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 cod… Show more
“…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.…”
Section: Discussionmentioning
confidence: 99%
“… 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.…”
Section: Discussionmentioning
confidence: 99%
“…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.…”
“…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.…”
Section: Discussionmentioning
confidence: 99%
“… 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.…”
Section: Discussionmentioning
confidence: 99%
“…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.…”
“…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 ].…”
Background: Tibial eminence fractures (TEF) of Meyers–McKeever type II-III-IV usually require surgical management. No consensus in the literature has been achieved regarding the best treatment option. The aims of the present systematic review were (1) to analyze the current literature and describe the outcomes of surgical treatment for TEF; and (2) to compare the outcomes of different surgical options using arthroscopic reduction and internal fixation (ARIF) with sutures or screws and open reduction and internal fixation (ORIF). Methods: A search was carried out with Pubmed, Medline, and Cochrane. Key terms were used “tibial” AND “eminence” or “spine” or “intercondylar” AND “paediatric” or “children” AND “fracture” or “avulsion” AND “treatment”. Twelve articles met the inclusion criteria. Demographic data, clinical outcomes, and complication rates were evaluated for each study. Means/standard deviation and sum/percentage were used for continuous and categorical variables, respectively. Chi-square or t-student tests were applied. A p-value < 0.05 was considered statistically significant. Results: ORIF showed superior clinical outcomes (Tegner (p < 0.05) and Lysholm (p < 0.001) scores) relative to ARIF and a lower incidence of arthrofibrosis (p < 0.05) and implant removal (p < 0.01). The Tegner, IKDC, and Lysholm scores showed statistically significant superior results following arthroscopic sutures compared to arthroscopic screws (p < 0.001). The incidence of arthrofibrosis was higher after arthroscopic sutures (p < 0.05), the implant removal was higher after screw fixation (p < 0.001) Conclusions: Better clinical results with low complication rates were achieved with ORIF surgery rather than ARIF; arthroscopic suture fixation resulted in higher clinical results compared to arthroscopic screw fixation and reduced the incidence of postoperative complications.
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