Tibial Spine Repair in the Pediatric Population: Outcomes and Subsequent Injury Rates

Abstract

To evaluate short-to mid-term outcomes after arthroscopic operative fixation of tibial spine fractures in pediatric patients, to determine the incidence of further ipsilateral and contralateral knee injuries, and to describe associated meniscal pathology and intraoperative findings at the time of tibial spine repair. Methods: All patients under age 18 with a tibial spine fracture treated arthroscopically at 1 institution by 2 surgeons from 2008 through 2019 were identified by Current Procedural Terminology codes. Patients at least 1 year from their date of surgery were contacted to complete a questionnaire, which included the International Knee Documentation Committee (IKDC) form. Questions pertained to knee function, pain, and further injury or surgery on either knee. Patient charts, preoperative imaging, and operative reports were reviewed to determine demographic information, tibial spine fracture type, concomitant injuries, and intraoperative details. Results: Sixty-six of 97 eligible patients (68%) completed questionnaires. Average age at initial surgery was 10.7 years (range, 4-17). Mean follow-up was 5.8 years (range, 1.0-11.9). Average IKDC score at follow-up was 91.4 (range, 62.1-100). Patients reported their knee as 92% of "normal" (range, 40-100). Thirty-five (53%) currently participate in sport; 6 (9%) remain limited because of instability and residual pain. Regarding pain on a visual analog scale, 94%, 95%, and 83% of patients reported less than a 3 at rest, with daily activity, and with sport, respectively. Seven patients (11%) had subsequent ACL rupture. Six patients (9%) underwent ACL reconstruction 3.1 years (range, 0.9-7) after initial repair. Fourteen patients (21%) required at least 1 additional procedure. Regarding the contralateral knee, there were no ACL or tibial spine injuries. Sixty-one (92%) patients were both satisfied and would definitely undergo the procedure again. Conclusions: Although many pediatric patients demonstrate excellent results after tibial spine repair at mean 5.8 years follow-up, 10.6% sustained an ipsilateral ACL rupture, and 21% required an additional procedure. No patient had a contralateral tibial spine or ACL injury. This is helpful when counseling patients regarding injury risk when returning to activity after tibial spine repair. Level of Evidence: Level IV, therapeutic case series.

A Technique for Arthroscopic Fixation of Tibial Eminence Avulsion Fractures: A Physeal-Sparing Construct With All-Suture Anchor Bridge Fixation

“…Good surgical outcomes have been reported with numerous techniques, including transphyseal and physeal-sparing single and double-row bony bridge suture fixation, tibial spine fixation with suture anchors, bioabsorbable nail fixation through arthroscopic portals, and screw fixation through arthroscopic portals. 2 , 3 , 4 , 5 , 6 Several of these techniques pass the suture through the ACL, which could compromise the integrity of the ligament. 2 , 3 , 4 ACL rupture after fixation of a tibial spine avulsion fracture can occur, but it is unclear whether this is related to suture passing through the ligament.…”

“… 2 , 3 , 4 ACL rupture after fixation of a tibial spine avulsion fracture can occur, but it is unclear whether this is related to suture passing through the ligament. 4 , 5 Another technique includes passing the suture through the fracture fragment, which could result in comminution of the piece and compromise fixation. 4 The Skyway Suture Bridge Technique provides suture bridge fixation and avoids passing the suture through both the ligament and the fragment.…”

“…Screw-fixation techniques include metal and bioabsorbable implants to reduce and maintain fracture reduction. 2 , 3 , 4 , 5 , 6 The cons of screw fixation include possible screw irritation, impingement, physeal damage, and potential need for hardware removal.…”

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

“…Eight studies were classified as level of evidence IV [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ] and 4 were classified as level of evidence III [ 23 , 24 , 25 , 26 ].…”

Fixation Strategy Does Not Affect Risk of Growth Disturbance After Surgical Treatment of Pediatric Tibial Spine Fracture

“… 2 , 3 , 4 , 5 Surgical treatment of tibial spine fractures is not without potential risk of complications, including infection, arthrofibrosis, anterior cruciate ligament injury, knee laxity, and meniscal injury. 6 , 7 , 8 , 9 , 10 , 11 , 12 …”