cruciate ligament (PCL) at the tibial insertion site, iliotibial band at lateral tibial condyle, and lateral collateral ligament (LCL) at femoral insertion site akin to osteoligamentous posterolateral corner injury. Anatomical reduction of the femoral LCL avulsion fragment was performed and fixed with a two 4-mm partially threaded cancellous screw. Iliotibial band avulsion was buttressed using Ellis t-plate and fixed with two 4-mm partially threaded cancellous screws. PCL avulsion fracture was conservatively treated owing to minimal displacement. At one-year follow-up, the patient was pain free with a range of motion of 0 to 150 degrees of flexion and had a pain free knee with no instability. Posterolateral corner injury in the patient was very significant as it involved LCL avulsion and iliotibial band avulsion, both of which are part of the posterolateral structures of the knee and also involve the growth plate. Fixation of the avulsion of Gerdy's tubercle with the buttress plate helps to provide additional stability to counteract the deforming forces of the iliotibial band. LCL is also the major stabilizer against varus forces, and hence fixation is required for stability while preventing growth disturbance. PCL avulsion can be treated conservatively in those patients where the fragment is undisplaced or minimally displaced. A good outcome can be achieved in skeletally immature patients who have osteoligamentous posterolateral corner injuries with associated avulsion fractures by using appropriate anatomical reduction and surgical fixation.

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Section: Discussionmentioning

confidence: 99%

An Unusual Complex Posterolateral Osteoligamentous Injury of the Knee in an Adolescent

Sodavarapu

Kumar

Guduru

et al. 2020

Cureus

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“…Although variety of implants (screws, staples, wires, anchors, and sutures) have been used for arthroscopic fixation of tibial spine, but currently arthroscopic suture pull-out fixation seems to be the most preferred fixation method in all age groups. 15,18,19,22,24 Many biomechanical cadaveric studies prove that suture pull-out fixation method seems to possess superior fixation properties over other methods. [25][26][27] However, few authors claim that suture fixation method has a higher chance of failure.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Suture Pull-Out Fixation of Displaced Tibial Spine Avulsion Fracture

et al. 2016

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The aim of this study is to assess the clinical and radiological outcomes of arthroscopic reduction and fixation of tibial spine avulsion in patients with either open physis or closed physis, using high strength nonabsorbable sutures utilizing intravenous cannula needle as suture passer and retriever. Twenty-six patients of mean age 24.5 years were included in the study with a mean follow-up period of 31 months. Twelve patients had McKeever type III avulsion fracture and 14 had type IV. A follow-up analysis was performed using fracture union time, range of motion assessment, and Lysholm and IKDC (International Knee Documentation Committee) scores with instrumental (KT-1000 arthrometer) laxity assessment. All avulsion fractures showed union at the end of a 3-month follow-up. Mean (± standard deviation [SD]) postoperative Lysholm and IKDC subjective scores were 97.7 (± 3.62, range, 89-100) and 95.55 (± 4.21, 82.8-100), respectively. All patients were graded IKDC grade A except one with grade B. The Lysholm score of open physis group was better than the closed physis group (99.6 vs. 96.5, < 0.03), whereas IKDC scores of open versus closed physis group (both subjective and objective) and type III and IV McKeever groups did not reveal any statistical difference. KT-1000 assessment revealed mean (± SD) anterior translation of the tibia as 0.85 (±0.9) mm. At the final follow-up, all patients achieved complete range of movement with no symptom of instability. Two patients underwent adhesiolysis for postoperative stiffness in their knee at 4th month postoperatively. Arthroscopic suture pull-out fixation for type III and IV tibial spine avulsion results in excellent clinical and radiological outcomes in patient with open and closed physis without any significant complications. This is a prospective case series with level of evidence IV.

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“…Comminutedtibial spine fractures still pose a great challenge to manage being technically demanding procedure. They are more common in children and the adolescent age group [10]. Achieving the biomechanics of the knee joint congruity and ligament integrity are the aims of the treatment.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic suture fixation of comminuted tibial spine fractures-a prospective study

et al. 2016

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Introduction: Tibial spine fractures are common injuries and various techniques have been described for the fixation. The purpose of the article is to make familiar with thearthroscopic fixation of the anterior cruciate ligament bony avulsion injuries using non absorbable sutures and simple methods and instruments. Adequate reduction, anterior cruciate ligament integrity and regaining the bio-mechanics of the knee are the ultimate goal to be achieved failing which non union and malunion ensues. This technique has resulted in achieving excellent results and thus avoiding complications like joint laxity, flexion deformity & pain. Methods: Twenty one patients underwent arthroscopic suture fixation of the comminutedtibial spine fractures. Mean age of the patient was 24.28 years (range 16 to 38 years). All of the patients belonged to the Meyer type IV. The mean duration of follow up was 15.5 months with a minimum of one year follow-up. Results: All patients showed negative Lachman test except one having grade 1 positive lachman. No patient showed extension loss. 90.4 % (n=19) patients had an IKDC grade A while two patients belonged to grade B. All patients returned to their previous activity level. Conclusion: The above excellent results show that arthroscopic suture fixation of the comminutedtibial spine is promising and reliable technique to achieve the best biomechanics of the knee.

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Tibial eminence fractures in the paediatric population: A systematic review

Cited by 70 publications

References 37 publications

An Unusual Complex Posterolateral Osteoligamentous Injury of the Knee in an Adolescent

An Unusual Complex Posterolateral Osteoligamentous Injury of the Knee in an Adolescent

Arthroscopic Suture Pull-Out Fixation of Displaced Tibial Spine Avulsion Fracture

Arthroscopic suture fixation of comminuted tibial spine fractures-a prospective study

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