Tibial spine fractures: State of the art

Salvato, Damiano; Green, Daniel W.; Accadbled, Franck; Tuca, María

doi:10.1016/j.jisako.2023.06.001

Cited by 8 publications

(8 citation statements)

References 63 publications

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“…The Porcine Stifle joint mirrors the human knee, making it an apt surrogate for data collection. Moreover, pediatric and, specifically, adolescent ACL injuries typically manifest as tibial eminence avulsion fractures, mirroring our experimental observations, where the ACL detaches from its tibial insertion [ 40 ]. This highlights the ligament’s strength compared to the growing bone—particularly physeal plates, which are less robust than ligamentous crosslinked collagen bundles.…”

Section: Discussionsupporting

confidence: 83%

“…The scarcity of young and adolescent cadaveric specimens also limits ACL intrinsic biomechanics data [39]. While the biomechanical properties of the adult human ACL are well-established [40] the same is under explored for pediatric and immature ACLs. To bridge this gap, a few studies have attempted to enhance our understanding by examining the immature ACL in porcine models, which act as surrogate for the human pediatric ACL [14,[41][42][43][44].…”

Section: MMmentioning

confidence: 99%

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Effects of various load magnitudes on ACL: an in vitro study using adolescent porcine stifle joints

Koh,

Mungalpara,

Kim

et al. 2024

J Orthop Surg Res

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Introduction The escalating incidence of anterior cruciate ligament (ACL) injuries, particularly among adolescents, is a pressing concern. The study of ACL biomechanics in this demographic presents challenges due to the scarcity of cadaveric specimens. This research endeavors to validate the adolescent porcine stifle joint as a fitting model for ACL studies. Methods We conducted experiments on 30 fresh porcine stifle knee joints. (Breed: Yorkshire, Weight: avg 90 lbs, Age Range: 2–4 months). They were stored at − 22 °C and a subsequent 24-h thaw at room temperature before being prepared for the experiment. These joints were randomly assigned to three groups. The first group served as a control and underwent only the load-to-failure test. The remaining two groups were subjected to 100 cycles, with forces of 300N and 520N, respectively. The load values of 300N and 520N correspond to three and five times the body weight (BW) of our juvenile porcine, respectively. Result The 520N force demonstrated a higher strain than the 300N, indicating a direct correlation between ACL strain and augmented loads. A significant difference in load-to-failure (p = 0.014) was observed between non-cyclically loaded ACLs and those subjected to 100 cycles at 520N. Three of the ten samples in the 520N group failed before completing 100 cycles. The ruptured ACLs from these tests closely resembled adolescent ACL injuries in detachment patterns. ACL stiffness was also measured post-cyclical loading by applying force and pulling the ACL at a rate of 1 mm per sec. Moreover, ACL stiffness measurements decreased from 152.46 N/mm in the control group to 129.42 N/mm after 100 cycles at 300N and a more significant drop to 86.90 N/mm after 100 cycles at 520N. A one-way analysis of variance (ANOVA) and t-test were chosen for statistical analysis. Conclusions The porcine stifle joint is an appropriate model for understanding ACL biomechanics in the skeletally immature demographic. The results emphasize the ligament’s susceptibility to injury under high-impact loads pertinent to sports activities. The study advocates for further research into different loading scenarios and the protective role of muscle co-activation in ACL injury prevention.

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Section: Discussionsupporting

confidence: 83%

Section: MMmentioning

confidence: 99%

Effects of various load magnitudes on ACL: an in vitro study using adolescent porcine stifle joints

Koh,

Mungalpara,

Kim

et al. 2024

J Orthop Surg Res

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“…This review demonstrated a higher overall complication risk with screw fixation—reoperation rates were higher due to the need for metalware in screw fixation. Screw fixation can increase the risk of anterior impingement and can damage the femoral notch, but this can be mitigated with the use of a bioabsorbable screw [ 59 ]. From the studies in the review, it appears that arthroscopic suture fixation is the most common practice.…”

Section: Discussionmentioning

confidence: 99%

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

Chandanani,

Jaibaji,

Jaibaji

et al. 2024

Children

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Background: Tibial spine avulsion fractures (TSAFs) account for approximately 14% of anterior cruciate ligament injuries. This study aims to systematically review the current evidence for the operative management of paediatric TSAFs. Methods: A search was carried out across four databases: MEDLINE, Embase, Scopus, and Google Scholar. Studies discussing the outcomes of the surgical management of paediatric TSAFs since 2000 were included. Results: Of 38 studies included for review, 13 studies reported outcomes of TSAF patients undergoing screw fixation only, and 12 studies used suture fixation only. In total, 976 patients underwent arthroscopic reduction and internal fixation (ARIF), and 203 patients underwent open reduction and internal fixation (ORIF). The risk of arthrofibrosis with the use of ARIF (p = 0.45) and screws (p = 0.74) for TSAF repair was not significant. There was a significantly increased risk of knee instability (p < 0.0001), reoperation (p = 0.01), and post-operative pain (p = 0.007) with screw fixation compared to sutures. Conclusions: While the overall benefits of sutures over screws and ARIF over ORIF are unclear, there is clear preference for ARIF and suture fixation for TSAF repair in practice. We recommend large-scale comparative studies to delineate long-term outcomes for various TSAF fixation techniques.

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“…Tibial spine avulsions (TSAs), once considered a rare event in the pediatric population, are actually relatively frequent in adolescents, with an annual incidence of 3 per 100,000 [1][2][3] as a consequence of a sports injury (e.g., skiing, cycling) but they can be encountered even in adults as a consequence of motor vehicle accidents [4][5][6]. Tibial spine avulsion injury, tibial eminence injury, tibial spine fracture, and anterior cruciate ligament (ACL) avulsion are multiple terms that express the same pathological condition.…”

Section: Introductionmentioning

confidence: 99%

Technical Note: Tibial Spine Avulsion Treatment with Arthroscopic Reduction and Internal Fixation with Kirschner Wires in Skeletally Immature Patients

Calvisi,

Romanini,

Staniscia

et al. 2023

Healthcare

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Introduction: Tibial spine avulsion injury, tibial eminence injury, tibial spine fracture, and anterior cruciate ligament (ACL) avulsion are multiple terms that express the same pathological condition. It can be encountered both in the pediatric and adult population. A wide array of surgical techniques have been proposed to manage displaced tibial spine avulsions. Anyway, insufficient evidence is currently available to prefer one fixation technique over another, and a gold-standard arthroscopy-based technique is still missing. In this article, we describe a mini-invasive, safe and user-friendly technique for arthroscopic reduction and internal fixation of displaced tibial eminence fractures. Materials and methods: Standard and patient-specific accessory arthroscopic portals allow for full access to knee visualization and management of concomitant intraarticular lesions. After performing the debridement of the inflammatory tissue and the release of eventual interposed tissues in the fracture site, the tibial eminence avulsion can be reduced by using a less-invasive bone impactor. With the knee flexed to 90°, the fracture fragments are then synthesized (under fluoroscopic control) with three thin Kirschner wires inserted in a proximal–distal direction in a cross-shaped geometry. Results: This technique allows a fast surgical and hospitalization time, a punctiform arthrotomy, proximal tibial physis preservation, and an early rehabilitation program. Conclusions: This novel technique seems attractive and very promising since it is respectful of the epiphyseal growth plates and is thus suitable for children and adolescents.

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Tibial spine fractures: State of the art

Cited by 8 publications

References 63 publications

Effects of various load magnitudes on ACL: an in vitro study using adolescent porcine stifle joints

Effects of various load magnitudes on ACL: an in vitro study using adolescent porcine stifle joints

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

Technical Note: Tibial Spine Avulsion Treatment with Arthroscopic Reduction and Internal Fixation with Kirschner Wires in Skeletally Immature Patients

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