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Silva R, Barreto J, Ferreira F, Areias M, Oliveira C, Alpoim B. Tibial Eminence Avulsion in a Tibial Plateau Fracture - Our Approach: A Clinical Case. Rev Bras Ortop 2024; 59:e318-e322. [PMID: 38606129 PMCID: PMC11006521 DOI: 10.1055/s-0041-1726067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/01/2020] [Indexed: 10/21/2022] Open
Abstract
A middle-aged female patient with a tibial plateau fracture combined with an avulsion of the tibial eminence was treated with a combination of medial plate fixation for the plateau and an arthroscopic aided nonabsorbable suture of the eminence. Our technique for tibial eminence avulsion fractures has no interference with tibial plateau osteosynthesis materials and has proven, once again, to have good results in the treatment of combined and complex injuries of the knee.
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Affiliation(s)
- Rómulo Silva
- Departamento de Ortopedia e Traumatologia, Unidade Local de Saúde do Alto Minho (ULSAM), Viana do Castelo, Portugal
| | - José Barreto
- Departamento de Medicina Física e Reabilitação, Centro Hospitalar Entre Douro e Vouga (CHEDV), Santa Maria da Feira, Portugal
| | - Filomena Ferreira
- Departamento de Ortopedia e Traumatologia, Unidade Local de Saúde do Alto Minho (ULSAM), Viana do Castelo, Portugal
| | - Margarida Areias
- Departamento de Ortopedia e Traumatologia, Unidade Local de Saúde do Alto Minho (ULSAM), Viana do Castelo, Portugal
| | - Carolina Oliveira
- Departamento de Ortopedia e Traumatologia, Unidade Local de Saúde do Alto Minho (ULSAM), Viana do Castelo, Portugal
| | - Bruno Alpoim
- Departamento de Ortopedia e Traumatologia, Unidade Local de Saúde do Alto Minho (ULSAM), Viana do Castelo, Portugal
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Williams NR, Yin S, Guzman AJ, Waldron P, Vallelanes E, Shin C, Chen JL. Tibial Spine Avulsion Repair With FiberRing Suture and Anterior Cruciate Ligament Repair TightRope. Arthrosc Tech 2023; 12:e2381-e2385. [PMID: 38196861 PMCID: PMC10773258 DOI: 10.1016/j.eats.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/13/2023] [Indexed: 01/11/2024] Open
Abstract
Tibial spine avulsion fractures occur predominantly in children and young adults and are an uncommon type of knee injury. To ensure knee stability and preserve range of motion with minimal knee laxity, it is essential to restore anterior cruciate ligament length through surgical reduction and fixation of the fracture. Achieving anatomic reduction of tibial spine avulsion fractures with an arthroscopic approach is a technically complex procedure. In this Technical Note and accompanying video, we describe a unique fixation repair of tibial spine avulsion fractures using Arthrex FiberRing sutures and an Arthrex ACL Repair TightRope. The technique presented is an effective method to reduce tibial spine avulsion fractures to anatomic position with a variable tensioning system that allows for a strong and secure fixation method.
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Affiliation(s)
| | - Sophia Yin
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - Alvarho J. Guzman
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - Patrick Waldron
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - Ethan Vallelanes
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - Caleb Shin
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - James L. Chen
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
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Chanlalit C, Mahasupachai N, Sakdapanichkul C. The Arthroscopic Three-Point Fixation for Anterior Cruciate Ligament Avulsion Fracture: Surgical Technique. Arthrosc Tech 2023; 12:e1679-e1685. [PMID: 37942113 PMCID: PMC10628130 DOI: 10.1016/j.eats.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/20/2023] [Accepted: 05/28/2023] [Indexed: 11/10/2023] Open
Abstract
Several arthroscopic repairs and fixation for tibial intercondylar eminence fracture have been developed for restoring anterior cruciate ligament function. Repairing the avulsion fragment with multiple-point fixation provides some benefits over a single-point fixation. It provides multidirectional force control, especially on the posterior part of the fragment, and produces area of compression. We propose a 3-point fixation technique for providing proper reduction and compression in large fragment anterior cruciate ligament avulsion fracture. This includes using hybrid intra-articular and tunnel pull-out suture fixation to provide good posterior reduction and fixation. The number of tunnels is decreased by using a suture anchor.
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Affiliation(s)
- Cholawish Chanlalit
- Center of Excellent in Upper Extremity Reconstruction and Sport Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Nattakorn Mahasupachai
- Center of Excellent in Upper Extremity Reconstruction and Sport Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Chidchanok Sakdapanichkul
- Center of Excellent in Upper Extremity Reconstruction and Sport Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
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Calvisi V, Romanini E, Staniscia D, Di Brigida G, Venosa M. Technical Note: Tibial Spine Avulsion Treatment with Arthroscopic Reduction and Internal Fixation with Kirschner Wires in Skeletally Immature Patients. Healthcare (Basel) 2023; 11:2404. [PMID: 37685438 PMCID: PMC10486765 DOI: 10.3390/healthcare11172404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
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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Affiliation(s)
- Vittorio Calvisi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Via Vetoio Coppito 2, 67100 L’Aquila, Italy; (V.C.)
- UOSD, Department of Mini-Invasive and Computer-Assisting Orthopedic Surgery, San Salvatore Hospital, Via L. Natali 1, 67100 L’Aquila, Italy
| | - Emilio Romanini
- RomaPro, Polo Sanitario San Feliciano, Via Mattia Battistini, 44, 00167 Rome, Italy
- GLOBE, Italian Working Group on Evidence-Based Orthopedics, Via Nicola Martelli, 3, 00197 Rome, Italy
| | - Donato Staniscia
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Via Vetoio Coppito 2, 67100 L’Aquila, Italy; (V.C.)
| | - Giovanni Di Brigida
- UOSD, Department of Mini-Invasive and Computer-Assisting Orthopedic Surgery, San Salvatore Hospital, Via L. Natali 1, 67100 L’Aquila, Italy
| | - Michele Venosa
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Via Vetoio Coppito 2, 67100 L’Aquila, Italy; (V.C.)
- RomaPro, Polo Sanitario San Feliciano, Via Mattia Battistini, 44, 00167 Rome, Italy
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Kelly S, DeFroda S, Nuelle CW. Arthroscopic Assisted Anterior Cruciate Ligament Tibial Spine Avulsion Reduction and Cortical Button Fixation. Arthrosc Tech 2023; 12:e1033-e1038. [PMID: 37533906 PMCID: PMC10390881 DOI: 10.1016/j.eats.2023.02.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/19/2023] [Indexed: 08/04/2023] Open
Abstract
Tibial spine avulsion fractures, or tibial eminence fractures, are intra-articular knee injuries that affect the bony attachment of the anterior cruciate ligament (ACL). It is commonly seen in children and adolescents aged 8 to 15 years old and can be caused by noncontact pivot shift injuries or by traumatic hyperextension knee injuries, as seen in adult ACL patients. A thorough history and physical exam is important in these patients alongside proper imaging that will confirm the diagnosis of a tibial spine avulsion. Proper imaging may also demonstrate other associated conditions or injuries to the cartilage, meniscus, or ligamentous structures. Following diagnosis, treatment can be both nonoperative versus operative, depending upon the degree of displacement and reducibility of the fragment, as well as other concomitant injuries. For nondisplaced or minimally displaced, and reducible injuries, the patient can be immobilized in full extension for several weeks. For displaced fragments that are unable to be reduced by closed methods, open reduction internal fixation or arthroscopic fixation is recommended. In this Technical Note, we describe an arthroscopy-assisted reduction and internal fixation with suture tape through 2 transtibial tunnels with a cortical suture button fixation technique.
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Affiliation(s)
| | | | - Clayton W. Nuelle
- Address correspondence to Clayton W. Nuelle, M.D., Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, 1100 Virginia Ave., Columbia, MO 65212, U.S.A.
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Jääskelä M, Turati M, Lempainen L, Bremond N, Courvoisier A, Henri A, Accadbled F, Sinikumpu J. Long-term Outcomes of Tibial Spine Avulsion Fractures After Open Reduction With Osteosuturing Versus Arthroscopic Screw Fixation: A Multicenter Comparative Study. Orthop J Sports Med 2023; 11:23259671231176991. [PMID: 37359980 PMCID: PMC10286196 DOI: 10.1177/23259671231176991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/22/2023] [Indexed: 06/28/2023] Open
Abstract
Background More information is needed regarding return to preinjury sport levels and patient-reported outcomes after tibial spine avulsion (TSA) fracture, which is most common in children aged 8 to 12 years. Purpose To analyze return to play/sport (RTP), subjective knee-specific recovery, and quality of life in patients after TSA fracture treated with open reduction with osteosuturing versus arthroscopic reduction with internal screw fixation. Study Design Cohort study; Level of evidence, 3. Methods This study included 61 patients <16 years old with TSA fracture treated via open reduction with osteosuturing (n = 32) or arthroscopic reduction with screw fixation (n = 29) at 4 institutions between 2000 and 2018; all patients had at least 24 months of follow-up (mean ± SD, 87.0 ± 47.1 months; range, 24-189 months). The patients completed questionnaires regarding ability to return to preinjury-level sports, subjective knee-specific recovery, and health-related quality of life, and results were compared between treatment groups. Univariate and multivariate logistic regression analyses were conducted to determine variables associated with failure to return to preinjury level of sport. Results The mean patient age was 11 years, with a slight male predominance (57%). Open reduction with osteosuturing was associated with a quicker RTP time than arthroscopy with screw implantation (median, 8.0 vs 21.0 weeks; P < .001). Open reduction with osteosuturing was also associated with a lower risk of failure to RTP at preinjury level (adjusted odds ratio, 6.4; 95% CI, 1.1-36.0; P = .035). Postoperative displacement >3 mm increased the risk of failure to RTP at preinjury level regardless of treatment group (adjusted odds ratio, 15.2; 95% CI, 1.2-194.9; P = .037). There was no difference in knee-specific recovery or quality of life between the treatment groups. Conclusion Open surgery with osteosuturing was a more viable option for treating TSA fractures because it resulted in a quicker RTP time and a lower rate of failure to RTP as compared with arthroscopic screw fixation. Precise reduction contributed to improved RTP.
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Affiliation(s)
- Maija Jääskelä
- Department of Pediatric Orthopaedics and Surgery, Oulu University Hospital; Research Unit of Clinical Medicine, University of Oulu; and Medical Research Center, Oulu, Finland
| | - Marco Turati
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Ripoll y De Prado FIFA Medical Centre of Excellence, Madrid, Spain
| | - Lasse Lempainen
- Ripoll y De Prado FIFA Medical Centre of Excellence, Madrid, Spain
- FinnOrthopaedics/Hospital Pihlajalinna, Turku, Finland
- Department of Physical Activity and Health, Paavo Nurmi Centre, University of Turku, Turku, Finland
| | - Nicolas Bremond
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Paediatric Orthopaedic Surgery, Hospital Couple Enfant, Grenoble Alpes University, Grenoble, France
| | - Aurelien Courvoisier
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Paediatric Orthopaedic Surgery, Hospital Couple Enfant, Grenoble Alpes University, Grenoble, France
| | - Antoine Henri
- Unité de Médecine du Sport, Centre Hospitalier Francois Mitterand de Pau, Pau, France
| | - Franck Accadbled
- Department of Orthopaedic Surgery, Hôpital des Enfants, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jaakko Sinikumpu
- Department of Pediatric Orthopaedics and Surgery, Oulu University Hospital; Research Unit of Clinical Medicine, University of Oulu; and Medical Research Center, Oulu, Finland
- Hospital TerveysTalo, Oulu, Finland
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Zhang L, Xia Q, Yang R, Fan L, Hu Y, Fu W. Anatomical factors associated with the development of anterior tibial spine fractures based on MRI measurements. J Orthop Surg Res 2023; 18:357. [PMID: 37173712 PMCID: PMC10182680 DOI: 10.1186/s13018-023-03836-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Numerous studies have investigated anatomic factors for anterior cruciate ligament (ACL) injuries, such as posterior tibial slope (PTS) and notch width index (NWI). However, anterior tibial spine fracture (ATSF) as a specific pattern of ACL injury, a bony avulsion of the ACL from its insertion on the intercondylar spine of the tibia, has rarely been explored for its anatomical risk factors. Identifying anatomic parameters of the knee associated with ATSF is important for understanding injury mechanisms and prevention. METHODS Patients who underwent surgery for ATSF between January 2010 and December 2021 were retrospectively reviewed, and 38 patients were included in the study group. Thirty-eight patients who suffered from isolated meniscal tear without other pathologic findings were matched in a 1:1 fashion by age, sex and BMI to the study group. The lateral posterior tibial slope (LPTS), medial posterior tibial slope (MPTS), medial tibial depth, lateral tibial height, lateral femoral condyle ratio (LFCR) and NWI were measured and compared between the ATSF and control groups. Binary logistic regressions identified independent predictors of ATSF. Receiver operator characteristic (ROC) curves were performed to compare the diagnostic performance and determine the cutoff values of associated parameters. RESULTS The LPTS, LFCR and MPTS were significantly larger in the knees in the ATSF group than in the control group (P = 0.001, P = 0.012 and P = 0.005, respectively). The NWI was significantly smaller in the knees in the ATSF group than in the control group (P = 0.005). According to the results of logistic regression analysis, the LPTS, LFCR and NWI were independently associated with ATSF. The LPTS was the strongest predictor variable, and the ROC analysis revealed 63.2% sensitivity and 76.3% specificity (area under the curve, 0.731; 95% CI 0.619-0.844) for values above 6.9. CONCLUSION The LPTS, LFCR and NWI were found to be associated with the ATSF; in particular, LPTS could provide the most accurate predictive performance. The findings of this study may aid clinicians in identifying people at risk for ATSF and taking individualized preventive measures. However, further investigation regarding the pattern and biomechanical mechanisms of this injury is required.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Qinghong Xia
- Operating Room of Anesthesia Surgery Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Runze Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Fan
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yunan Hu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Weili Fu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
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Sun C, Du R, Luo S, Chen L, Ma Q, Cai X. A New Arthroscopic Tightrope Suture-Button Fixation Procedure for Tibial Eminence Avulsion Fracture. J Knee Surg 2023; 36:132-138. [PMID: 34187070 DOI: 10.1055/s-0041-1731326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This case-series outcome study presents a new arthroscopic technique for tibial eminence avulsion fracture (TEAF) with double-tunnel using two tightrope suture buttons. From May 2017 to July 2020, we performed a new arthroscopic technique for TEAF with double tunnels, using two tightrope suture buttons on 13 patients. Clinical assessments included anterior drawer, Lachman, and pivot shift tests, the International Knee Documentation Committee (IKDC), Lysholm knee scores, visual analog scale (VAS) scores, and range of motion (ROM). An independent observer noted conditions before surgery and during the last follow-up. The patients had an average follow-up of 26.2 months, ranging from 15 to 37 months. During the last postsurgical follow-up, the anterior drawer, Lachman, and pivot shift tests were negative in all the cases. According to the IKDC, Lysholm, and VAS final scores, all patients presented a significant knee function improvement at last follow-ups compared with preoperatively. The study shows that satisfactory results about an anatomic reduction of the fragment, knee stability, function, and strength can be achieved with the new arthroscopic technique for TEAF with double tunnels using two tightrope suture buttons. This study is a therapeutic case series and its level of evidence is IV.
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Affiliation(s)
- Changjiao Sun
- Department of Orthopaedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Ruiyong Du
- Department of Orthopaedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Song Luo
- Southern Medical District of Chinese PLA General Hospital, Beijing, China
| | - Lianxu Chen
- Department of Orthopaedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Qi Ma
- Department of Orthopaedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xu Cai
- Department of Orthopaedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Nikmatullah H, Hernugrahanto KD. Arthroscopic reduction of adult comminuted tibial eminence avulsion with single tunnel pull-through suture fixation: A case report of technical note. Int J Surg Case Rep 2022; 99:107616. [PMID: 36099769 PMCID: PMC9568722 DOI: 10.1016/j.ijscr.2022.107616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction and importance Case presentation Clinical discussion Conclusion Operative treatment is highly recommended for comminuted tibial eminence avulsion fractures. Arthroscopic-assisted reduction becomes the treatment of choice in these injuries. But the most optimal procedure of arthroscopic reduction and suture fixation technique still remains uncertain.
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Affiliation(s)
- Hudaya Nikmatullah
- Fellowship of Indonesia Hip and Knee Society, Department of Orthopaedic and Traumatology, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Kukuh Dwiputra Hernugrahanto
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Hospital, Surabaya, Indonesia.
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Arthroscopic Reduction of Bicruciate Tibial Avulsion Fractures: Lever Push Technique. Arthrosc Tech 2022; 11:e1525-e1530. [PMID: 36185125 PMCID: PMC9519939 DOI: 10.1016/j.eats.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/19/2022] [Indexed: 02/03/2023] Open
Abstract
Combined anterior cruciate ligament and posterior cruciate ligament tibial avulsion fractures are rare knee injuries that are primarily seen in adults. Prompt surgical intervention is indicated for displaced fractures to restore knee stability. Arthroscopic techniques are now the preferred method for treating anterior tibial spine avulsion fractures with posterior cruciate ligament tibial avulsion fractures being treated arthroscopically or with open reduction and internal fixation methods. This Technical Note and accompanying video demonstrate an arthroscopically assisted repair of bicruciate tibial avulsion fractures using an arthroscopic lever push technique. Two sutures are passed through the anterior cruciate ligament and pulled down through two bone tunnels placed within the tibial fracture bed, and one suture is passed around the posterior cruciate ligament and pulled down through one bone tunnel passing from the anterior tibia to the tibial fracture bed. Our technique is simple and effective in reducing bicruciate tibial avulsion fractures to anatomic position.
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Albertson B, Beynnon B, Endres N, Johnson R. Incidence of anterior tibial spine fracture among skiers does not differ with age. Knee Surg Sports Traumatol Arthrosc 2022; 30:2291-2297. [PMID: 34800136 PMCID: PMC9310445 DOI: 10.1007/s00167-021-06782-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Injury to the anterior cruciate ligament (ACL) is common in alpine skiing in the form of either an intra-substance ACL tear or anterior tibial spine fracture (ATSF). Anterior tibial spine fractures are typically reported in children. However, several case reports describe these injuries in adults while skiing. The purpose of this study is to describe the sport specific incidence of ATSF in alpine skiing. METHODS The study was conducted over a 22-year period. Skiers who suffered an ATSF were identified and radiographs were reviewed to confirm the diagnosis. Additionally, control data from intra-substance ACL injury groups were collected. The incidence of these injuries in children, adolescents, and adults (grouped as ages 0-10, 11-16, and 17 + years old, respectively) was evaluated and the risk factors for ATSF versus ACL tear were determined. RESULTS There were 1688 intra-substance ACL and 51 ATSF injuries. The incidence of intra-substance ACL injury was greater in adults (40.0 per 100,000 skier days) compared to the adolescent (15.4 per 100,000) and child (1.1 per 100,000) age groups. In contrast, the incidence of ATSF was similar in the adult (0.9 per 100,000), adolescent (1.9 per 100,000), and child (1.9 per 100,000) age groups. Loose ski boot fit was identified as a risk factor for ATSF. CONCLUSION The incidence of ATSF in alpine skiers is similar among all age groups. However, the incidence of intra-substance ACL injuries is far greater in adult skiers compared to adolescents and children. Risk factors for ATSF relate to compliance between the foot/ankle and the ski boot. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Benjamin Albertson
- Department of Orthopaedics and Rehabilitation, University of New Mexico Health Sciences Center, MSC10 5600, 1, Albuquerque, NM, 87131-0001, USA.
| | - Bruce Beynnon
- Department of Orthopaedics and Rehabilitation, University of Vermont Medical Center, Burlington, VT, USA
| | - Nathan Endres
- Department of Orthopaedics and Rehabilitation, University of Vermont Medical Center, Burlington, VT, USA
| | - Robert Johnson
- Department of Orthopaedics and Rehabilitation, University of Vermont Medical Center, Burlington, VT, USA
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Yuan L, Shi R, Chen Z, Ding W, Tan H. The most economical arthroscopic suture fixation for tibial intercondylar eminence avulsion fracture without any implant. J Orthop Surg Res 2022; 17:327. [PMID: 35752828 PMCID: PMC9233839 DOI: 10.1186/s13018-022-03219-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Avulsion fracture of the tibial intercondylar eminence is a rare injury, which mainly occurs in adolescents aged 8–14 years and in those with immature bones. The current commonly used surgery may result in severe surgical trauma, affecting knee joint function and accompanied by serious complications. In this study, we described an all-inside and all-epiphyseal arthroscopic suture fixation technique for a patient to treat tibial intercondylar eminence fracture. Methods ETHIBOND EXCEL-coated braided polyester sutures were used for fixation. Three ETHIBOND sutures were passed through the ACL at 2, 6 and 10 o’clock of the footprint of the ACL and made a cinch-knot loop separately. Under the guidance of ACL tibial locator, three corresponding tibial tunnels were drilled with K-wires at 2, 6 and 10 o’clock of the fracture bed, and the two ends of the suture were pulled out through the tunnel with double-folded steel wire heads. After reduction of the tibial eminence, three sutures were tightened and tied to the medial aspect of the tibial tubercle. Results After all the surgical treatments surgically performed by this method and following a standard postoperative protocol, our patient's ROM, stability, and functional structural scores all improved significantly. Conclusion This three-point suture technique provides a suitable reduction and stable fixation and is suitable for patients with all types of avulsion fractures of the tibial intercondylar eminence.
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Affiliation(s)
- Libo Yuan
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920Th Hospital, No. 212 Daguan Road, Xi Shan District, Kunming, 650032, Yunnan, China
| | - Rongmao Shi
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920Th Hospital, No. 212 Daguan Road, Xi Shan District, Kunming, 650032, Yunnan, China
| | - Zhian Chen
- Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Wei Ding
- College of Medicine Technology, Yunnan Medical Health College, Kunming, 650106, Yunnan, China
| | - Hongbo Tan
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920Th Hospital, No. 212 Daguan Road, Xi Shan District, Kunming, 650032, Yunnan, China.
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She Y, Guo D, Chen G, Xu Y. Therapeutic efficacy of arthroscopy-assisted transosseous fixation with the Versalok suture anchor for tibial eminence fractures in adults. Medicine (Baltimore) 2021; 100:e26284. [PMID: 34115031 PMCID: PMC8202665 DOI: 10.1097/md.0000000000026284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 05/04/2021] [Indexed: 01/04/2023] Open
Abstract
To investigate the clinical outcomes of arthroscopy-assisted transosseous fixation of tibial eminence fractures with the Versalok suture anchor in adults.A total of 23 adult cases of tibial eminence fractures treated between June 2016 and March 2019 were retrospectively analyzed. The results of the preoperative drawer test and Lachman test were positive. Radiography and computed tomography were performed before and after the procedure. Magnetic resonance imaging was performed in every patient after admission. Arthroscopy-assisted fracture reduction and Orthocord high-strength suture fixation with two Versalok anchors were performed in all the patients. The International Knee Documentation Committee scale and the Lysholm Knee Scoring Scale were used to evaluate outcomes during the follow-up period. Additionally, the KT-2000 knee stability test was performed.At the final follow-up, all the fractures had proceeded to bony union and no wound infection was observed. The average Lysholm Knee Score of the affected knees was 93.1 (range, 90-98), which was not significantly different from that of the healthy knees (t = 0.732, P = .132). Based on the International Knee Documentation Committee scale results, 21 patients were graded as normal and the other 2 patients were graded as nearly normal. The KT-2000 test showed that the anterior displacement of the affected side and the healthy side was less than 3.6 mm in all cases.The outcomes indicated firm fixation and good fracture healing with minimal trauma. Thus, arthroscopy-assisted transosseous fixation with Versalok suture anchors for adult tibial eminence fractures seems to have satisfactory clinical outcomes.
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Affiliation(s)
- Yuanshi She
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Suzhou
| | - Dongsheng Guo
- Department of Orthopedics, The First People's Hospital of Lianyungang, Lianyungang
| | - Guangxiang Chen
- Department of Orthopedics, Nanjing Medical University Affiliated Suzhou Hospital (Suzhou Municipal Hospital), Suzhou, Jiangsu, China
| | - Youjia Xu
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Suzhou
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Tuca M, Pineda T. LESIONES TRAUMÁTICAS DE RODILLA EN NIÑOS Y ADOLESCENTES. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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15
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Wolfson T, Vadhera AS, Parvaresh K, Verma N, LaPrade RF, Chahla J. Arthroscopic Reduction and Internal Fixation of Tibial Eminence Fractures With Transosseous Suture Bridge Fixation. Arthrosc Tech 2021; 10:e1039-e1046. [PMID: 33981548 PMCID: PMC8085312 DOI: 10.1016/j.eats.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/05/2020] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic reduction-internal fixation (ARIF) is an increasingly popular option for surgical management of displaced tibial eminence fractures. Although a variety of ARIF techniques have been described, anatomic reduction and stable fixation remain challenging. As a result, complications such as malunion, nonunion, anterior instability, arthrofibrosis, and hardware issues persist. In an effort to reduce complications and improve outcomes, modern suture-based ARIF techniques have been developed. However, the optimal technique and construct remain elusive. This article presents a technique for ARIF of tibial eminence fractures using a transosseous suture bridge construct with extracortical fixation. This technique uses a commercially available suture-passage device and meniscal root repair system for accurate tunnel placement, efficient suture management, and reliable fixation.
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Affiliation(s)
| | | | | | | | | | - Jorge Chahla
- Address correspondence to Jorge Chahla, M.D., Ph.D., Midwest Orthopedics at Rush, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612, U.S.A.
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Zhang K, Catapano M, Carsen S, Peterson D, de Sa D. Management and Complications in Nonoperative Fractures of the Tibial Spine: A Systematic Review. J Pediatr Orthop 2021; 41:e272-e278. [PMID: 33448724 DOI: 10.1097/bpo.0000000000001750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Effective options exist for acute nonoperative management of anterior tibial spine fractures, yet there exists a paucity of literature describing long-term outcomes for these patients. This systematic review thus aims to consolidate management strategies and complications for patients with nonoperative anterior tibial spine fractures. In accordance with PRISMA guidelines, 5 databases (CINAHL, MEDLINE, EMBASE, Cochrane, and Pubmed) were searched and screened in duplicate. Quality assessment was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Of 485 studies identified in the initial search, a total of 18 studies involving 369 patients were eligible for this review. These were stratified into 173 type I, 124 type II, and 72 type III injuries as described by Meyers and McKeever. All patients were treated with knee immobilization in either full extension or slight flexion, with possible closed reduction and/or aspiration of hemarthrosis. Complications at final follow-up comprised 33.9% of patients with persistent stiffness, 19.4% persistent instability, 11.1% mechanical symptoms, 6.37 delayed anterior cruciate ligament reconstruction, 4.9% delayed operative intervention for other complications, and 1.9% extension impingement. Given the lack of comparative studies in this review, definitive conclusions for nonoperative management are difficult to establish on the basis of the current body of literature alone. A modestly higher rate of arthrofibrosis and persistent laxity are seen in higher-grade injuries, however, only a minority of studies stratified complications by Meyers and McKeever classification in this review. A better understanding of variables in treatment decision making require further prospective study focused on the collection of functional and patient-reported outcome measures, whereas also further delineating complications by injury severity.
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Affiliation(s)
- Kailai Zhang
- Department of Physical Medicine and Rehabilitation
| | - Michael Catapano
- Department of Physical Medicine and Rehabilitation, University of Toronto, Toronto
| | - Sasha Carsen
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Devin Peterson
- Division of Orthopaedic Surgery, McMaster University, Hamilton
| | - Darren de Sa
- Division of Orthopaedic Surgery, McMaster University, Hamilton
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Chu Y, Hu T, Chen M, Jiang C, Wu Z, Shi J. Preliminary clinical outcomes of the double-row anchor suture-bridge technique for the fixation of tibial intercondylar eminence fractures in adults: a 12-months minimal follow-up. BMC Musculoskelet Disord 2021; 22:74. [PMID: 33441126 PMCID: PMC7807492 DOI: 10.1186/s12891-021-03948-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background Tibial intercondylar eminence avulsion fractures occur primarily in adolescents and young adults. However, the incidence of such fractures is increasing in adults, concurrent with an increase in sports injuries and traffic accidents. This study describes the fixation-based double-row anchor suture-bridge technique, a novel technique for treating tibial intercondylar eminence fractures in adults; and evaluates its preliminary clinical outcomes. Methods A retrospective evaluation of adult patients with tibial intercondylar eminence fractures treated at our institution from June 2016 to June 2018 was conducted. Seven such patients, treated with the anchor suture-bridge technique, were included. All patients were assessed for knee joint range of motion (ROM), Lysholm knee score, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form score, Tegner activity score pre-surgery, and the healing of the fracture at 3, 6 and 12 months minimal post-surgery follow-up. Results Patients were followed for a mean of 12.43 months (range 9-15 months). By the final follow-up, all fractures had fully healed. The mean Lysholm score improved from 27.86 (range, 2 to 54) pre-surgery to 88.14 (range, 81 to 100) 3 months post-surgery (p < 0.05). Similarly, the mean IKDC score improved from 48.86 (range, 43 to 55) to 84.29 (range, 75 to 90) (P < 0.05); and the mean Tegner activity score improved from 1.71 (range, 0 to 4) to 3.29 (range, 2 to 4) (p < 0.05). Furthermore, knee joint ROM, Lysholm scores, IKDC scores, and Tegner activity scores displayed excellent outcomes at the 6 and 12 months minimal follow-up. Conclusion The arthroscopic anchor suture-bridge technique is a valid and secure method for achieving effective fixation of tibial intercondylar eminence fractures in adults.
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Affiliation(s)
- Yupeng Chu
- Department of Orthopaedic Surgery, The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
| | - Ting Hu
- Department of Orthopaedic Surgery, The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Mangmang Chen
- Department of Orthopaedic Surgery, The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Chendi Jiang
- Department of Orthopaedic Surgery, The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Zhuqi Wu
- Department of Orthopaedic Surgery, The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Junwu Shi
- Department of Orthopaedic Surgery, The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
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Bayoumy MA, Abdelhamid MM, Elkady HA, Mohamed MM. Arthroscopic Reduction and Fixation by Cerclage Wire Loop for Tibial Spine Avulsion in Adults: Short-term Results. Orthop J Sports Med 2020; 8:2325967120963118. [PMID: 33415171 PMCID: PMC7750761 DOI: 10.1177/2325967120963118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/18/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Several arthroscopic techniques for the treatment of avulsion tibial spine
fractures have been described in the literature. Purpose: To evaluate the outcomes of the arthroscopically assisted stainless steel
wiring technique in the treatment of avulsed tibial spine in adults. Study Design: Case series; Level of evidence, 4. Methods: This retrospective study involved 28 patients (28 knees), 16 to 42 years of
age, with tibial spine avulsion fracture that was treated using arthroscopic
reduction and cerclage wire fixation by a single surgeon between March 2015
and August 2018. The degrees of avulsion in these patients were type II (n =
12), type III (n = 10), and type IV fractures (n = 6). Clinical assessment
included International Knee Documentation Committee (IKDC) objective score
(which noted swelling), range of knee movement, Tegner activity scale,
Lachman test, and pivot-shift test compared with the normal opposite
knee. Results: The mean follow-up period was 24.1 months (range, 18-30 months). The mean
IKDC score was 93.7 (range, 88.5-98.9); the IKDC score was normal in 22
patients and nearly normal in 6 patients. The Lachman test was grade 1 in 25
patients and grade 2 in 3 patients, whereas the pivot-shift test was grade 0
in 26 patients and grade 1 in 2 patients. All patients achieved their
preinjury Tegner activity levels. Radiological assessment showed healing in
all patients within a mean of 12 weeks after surgery. Conclusion: The outcomes of all patients were satisfactory; fixation by cerclage wiring
permitted reduction of tibial spine fragment anatomically to its fracture
bed, provided stable fixation in displaced tibial spine avulsion, and
allowed for early rehabilitation and weightbearing because of stable
fixation.
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Affiliation(s)
| | - Mohamed M Abdelhamid
- Orthopaedic and Traumatology Department, Assiut University Hospitals, Assiut, Egypt
| | - Hesham A Elkady
- Orthopaedic and Traumatology Department, Assiut University Hospitals, Assiut, Egypt
| | - Mohamed Mosa Mohamed
- Orthopaedic and Traumatology Department, Al-Azhar University, Faculty of Medicine, Assiut, Egypt
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Bram JT, Aoyama JT, Mistovich RJ, Ellis HB, Schmale GA, Yen YM, McKay SD, Fabricant PD, Green DW, Lee RJ, Cruz AI, Kushare IV, Shea KG, Ganley TJ. Four Risk Factors for Arthrofibrosis in Tibial Spine Fractures: A National 10-Site Multicenter Study. Am J Sports Med 2020; 48:2986-2993. [PMID: 32898426 DOI: 10.1177/0363546520951192] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tibial spine fractures (TSFs) are relatively rare pediatric injuries. Postoperative arthrofibrosis remains the most common complication, with few studies having examined factors associated with its development. PURPOSE To identify risk factors for arthrofibrosis and required MUA or lysis of adhesions in the largest known cohort of patients with TSFs. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS This was a multicenter study of 249 patients ≤18 years old who had a TSF between January 2000 and February 2019. Patients were separated into cohorts based on whether they developed arthrofibrosis, defined as a 10° deficit in extension and/or 25° deficit in flexion at postoperative 3 months or a return to the operating room for manipulation under anesthesia (MUA) and/or lysis of adhesions. RESULTS A total of 58 (23.3%) patients developed postoperative arthrofibrosis, with 19 (7.6%) requiring a return to the operating room for MUA. Patients with arthrofibrosis were younger (mean ± SD, 11.3 ± 2.7 vs 12.3 ± 2.8 years; P = .029). They were more likely to have a nonsport, trauma-related injury (65.4% vs 32.1%; P < .001) and a concomitant ACL injury (10.3% vs 1.1%; P = .003). Those with arthrofibrosis had longer operative times (135.0 vs 114.8 minutes; P = .006) and were more likely to have been immobilized in a cast postoperatively (30.4% vs 16.6%; P = .043). In multivariate regression, concomitant anterior cruciate ligament (ACL) injury (odds ratio [OR], 20.0; P = .001), traumatic injury (OR, 3.8; P < .001), age <10 years (OR, 2.2; P = .049), and cast immobilization (OR, 2.4; P = .047) remained significant predictors of arthrofibrosis. Concomitant ACL injury (OR, 7.5; P = .030) was additionally predictive of a required return to the operating room for MUA. CONCLUSION Surgeons should be cognizant of arthrofibrosis risk in younger patients with concomitant ACL tears and traumatic injuries not resulting from athletics. Furthermore, postoperative immobilization in a cast should be avoided given the high risk of arthrofibrosis. Concomitant ACL injury is associated with a higher return to the operating room for MUA.
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Affiliation(s)
- Joshua T Bram
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Julien T Aoyama
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - R Justin Mistovich
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Henry B Ellis
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Gregory A Schmale
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Yi-Meng Yen
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Scott D McKay
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Peter D Fabricant
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Daniel W Green
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - R Jay Lee
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Aristides I Cruz
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Indranil V Kushare
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kevin G Shea
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Theodore J Ganley
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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20
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Yu D, Yu R, Zhang J, Chen T, Zhang B. Arthroscopic treatment of adult displaced tibial eminence fractures with anchor and pushlock fixation. Medicine (Baltimore) 2020; 99:e21237. [PMID: 32957304 PMCID: PMC7505351 DOI: 10.1097/md.0000000000021237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Arthroscopic techniques are considered the gold standard for treatment of displaced avulsion fractures of the anterior cruciate ligament. However, most arthroscopic surgical techniques and fixation methods are technically demanding and require removal of hard implant. This report describes a new, easy, safe, and all-arthroscopic method for reduction and fixation of displaced tibial intercondylar eminence fractures by using 1 anchor and 1 Pushlock.From January 2015 to June 2017, 8 adult patients with type II and III displaced tibial intercondylar eminence fractures were operated using this technique. Clinical assessment included patient demographics, cause of injury, delay before surgery, operation time, time to return to work and sport, International Knee Documentation Committee scores, and Lysholm knee scores.The average operation time was 48 minutes. The average follow-up period was 12.5 months. At the 6-month follow-up, all patients had acquired fracture union and complete functional recovery and were able to return to work. International Knee Documentation Committee objective scores and Lysholm knee scores were 92.4 (range 88-94) and 93.6 (range 90-96), respectively. At the last follow-up, anterior drawer, Lachman's test, and pivot shift tests were negative, and all patients had returned to their preinjury activity levels.Arthroscopic fixation by use of 1 anchor and 1 Pushlock is an easy, safe, and minimally invasive technique for treatment of displaced tibial intercondylar eminence fractures and does not require further surgery to remove fixation devices.Level of Evidence: Level IV, therapeutic case series.
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21
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Bi M, Zhao C, Chen J, Hong Z, Wang Z, Gan K, Tong Y, Bi Q. Arthroscopic Suture Fixation With Autograft Augmentation Reconstruction for Delayed Tibial Avulsion Fractures of the Posterior Cruciate Ligament. Orthop J Sports Med 2020; 8:2325967120944047. [PMID: 32923500 PMCID: PMC7450458 DOI: 10.1177/2325967120944047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/19/2020] [Indexed: 11/17/2022] Open
Abstract
Background: The optimal surgical treatment of delayed avulsion fractures of the posterior
cruciate ligament (PCL) is still controversial. Purpose: To evaluate the clinical results of arthroscopic suture fixation of tibial
avulsion fractures of the PCL with autograft augmentation
reconstruction. Study Design: Case series; Level of evidence, 4. Methods: From January 2013 to February 2017, we treated 15 patients with delayed
tibial avulsion fractures of the PCL arthroscopically through posteromedial
and posterolateral portals. The PCL and avulsion bone fragment were fixed
with No. 2 nonabsorbable FiberWire sutures that were pulled out through a
single tibial bone tunnel and fixed on a small Endobutton. Concomitantly,
anatomic PCL augmentation reconstruction was performed, and the graft was
pulled out through the same tunnel and fixed with an interference screw.
Knee stability was assessed using the posterior drawer test, and the
side-to-side difference was determined using a KT-1000 arthrometer with 134
N of posterior force at 30° of knee flexion. The International Knee
Documentation Committee (IKDC) 2000 subjective form and Lysholm scale were
used to evaluate clinical outcomes at follow-up. Overall, 12 patients were
enrolled for analysis. The mean follow-up period was 34.4 months (range,
26-49 months). Results: At the final follow-up, 2 patients encountered 10° terminal flexion
limitations. All patients had negative posterior drawer test results. The
KT-1000 arthrometer side-to-side difference was significantly decreased from
8.25 ± 1.96 mm preoperatively to 1.08 ± 0.86 mm at the last follow-up
(P < .001). The mean IKDC and Lysholm scores,
respectively, increased from 54.67 ± 7.13 and 53.50 ± 7.90 preoperatively to
91.13 ± 3.78 and 94.25 ± 3.32 at the final follow-up (P
< .001 for both). Conclusion: Arthroscopic suture fixation with autograft augmentation reconstruction for
delayed tibial avulsion fractures of the PCL showed good clinical stability
and function in this study.
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Affiliation(s)
- Mingguang Bi
- Lihuili Hospital, Ningbo Medical Center, Ningbo University School of Medicine, Ningbo, China
| | - Chen Zhao
- Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Jihang Chen
- Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Zheping Hong
- Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Zhen Wang
- Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Kaifeng Gan
- Lihuili Hospital, Ningbo Medical Center, Ningbo University School of Medicine, Ningbo, China
| | - Yu Tong
- Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Qing Bi
- Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, China
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Abstract
The aim of this article is to discuss the diagnosis, management and pitfalls of bony injuries around the skeletally immature knee. Each within their own right is a relatively uncommon injury but associated with potential complications. Distal femoral physeal fractures can result in growth arrest and vascular injury. Tibial spine avulsions can result in an unstable knee. Tibial tubercle fractures can be associated with compartment syndrome and pose a risk to the extensor mechanism of the knee. Fixation can be complicated by growth arrest and subsequent recurvatum deformity. Finally, patella sleeve injuries are often missed and this can also threaten the extensor mechanism. We discuss the approach to clinical and radiological assessment of these injuries, and evidence based recommendations as to how they are best managed to avoid complications.
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Tibial eminence fracture with midsubstance anterior cruciate ligament tear in a 10-year-old boy: A case report. Int J Surg Case Rep 2020; 67:13-17. [PMID: 31991376 PMCID: PMC7076271 DOI: 10.1016/j.ijscr.2019.12.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/23/2019] [Indexed: 01/08/2023] Open
Abstract
We present a tibial eminence fracture with an ACL tear in a 10-year-old boy. A tibial eminence fracture with an ACL midsubstance tear can occur in a child. Preoperative MRI studies are necessary to detect and diagnose them. MRI also allows surgeons to identify cases that might need ACLR.
Introduction There are few reports about tibial eminence fractures with a concomitant midsubstance ACL tear in children. In this report, we present a case of a tibial eminence fracture with an ACL midsubstance tear in a 10-year-old boy. Presentation of case The boy twisted his right knee and was seen at our facility 8 days later. Magnetic resonance imaging revealed an osteochondral fragment in the intercondylar fossa and a high-intensity area in the ACL midsubstance. This injury was diagnosed as a type III tibial eminence fracture by Meyers and McKeever classification. On the 10th day after the injury, the patient underwent arthroscopic reduction and fixation. During arthroscopy proximally displaced avulsion fragment in the intercondylar fossa was found. Although the continuity of the anteromedial bundle of the ACL was confirmed, the posterolateral bundle was completely torn and the tension of ACL was weakened. The fragment and torn ACL were fixed with pull out suture. One year after the operation, the patients can play sports without any pain. Discussion This case demonstrates that a tibial eminence fracture with an ACL midsubstance tear can occur in a child. Despite the rarity of such cases, preoperative MRI studies are necessary to detect and diagnose them. MRI also allows surgeons to identify cases that might need ACLR. Conclusion It should be noted that a midsubstance ACL tear can occur with a tibial eminence fracture even in skeletally immature patients, and that preoperative MRI is necessary to diagnose and select the appropriate treatment.
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Mayo MH, Mitchell JJ, Axibal DP, Chahla J, Palmer C, Vidal AF, Rhodes JT. Anterior Cruciate Ligament Injury at the Time of Anterior Tibial Spine Fracture in Young Patients: An Observational Cohort Study. J Pediatr Orthop 2019; 39:e668-e673. [PMID: 31503222 DOI: 10.1097/bpo.0000000000001011] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anterior tibial spine fractures (ATSF) in the skeletally immature parallel anterior cruciate ligament (ACL) tears in adult patients, yet these injuries are generally regarded as mutually exclusive. Biomechanical analysis suggests that intrinsic ACL damage occurs during ATSF, and long-term clinical studies demonstrate residual anteroposterior knee laxity following ATSF. We aim to describe prevalence, demographics, and characteristics of pediatric patients who sustained ATSF with concomitant ACL injury. METHODS We included 129 patients with ATSF over a 16-year period. Age, sex, injury mechanism, ATSF type, magnetic resonance imaging (MRI) evaluation, treatment modality, ACL injury, and concomitant meniscal/chondral injuries were analyzed. Concurrent ACL injury was confirmed either from MRI or intraoperatively. RESULTS Nineteen percent (n=25) of ATSF patients had concomitant ACL injury, with ACL injury significantly more likely in type II or type III ATSF compared with type I ATSF (P=0.03). Patients with combined ATSF/ACL injury were significantly older (P=0.02) and more likely to be male (P=0.01). Mechanism of ATSF injury was not associated with ACL injury (P=0.83). Preoperative MRI had low sensitivity (0.09) for recognizing ACL injury at the time of ATSF relative to intraoperative assessment. Half of ATSF/ACL-injured patients had additional meniscal or chondral injury, with meniscal repair or debridement required in 37.5% of the type II ATSF/ACL injury. CONCLUSIONS There are demographic characteristics, such as age (older) and sex (male), associated with a higher risk of concomitant ACL injury at the time of ATSF. Type II and type III ATSF patterns had a higher prevalence of ACL injury. MRI failed to correctly identify ACL injury at the time of ATSF. Concomitant ACL injury at the time of ATSF is highly prevalent in the skeletally immature, occurring in 19.4% of patients with ATSF. LEVEL OF EVIDENCE Level IV-case series.
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Affiliation(s)
- Meredith H Mayo
- Department of Orthopaedic Surgery, University of Colorado Hospital
| | - Justin J Mitchell
- Department of Orthopaedic Surgery, University of Colorado Hospital
- The Steadman Philippon Research Institute, Vail, CO
| | - Derek P Axibal
- Department of Orthopaedic Surgery, University of Colorado Hospital
| | - Jorge Chahla
- The Steadman Philippon Research Institute, Vail, CO
| | - Claire Palmer
- Department of Orthopaedic Surgery, University of Colorado Hospital
- Department of Orthopedic Surgery, Children's Hospital of Colorado, Aurora
| | - Armando F Vidal
- Department of Orthopaedic Surgery, University of Colorado Hospital
| | - Jason T Rhodes
- Department of Orthopaedic Surgery, University of Colorado Hospital
- Department of Orthopedic Surgery, Children's Hospital of Colorado, Aurora
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25
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Adams AJ, O'Hara NN, Abzug JM, Aoyama JT, Ganley TJ, Carey JL, Cruz AI, Ellis HB, Fabricant PD, Green DW, Heyworth BE, Janicki JA, Kocher MS, Lawrence JTR, Lee RJ, McKay SD, Mistovich RJ, Patel NM, Polousky JD, Rhodes JT, Sachleben BC, Sargent MC, Schmale GA, Shea KG, Yen YM. Pediatric Type II Tibial Spine Fractures: Addressing the Treatment Controversy With a Mixed-Effects Model. Orthop J Sports Med 2019; 7:2325967119866162. [PMID: 31489334 PMCID: PMC6713965 DOI: 10.1177/2325967119866162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Tibial spine fractures, although relatively rare, account for a substantial
proportion of pediatric knee injuries with effusions and can have
significant complications. Meyers and McKeever type II fractures are
displaced anteriorly with an intact posterior hinge. Whether this subtype of
pediatric tibial spine fracture should be treated operatively or
nonoperatively remains controversial. Surgical delay is associated with an
increased risk of arthrofibrosis; thus, prompt treatment decision making is
imperative. Purpose: To assess for variability among pediatric orthopaedic surgeons when treating
pediatric type II tibial spine fractures. Study Design: Cross-sectional study. Methods: A discrete choice experiment was conducted to determine the patient and
injury attributes that influence the management choice. A convenience sample
of 20 pediatric orthopaedic surgeons reviewed 40 case vignettes, including
physis-blinded radiographs displaying displaced fractures and a description
of the patient’s sex, age, mechanism of injury, and predominant sport.
Surgeons were asked whether they would treat the fracture operatively or
nonoperatively. A mixed-effects model was then used to determine the patient
attributes most likely to influence the surgeon’s decision, as well as
surgeon training background, years in practice, and risk-taking
behavior. Results: The majority of respondents selected operative treatment for 85% of the
presented cases. The degree of fracture displacement was the only attribute
significantly associated with treatment choice (P <
.001). Surgeons were 28% more likely to treat the fracture operatively with
each additional millimeter of displacement of fracture fragment. Over 64% of
surgeons chose to treat operatively when the fracture fragment was displaced
by ≥3.5 mm. Significant variation in surgeon’s propensity for operative
treatment of this fracture was observed (P = .01). Surgeon
training, years in practice, and risk-taking scores were not associated with
the respondent’s preference for surgical treatment. Conclusion: There was substantial variation among pediatric orthopaedic surgeons when
treating type II tibial spine fractures. The decision to operate was based
on the degree of fracture displacement. Identifying current treatment
preferences among surgeons given different patient factors can highlight
current variation in practice patterns and direct efforts toward promoting
the most optimal treatment strategies for controversial type II tibial spine
fractures.
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Affiliation(s)
- Alexander J Adams
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nathan N O'Hara
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joshua M Abzug
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Julien T Aoyama
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Theodore J Ganley
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - James L Carey
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Aristides I Cruz
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Henry B Ellis
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Peter D Fabricant
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Daniel W Green
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Benton E Heyworth
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joseph A Janicki
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Mininder S Kocher
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - John T R Lawrence
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - R Jay Lee
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Scott D McKay
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - R Justin Mistovich
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Neeraj M Patel
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - John D Polousky
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jason T Rhodes
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Brant C Sachleben
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - M Catherine Sargent
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Gregory A Schmale
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kevin G Shea
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Yi-Meng Yen
- Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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26
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Dung TT, Du HG, Long NH, Son LM, Thanh DX, Son DN, Tuyen NT, Minh DV, Phương NH, Nam VT, Hieu PT, Thanh MN. Arthroscopic fixation of ACL avulsion fracture in the saint pault hospital: A review of treatment outcomes: Cohort study. Ann Med Surg (Lond) 2019; 48:91-94. [PMID: 31737267 PMCID: PMC6849137 DOI: 10.1016/j.amsu.2019.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/04/2019] [Indexed: 11/28/2022] Open
Abstract
Background The purpose of this research is to evaluate the results of arthroscopic suture fixation with fiber wires used as treatment for ACL avulsion fracture, and to determine how effective such a technique is when it comes to restoring of knee function. Materials and methods This prospective study involves 28 patients, who underwent arthroscopic fixation of displaced ACL avulsion fractures at Saint Paul Hospital (Hanoi) from January 2014 to March 2018. Results The first three weeks were not marked with any abnormalities associated with post-operative sutures and hematomas, infectious complications were not detected either. Post-operative displacement of fracture fragments did not take place among the patients involved in the study. At the 3-month follow-up, the average IKDC score was 90.7 (range: 76–100), and the average Lysholm score was 93.6 (range 82–100). The percentage of excellent scores was 42.9% (12 patients), good scores accounted for 50% (14 patients), while fair/poor scores accounted for 3.6% each (1 patient on each score). The percentage of excellent/good scores was 92.9% in total. Conclusion This study shows that ACL avulsion fracture can be treated effectively by arthroscopic suture fixation with fiber wires. In fact, this technique may restore knee function and stability. Evaluating the results of arthoscopic suture fixation with fiber wires used as treatment for ACL avulsion fracture. The study involves 28 patients. The ACL avulsion fracture can be treated effectively by arthoscopic suture fixation with fiber wires. It may restore knee function and stabiity.
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Affiliation(s)
- Tran Trung Dung
- Hanoi Medical University, Viet Nam.,Saint Paul University Hospital, USA.,Hanoi Medical University Hospital, Viet Nam
| | - Hoang Gia Du
- Hanoi Medical University, Viet Nam.,Bachmai University Hospital, Viet Nam
| | - Nguyen Hoang Long
- Hanoi Medical University, Viet Nam.,Vietduc University Hospital, Viet Nam
| | - Le Manh Son
- Hanoi Medical University, Viet Nam.,Vietduc University Hospital, Viet Nam
| | - Dao Xuan Thanh
- Hanoi Medical University, Viet Nam.,Bachmai University Hospital, Viet Nam
| | - Dinh Ngoc Son
- Hanoi Medical University, Viet Nam.,Vietduc University Hospital, Viet Nam
| | | | - Do Van Minh
- Hanoi Medical University, Viet Nam.,Hanoi Medical University Hospital, Viet Nam
| | - Nguyen Huy Phương
- Hanoi Medical University, Viet Nam.,Saint Paul University Hospital, USA
| | - Vu Tu Nam
- Hanoi Medical University, Viet Nam.,Saint Paul University Hospital, USA
| | - Pham Trung Hieu
- Hanoi Medical University, Viet Nam.,Saint Paul University Hospital, USA
| | - Ma Ngoc Thanh
- Hanoi Medical University, Viet Nam.,Hanoi Medical University Hospital, Viet Nam
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27
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Dung TT, Du HG, Long NH, Son LM, Thanh DX, Son DN, Tuyen NT, Van Minh D, Phương NH, Nam VT, Hieu PT, Thanh MN. Arthroscopic fixation of ACL avulsion fracture in the Saint Paul Hospital: a review of treatment outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1485-1491. [PMID: 31236684 DOI: 10.1007/s00590-019-02466-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/06/2019] [Indexed: 11/26/2022]
Abstract
The purpose of this research is to evaluate the results of arthroscopic suture fixation with fiber wires used as treatment for ACL avulsion fracture, and to determine how effective such a technique is when it comes to restoring of knee function. This prospective study involves 28 patients, who underwent arthroscopic fixation of displaced ACL avulsion fractures at Saint Paul Hospital (Hanoi) from January 2014 to March 2018. The first 3 weeks were not marked with any abnormalities associated with postoperative sutures and hematomas; infectious complications were not detected either. Postoperative displacement of fracture fragments did not take place among the patients involved in the study. At the 3-month follow-up, the average IKDC score was 90.7 (range 76-100), and the average Lysholm score was 93.6 (range 82-100). The percentage of excellent scores was 42.9% (12 patients), good scores accounted for 50% (14 patients), while fair/poor scores accounted for 3.6% each (one patient on each score). The percentage of excellent/good scores was 92.9% in total. This study shows that ACL avulsion fracture can be treated effectively by arthroscopic suture fixation with fiber wires. In fact, this technique may restore knee function and stability.
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Affiliation(s)
- Tran Trung Dung
- Hanoi Medical University, Hanoi, Vietnam.
- Saint Paul University Hospital, Surigao City, Philippines.
- Hanoi Medical University Hospital, Hanoi, Vietnam.
| | - Hoang Gia Du
- Hanoi Medical University, Hanoi, Vietnam
- Bachmai University Hospital, Hanoi, Vietnam
| | - Nguyen Hoang Long
- Hanoi Medical University, Hanoi, Vietnam
- Vietduc University Hospital, Hanoi, Vietnam
| | - Le Manh Son
- Hanoi Medical University, Hanoi, Vietnam
- Vietduc University Hospital, Hanoi, Vietnam
| | - Dao Xuan Thanh
- Hanoi Medical University, Hanoi, Vietnam
- Bachmai University Hospital, Hanoi, Vietnam
| | - Dinh Ngoc Son
- Hanoi Medical University, Hanoi, Vietnam
- Vietduc University Hospital, Hanoi, Vietnam
| | - Nguyen Trung Tuyen
- Hanoi Medical University, Hanoi, Vietnam
- Saint Paul University Hospital, Surigao City, Philippines
| | - Do Van Minh
- Hanoi Medical University, Hanoi, Vietnam
- Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Nguyen Huy Phương
- Hanoi Medical University, Hanoi, Vietnam
- Saint Paul University Hospital, Surigao City, Philippines
| | - Vu Tu Nam
- Hanoi Medical University, Hanoi, Vietnam
- Saint Paul University Hospital, Surigao City, Philippines
| | - Pham Trung Hieu
- Hanoi Medical University, Hanoi, Vietnam
- Saint Paul University Hospital, Surigao City, Philippines
| | - Ma Ngoc Thanh
- Hanoi Medical University, Hanoi, Vietnam
- Hanoi Medical University Hospital, Hanoi, Vietnam
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28
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Editorial Commentary: Anterior Cruciate Ligament Tibial Eminence Avulsion Fractures: Are They Trying to Tell Us Something? Arthroscopy 2019; 35:1545-1546. [PMID: 31054729 DOI: 10.1016/j.arthro.2019.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 02/02/2023]
Abstract
Arthroscopic reduction and fixation of tibial eminence avulsion fractures has excellent clinical results and adequately restores anterior cruciate ligament function with a low rate of complications. Clinical outcomes are preserved at an average of 8 years, and the incidence of osteoarthritis is low at midterm follow up. These injuries may represent the best-case scenarios of anterior cruciate ligament injury because they represent lower energy injuries without significant associated meniscal or chondral pathologies. These findings may give us additional clues about which patients are the best candidates for primary anterior cruciate ligament repair in the setting of femoral-sided avulsions.
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29
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Rhee SJ, Jang JH, Choi YY, Suh JT. Arthroscopic reduction of posterior cruciate ligament tibial avulsion fracture using two cross-linked pull-out sutures: A surgical technique and case series. Injury 2019; 50:804-810. [PMID: 30447986 DOI: 10.1016/j.injury.2018.11.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/08/2018] [Indexed: 02/02/2023]
Abstract
Surgical treatment of the posterior cruciate ligament (PCL) tibial avulsion fracture is challenging due to the deep-seated location of the lesion with complex adjacent anatomy and usually with small-sized bone fragment. We introduce a novel arthroscopic reduction technique using two cross-linked pull-out sutures (2XLPOS) through triple bone tunnels in posterior cruciate ligament (PCL) tibial avulsion fracture. Posterior trans-septal portal was established following the four standard arthroscopic portals. Bilateral margins of the PCL with 1∼2 mm margin from the border were penetrated using suture hook. Fiberwire sling tied with a No. 0 PDS knot was introduced anterior to the PCL by the two posteriorly pulled shuttle sutures. Three bone tunnels were drilled in the inferomedial, inferolateral, and apex edge of the avulsed tibial crater. Each end of the Fiberwire was drawn out through the inferomedial and inferolateral bone tunnel, respectively. Two ends of the No. 0 PDS were drawn out through the apex tunnel by the same manner. Fiberwire was tied on the anteromedial aspect of the proximal tibia with one strand of the No. 0 PDS placed underneath the Fiberwire knot. And, the No. 0 PDS loop was tied to complete cross-linking of pull-out construct. Arthroscopic reduction of PCL tibial insertion avulsion fracture using 2XLPOS technique was performed in eleven patients. Mean range of motion at the first postoperative year was 126.8°. Mean Lysholm score, Tegner activity scale, and IKDC was 69.2, 4.2, and 58.1, respectively. Posterior instability decreased from mean 12.6 mm preoperatively to 3.2 mm at 1-year postoperative follow up. Radiographic union of the fracture site was confirmed in 11 cases. Our new surgical technique yielded good clinical and radiological outcome, and we consider it is unique in utilizing two cross-linked sling type pull-out suture constructs and triple bone tunnels for their passage.
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Affiliation(s)
- Seung Joon Rhee
- Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
| | - Jae Hoon Jang
- Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Yoon Young Choi
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jeung Tak Suh
- Department of Orthopedic Surgery, Busan Medical Center, Busan, Republic of Korea
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30
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Liu J, Yue Y, Li Z. [Arthroscopic treatment of anterior cruciate ligament tibial eminence avulsion fracture with double heads compressive cannulated screw fixation in adolescents]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1172-1176. [PMID: 30129349 DOI: 10.7507/1002-1892.201803012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To discuss the effectiveness of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture in adolescents by using double heads compressive cannulated screw fixation. Methods Twenty-four patients with ACL tibial eminence avulsion fractures were treated by arthroscopic reduction and internal fixation with double heads compressive cannulated screw fixation between June 2014 and June 2017. There were 15 males and 9 females with an average age of 12.3 years (range, 5-18 years). The body mass index was 19.3-26.4 kg/m
2 (mean, 23.3 kg/m
2). The injury causes included traffic accident injury in 10 cases, sports injury in 8 cases, and falling injury in 6 cases. According to the Meyers-McKeever classification, there were 19 cases of type Ⅱ and 5 cases of type Ⅲa. All patients’ drawer test and pivot shift test were positive. The interval between injury and operation was 3-14 days (mean, 6.2 days). During the follow-up period, the fracture healing condition of patients were determined by X-ray examination; Lysholm score, International Knee literature Committee (IKDC) score, and Tegner score were used to evaluate the knee function. Results Primary healing of incision was obtained in all patients after operation. All the 24 patients were followed up 6-32 months (mean, 16.4 months). At 6 weeks after operation, 3 patients had difficulty in knee flexion. After the release of the knee joint by manipulation, the knee joint function recovered normally at 6 months after operation. At last follow-up, the X-ray films showed that all the fractures healed and no epiphyseal dysplasia, knee joint deformity, or leg length discrepancy occurred. The Lysholm score, IKDC score, and Tegner score were improved from preoperative 44.3±5.4, 43.7±4.4, and 3.0±1.3 to postoperative 93.1±4.3, 94.6±3.3, and 8.1±1.2, the differences were all significant (
t=25.152,
P=0.000;
t=28.634,
P=0.000;
t=13.226,
P=0.000). Conclusion The arthroscopic reduction and internal fixation with double heads compressive cannulated screw in treatment of ACL tibial avulsion fracture (Meyers-McKeever type Ⅱ and Ⅲ) in adolescents has so many advantages, such as minimal trauma, simple operation, firm fixation, little effect on the epiphyseal plate, and has a good joint function recovery.
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Affiliation(s)
- Juncai Liu
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Yongchuan Yue
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Zhong Li
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000,
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Abstract
Tibial spine fractures are uncommon injuries affecting the insertion of the anterior cruciate ligament on the tibia. They typically occur in skeletally immature patients aged 8 to 14 years and result from hyperextension of the knee with a valgus or rotational force. Diagnosis is based on history, physical examination, and standard radiographs. The use of MRI can identify entrapped soft tissue that may prevent reduction. Open or arthroscopic repair is indicated in patients with partially displaced fractures (>5 mm) with one third to one half of the avulsed fragment elevated, in patients who have undergone unsuccessful nonsurgical reduction and long leg casting or bracing, and in patients with completely displaced fractures. Arthroscopy offers reduced invasiveness and decreased morbidity. Suture fixation and screw fixation have produced successful results. Suture fixation can eliminate the risk of fracture fragment comminution during screw insertion, the risk of neurovascular injury, and the need for hardware removal. Suture fixation is ideal in cases in which existing comminution prevents screw fixation.
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32
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Elsaid ANS, Zein AMN, ElShafie M, El Said NS, Mahmoud AZ. Arthroscopic Single-Tunnel Pullout Suture Fixation for Tibial Eminence Avulsion Fracture. Arthrosc Tech 2018; 7:e443-e452. [PMID: 29868417 PMCID: PMC5984281 DOI: 10.1016/j.eats.2017.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/01/2017] [Indexed: 02/03/2023] Open
Abstract
Various arthroscopic techniques have been devised for fixation of tibial eminence avulsions, namely percutaneous K-wires, arthroscopy-guided screw fixation, staples, TightRope (Arthrex)-suture button fixation, and transosseous suture fixation. Such techniques provide well-pronounced advantages including less postoperative pain, a reduced hospital stay, and minimal scar with resultant earlier and more compliant rehabilitation. As for transosseous suture fixation, the standard technique comprises the creation of 2 tibial tunnels exiting on both sides of the footprint of the avulsion fracture using an anterior cruciate ligament tibial guide with the angle set at 45°. Our technique entails the creation of a single tibial tunnel directed from the proximal anteromedial tibia to the center of the tibial eminence. The technique uses Ethibond suture (No. 5) and/or FiberWire suture (Arthrex) to fix the tibial eminence by pulling the anterior cruciate ligament fibers and tightening the pullout suture at the tibial exit of the tunnel with a 4-hole button. This modified single-tunnel pullout suture technique is an appealing option that has proved to be effective and economical with a shorter operative time. Moreover, it provides a less invasive option for skeletally immature patients.
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Affiliation(s)
- Ahmed Nady Saleh Elsaid
- Address correspondence to Ahmed Nady Saleh Elsaid, M.D., Department of Orthopedic Surgery and Traumatology, Minia University, Abrag Elgmaa Borg (G), Third Floor, Flat No. 9 Ard Sltan Taha Hessen Street, Minia, Egypt.
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33
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Samuelsson K, Svantesson E, Hamrin Senorski E, Östman B. Unique simultaneous avulsion fracture of both the proximal and distal insertion sites of the anterior cruciate ligament. BMJ Case Rep 2018; 2018:bcr-2017-222265. [PMID: 29496684 PMCID: PMC5847931 DOI: 10.1136/bcr-2017-222265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
February is a busy month for the ambulance skiing patrol at the skiing resorts in Norway and on this day, a call regarding an 11-year-old boy on one of the hills reached the team. What no one knew at that moment was that this boy had suffered a unique injury and that his X-rays would reveal something that, prior to this, had never been described in the history of mankind. This patient had suffered a simultaneous avulsion fracture of both the femoral and tibial insertion sites of the anterior cruciate ligament without suffering any other injuries to the knee. The injury was treated conservatively and at 1-year follow-up, the patient was completely recovered.
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Affiliation(s)
- Kristian Samuelsson
- Department of Orthopaedics, Sahlgrenska universitetssjukhuset, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eleonor Svantesson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bengt Östman
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Kalnes, Norway
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34
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Lombardo-Torre M, Espejo-Reina A, García-Gutiérrez G, Espejo-Baena A, Espejo-Reina MJ. Arthroscopic Treatment of Concurrent Avulsion Fracture of Anterior and Posterior Cruciate Ligament with Suspension Device. J Orthop Case Rep 2018; 8:81-85. [PMID: 30167421 PMCID: PMC6114203 DOI: 10.13107/jocr.2250-0685.1062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Simultaneous avulsion fractures of the insertion of both cruciate ligaments of the knee are extremely uncommon lesions and their treatment remains difficult. The purpose of this paper is to show an arthroscopic repair technique of simultaneous tibial avulsion fracture of both cruciate ligaments of the knee such by using an adjustable length suspension device. CASE REPORT A 25-year-oldmale patient was treated by arthroscopic reduction and fixation of both bony avulsion of cruciate ligaments of the knee with a sliding and adjustable length suspension device (ZipTight, Biomet, Warsaw, IN, USA). There were no post-operative complications appeared. At 18-month follow-up, the patient was conducting normal life, free of symptoms. At clinical examination, Lachman, anterior drawer, pivot shift, posterior drawer, and reverse pivot shift tests were negative. Range of motion was 130° flexion, presenting a slight 5° of extension deficit. The International Knee Documentation Committee score was 83.80 points. Lysholm scale was 85 points. CONCLUSION The described repair technique is able to provide stable fixation of bone fragments in the face of early fracture consolidation, as well as minimizing potential complications and surgical time.
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35
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Arthroscopic Treatment of Tibial Eminence Avulsion Fracture With Suture Tensioning Technique. Arthrosc Tech 2018; 7:e251-e256. [PMID: 29881697 PMCID: PMC5989734 DOI: 10.1016/j.eats.2017.08.078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 08/30/2017] [Indexed: 02/03/2023] Open
Abstract
Although a tibial eminence avulsion fracture is a rare knee injury, it can result in some complications such as nonunion, limited range of motion, and anterior instability of the knee if the displaced fracture is not well reduced. Arthroscopic procedures for this fracture have been commonly performed in recent years. In patients with small fragments, a pullout operation is usually performed, but arthroscopic suture reduction is technically difficult. In addition, anterior instability of the knee may remain even if the fragment is well reduced at the time of the surgical procedure. Generally, surgeons are concerned about anatomic reduction compared with appropriate tensioning during surgery. Therefore, one of the key points to avoid remaining anterior instability of the knee is to obtain and maintain appropriate tensioning. The purpose of this article is to present an easy and safe technique for acquisition of appropriate tensioning using a tensioning device for tibial eminence avulsion fractures. Although it has limitations, this technique can facilitate the reduction of tibial eminence avulsion fractures and appropriate tensioning of the anterior cruciate ligament.
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36
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Xu X, Liu Z, Wen H, Pan X. Arthroscopic fixation of pediatric tibial eminence fractures using suture anchors: a mid-term follow-up. Arch Orthop Trauma Surg 2017; 137:1409-1416. [PMID: 28779215 DOI: 10.1007/s00402-017-2770-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to follow a group of skeletally immature patients who received arthroscopy-assisted fixation of the displaced tibial eminence fractures with suture anchors and evaluate the clinical results. METHODS Twenty-one pediatric patients with displaced tibial eminence fractures were enrolled in this retrospectively study. They received arthroscopy-assisted reduction and fixation using suture anchors. All cases were followed up for 40-47 months with a mean of 43.4 months. Follow-up examinations included radiographic assessment, Lysholm score, Tegner score, International Knee Documentation Committee (IKDC) rating scale and KT-1000 test. RESULT Twenty patients were available for our final evaluations. They improved significantly at the final follow-up compared with preoperative examinational results with respect to the results of radiographic assessment, Lysholm score, Tegner score, IKDC rating scale and KT-1000 test. CONCLUSION Arthroscopy-assisted reduction and fixation of the displaced tibial eminence fractures using suture anchors is a simple and reliable technique and is suitable for skeletally immature patients.
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Affiliation(s)
- Xinxian Xu
- The Osteopathy Department, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhongtang Liu
- The Osteopathy Department, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Hong Wen
- The Osteopathy Department, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaoyun Pan
- The Osteopathy Department, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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37
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DeFroda SF, Hodax JD, Shah KN, Cruz AI. Tibial Eminence Fracture Repair With Double Hewson Suture Passer Technique. Arthrosc Tech 2017; 6:e1275-e1279. [PMID: 29354428 PMCID: PMC5622207 DOI: 10.1016/j.eats.2017.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/04/2017] [Indexed: 02/03/2023] Open
Abstract
Displaced tibial eminence fractures are commonly encountered in pediatric patients and are often considered to be functionally equivalent to an anterior cruciate ligament (ACL) rupture. While a variety of techniques are available for fixation of this injury, we describe an anchorless technique relying on suture fixation tied over a bone bridge. This technique also relies on two intra-articular Hewson suture passers to quickly and effectively pass and shuttle sutures through the ACL and tibial bone tunnels in order to reduce and fix the fracture fragment. We also briefly review various types of fixation used for tibial eminence fractures.
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Affiliation(s)
- Steven F. DeFroda
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A.,Address correspondence to Steven F. DeFroda, M.D., M.E., Department of Orthopaedics, Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02903.Department of OrthopaedicsAlpert Medical School of Brown University593 Eddy StreetProvidenceRI02903
| | - Jonathan D. Hodax
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A
| | - Kalpit N. Shah
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A
| | - Aristides I. Cruz
- Department of Orthopaedics, Division of Pediatric Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A
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Gamboa JT, Durrant BA, Pathare NP, Shin EC, Chen JL. Arthroscopic Reduction of Tibial Spine Avulsion: Suture Lever Reduction Technique. Arthrosc Tech 2017; 6:e121-e126. [PMID: 28373949 PMCID: PMC5368284 DOI: 10.1016/j.eats.2016.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 09/09/2016] [Indexed: 02/03/2023] Open
Abstract
Tibial spine avulsion fractures are uncommon knee injuries that predominantly occur in children and young adults. Restoration of anterior cruciate ligament length through surgical reduction and fixation of the fracture is necessary to ensure stability of the knee with suitable range of motion and minimal knee laxity. Arthroscopic repair of tibial spine avulsion fractures is a technically complex procedure, specifically when performing and maintaining the initial anatomic reduction. We describe in this technical note and accompanying video a unique 3-point fixation repair of tibial spine avulsion fractures using an arthroscopic assisted suture lever reduction technique. Our technique is both simple and efficacious in the reduction of tibial spine avulsion fractures to anatomic position by passing the first suture through the anterior cruciate ligament, and subsequently anterior to the avulsion fragment, and then beneath the fragment through a posteriorly placed bone tunnel within the tibial fracture bed.
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Affiliation(s)
- Joseph T. Gamboa
- Address correspondence to Joseph T. Gamboa, M.D., Advanced Orthopaedics and Sports Medicine, 450 Sutter St., Suite 400, San Francisco, CA 94108, U.S.A.Advanced Orthopaedics and Sports Medicine450 Sutter St.Suite 400San FranciscoCA94108U.S.A.
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Zhang Q, Yang J, Zhao G, Zheng D, Zhou X, Xu N, Wang Y. A new technique for arthroscopic reduction and fixation of displaced tibial intercondylar eminence fractures, using suture anchor and EndoButton system. J Orthop Surg (Hong Kong) 2017; 25:2309499016685011. [PMID: 28142355 DOI: 10.1177/2309499016685011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIM The study aims to describe a less invasive technique for displaced tibial intercondylar eminence fractures, using only one bone tunnel with suture anchor and EndoButton system. METHODS Seventeen patients were followed up after arthroscopic fixation for tibial eminence fractures using suture anchor and EndoButton. The patients were followed with clinical examinations such as Lysholm, Tegner, and International Knee Documentation Committee (IKDC) rating scales. Radiographic assessments were also performed during the follow-up for evaluating the healing of the fracture. RESULTS There were 14 male patients and 3 female patients with 10 right knees, and 7 left knees included. All the fractures healed anatomically at final follow-up. Also, no clinical signs of anterior cruciate ligament deficiency were detected. The mean Lysholm score improved significantly from 74.72 ± 3.24 (range from 70 to 79) to 96.2 ± 2.54 (range from 89 to 98) ( p < 0.001). The IKDC category was abnormal or severely abnormal preoperatively and all the patients improved to normal or nearly normal at final follow-up. The Tegner score also improved significantly postoperatively from 3.45 ± 1.02 to 6.34 ± 1.22 ( p < 0.001). CONCLUSION The study demonstrated that the procedure is safe and effective, which can be another option for tibial intercondylar eminence fractures.
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Affiliation(s)
- Qiang Zhang
- 1 Department of Orthopaedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, Changzhou, People's Republic of China
| | - Jianjun Yang
- 2 Department of Orthopaedics, Shanghai Tenth People's Hospital, Shanghai, China
| | - Gongyin Zhao
- 1 Department of Orthopaedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, Changzhou, People's Republic of China
| | - Dong Zheng
- 1 Department of Orthopaedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, Changzhou, People's Republic of China
| | - Xianju Zhou
- 3 Department of Neurology, Laboratory of Neurological Diseases, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, Changzhou, People's Republic of China
| | - Nanwei Xu
- 1 Department of Orthopaedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, Changzhou, People's Republic of China
| | - Yuji Wang
- 1 Department of Orthopaedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, Changzhou, People's Republic of China.,4 Department of Orthopaedics, Laboratory of Clinical Orthopaedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, Changzhou, People's Republic of China
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Sekiya H, Takatoku K, Kimura A, Kanaya Y, Fukushima T, Takeshita K. Arthroscopic fixation with EndoButton for tibial eminence fractures visualised through a proximal superomedial portal: a surgical technique. J Orthop Surg (Hong Kong) 2016; 24:417-420. [PMID: 28031518 DOI: 10.1177/1602400329] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Most tibial eminence fractures are avulsion fractures of the anterior cruciate ligament (ACL) from its tibial insertion. This study describes a new arthroscopic technique using an additional proximal superomedial portal to visualise the tibial eminence fracture and to fix the fracture with the EndoButton to avoid the risk of fragment breakage. The proximal superomedial portal enables fracture reduction without damage to the intermeniscal ligament. Fixation with the EndoButton is strong enough to allow early rehabilitation with vigorous exercise. All 5 patients achieved bone union; no young patient had growth disturbance of the tibia; all knees were stable with excellent range of motion and negative Lachman and pivot shift tests and no flexion contracture. Arthroscopic fixation with the EndoButton visualised through the proximal superomedial portal is a safe, simple, and secure method for treating tibial eminence fractures, particularly in children with small fragments.
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Affiliation(s)
- Hitoshi Sekiya
- Department of Orthopaedic Surgery, Shin-Kaminokawa Hospital, Tochigi, Japan
| | - Kenzo Takatoku
- Department of Orthopaedic Surgery, Shin-Kaminokawa Hospital, Tochigi, Japan
| | - Akinori Kimura
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Yuji Kanaya
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Takashi Fukushima
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
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Abstract
While some fractures may be managed similarly in adults and children, physeal fractures are uniquely limited to the pediatric population and require special consideration. Although physeal fractures about the knee are relatively rare, they are occurring more frequently due to increasing youth participation in sports and high-energy recreational activities. The evaluation and management of distal femoral and proximal tibial physeal fractures are similar to one another, but fractures of the tibial spine and tibial tubercle are approached somewhat differently. A thorough understanding of the pertinent developmental anatomy is critical for correlating the clinical findings with the imaging work-up, and for anticipating the most common and the most serious complications of each fracture. Diagnosis is usually made with appropriate plain radiographs with advanced imaging often used for preoperative planning. In general, fracture pattern and degree of displacement determine the need for surgical intervention and the overall outcome. While a variety of fixation techniques or constructs may be used, because of the importance of restoring physeal and articular anatomy for avoidance of growth disturbance and degenerative joint disease, respectively, achieving anatomic, rigid fixation is of greater importance than with many other fracture locations in the growing skeleton.
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Prevalence of knee stiffness after arthroscopic bone suture fixation of tibial spine avulsion fractures in adults. Orthop Traumatol Surg Res 2016; 102:625-9. [PMID: 27426237 DOI: 10.1016/j.otsr.2016.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/11/2016] [Accepted: 05/13/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tibial spine avulsion fractures (TSAFs) occur chiefly in adolescents. Few published data are available on outcomes after arthroscopic surgical treatment of TSAFs in adults. OBJECTIVES To evaluate outcomes of consecutive patients with TSAFs managed by arthroscopic bone suture followed by a standardised non-aggressive rehabilitation programme. HYPOTHESIS Arthroscopic bone suture followed by non-aggressive rehabilitation therapy reliably produces satisfactory outcomes in adults with TSAF. METHODS Thirteen adults were included. Outcomes were evaluated based on the Tegner score, International Knee Documentation Committee (IKDC) score, anterior-posterior knee laxity, passive and active motion ranges, and radiological appearance. RESULTS After a mean follow-up of 41±27months (12-94months), all 13 patients had healed fractures without secondary displacement. No patient had knee instability. Post-operative stiffness was noted in 5 patients (2 with complex regional pain syndrome and 3 with extension lag), 1 of whom required surgical release. The mean IKDC score was 91.3±11.7. The mean Tegner score was 5.46±1.37 compared to 6.38±0.70 before surgery. Mean tibial translation (measured using the Rolimeter) was 1.09±1.22mm, compared to 5.9±1.85mm before surgery. CONCLUSION The outcomes reported here support the reliability of arthroscopic bone suture for TSAF fixation. Nevertheless, a substantial proportion of patients experienced post-operative stiffness, whose contributory factors may include stunning of the quadriceps due to the short time from injury to surgery and the use of a gentle rehabilitation programme. LEVEL OF EVIDENCE IV, retrospective study of treatment outcomes.
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Liao W, Li Z, Zhang H, Li J, Wang K, Yang Y. Arthroscopic Fixation of Tibial Eminence Fractures: A Clinical Comparative Study of Nonabsorbable Sutures Versus Absorbable Suture Anchors. Arthroscopy 2016; 32:1639-50. [PMID: 27039964 DOI: 10.1016/j.arthro.2016.01.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 12/14/2015] [Accepted: 01/21/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare clinical outcomes of arthroscopic therapy for tibial eminence fracture with nonabsorbable suture and absorbable suture anchor. METHODS Between February 2010 and September 2012, a total of 60 tibial eminence fracture patients were treated with nonabsorbable suture fixation or absorbable suture anchor fixation under arthroscopy. Patients with tibial plateau fractures and other significant injuries, including osteochondral lesions, meniscal tear, and anterior cruciate ligament (ACL) or mutiligament injuries, were excluded from the study. Radiographs, anterior drawer test (ADT), Lachman test, Lysholm score, and International Knee Documentation Committee (IKDC) 2000 subjective score were employed to evaluate clinical outcomes in follow-up. RESULTS A total of 41 patients were analyzed. Among these patients, 22 were treated with nonabsorbable suture fixation and 19 with absorbable suture anchor fixation. According to the modified Meyers-McKeever classification, 15 cases were categorized as type II, 21 as type III, and 5 as type IV fractures. The mean time from injury to surgery was 7.1 days (range, 3 to 12 days). All patients were followed up for a median period of 33.7 months (range, 24 to 45 months). Radiographic evaluation showed optimal reduction immediately after operation and bone union within 3 months in all patients. At the final follow-up, there was no limitation of knee motion range in any patient. Grade II laxity was found in 2 cases from suture group and 1 from suture anchor group, showing no significant difference based on ADT (χ(2) = 0.538, P = .764) and Lachman test (χ(2) = 0.550, P = .760). Lysholm and IKDC 2000 subjective scores were significantly improved (P < .001). However, there were no significant differences in the improvement of Lysholm (t = 0.522, P = .604) and IKDC 2000 subjective scores (t = 0.644, P = .523) between the 2 groups. CONCLUSIONS Nonabsorbable suture fixation and absorbable suture anchor fixation are equivalent techniques in terms of the clinical efficacy of arthroscopic tibial eminence fracture treatment. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Weixiong Liao
- Department of Orthopedics, General Hospital of PLA, Beijing, China
| | - Zhongli Li
- Department of Orthopedics, General Hospital of PLA, Beijing, China.
| | - Hao Zhang
- Department of Orthopedics, General Hospital of PLA, Beijing, China
| | - Ji Li
- Department of Orthopedics, General Hospital of PLA, Beijing, China
| | - Ketao Wang
- Department of Orthopedics, General Hospital of PLA, Beijing, China
| | - Yimeng Yang
- Department of Orthopedics, General Hospital of PLA, Beijing, China
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Osti L, Buda M, Soldati F, Del Buono A, Osti R, Maffulli N. Arthroscopic treatment of tibial eminence fracture: a systematic review of different fixation methods. Br Med Bull 2016; 118:73-90. [PMID: 27151952 PMCID: PMC5127426 DOI: 10.1093/bmb/ldw018] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Arthroscopy procedures are the gold standard for the management of tibial spine avulsion. This review evaluates and compares different arthroscopic treatment options for tibial spine fractures. SOURCE OF DATA PubMed, Medline, Ovid, Google Scholar and Embase databases were systematically searched with no limit regarding the year of publication. AREAS OF AGREEMENT An arthroscopic approach compared with arthrotomy reduces complications such as soft-tissue lesions, post-operative pain and length of hospitalization. AREAS OF CONTROVERSY The use of suture techniques, compared to cannulated screw technique, avoids a second surgery for removal of the screws, but requires longer immobilization and partial weight bearing. GROWING POINTS Clinical outcomes and radiographic results do not seem to differ in relation to the chosen method of fixation. AREAS TIMELY FOR DEVELOPING RESEARCH Further studies are needed to produce clear guidelines to define the best choice in terms of clinical outcomes, function and complications.
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Affiliation(s)
- Leonardo Osti
- Unit of Arthroscopy and Sports Medicine, Hesperia Hospital, Via Arquá', Modena, Italy
| | - Matteo Buda
- Department of Orthopedic and Traumatology, University of Ferrara, Via Aldo Moro, Italy
| | - Francesco Soldati
- Department of Orthopedic and Traumatology, University of Ferrara, Via Aldo Moro, Italy
| | - Angelo Del Buono
- Department of Orthopedic and Trauma Surgery, Ospedale Vaio, Fidenza, Italy
| | - Raffaella Osti
- Department of Orthopedic and Traumatology, University of Ferrara, Via Aldo Moro, Italy
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, University of Salerno, Italy Centre for Sports and Exercise Medicine Queen Mary University of London Barts and The London School of Medicine and Dentistry , Mile End Hospital London, UK
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Kokkalis ZT, Iliopoulos ID, Pantazis C, Panagiotopoulos E. What's new in the management of complex tibial plateau fractures? Injury 2016; 47:1162-9. [PMID: 26989043 DOI: 10.1016/j.injury.2016.03.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The management of complex tibial plateau fractures is ever evolving. The severity of the injury to the surrounding soft tissues influences the timing and the method of fixation. Minimal invasive techniques continue to dominate our philosophy of reduction and reconstruction whereas augmentation of depressed intra-articular fragments remains an accepted strategy to maintain reduction and prevent secondary collapse. Locking plates, conventional plates and fine wire fixators all have been used successfully with satisfactory outcomes. In this article we report on the latest advances made in the management of these complex injuries.
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Affiliation(s)
- Zinon T Kokkalis
- University of Patras, School of Medicine, University Hospital of Patras, Department of Orthopaedics, Papanikolaou 1, 26504 Rio-Patras, Greece.
| | - Ilias D Iliopoulos
- University of Patras, School of Medicine, University Hospital of Patras, Department of Orthopaedics, Papanikolaou 1, 26504 Rio-Patras, Greece
| | - Constantinos Pantazis
- University of Patras, School of Medicine, University Hospital of Patras, Department of Orthopaedics, Papanikolaou 1, 26504 Rio-Patras, Greece
| | - Elias Panagiotopoulos
- University of Patras, School of Medicine, University Hospital of Patras, Department of Orthopaedics, Papanikolaou 1, 26504 Rio-Patras, Greece.
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Edmonds EW, Fornari ED, Dashe J, Roocroft JH, King MM, Pennock AT. Results of Displaced Pediatric Tibial Spine Fractures: A Comparison Between Open, Arthroscopic, and Closed Management. J Pediatr Orthop 2016; 35:651-6. [PMID: 25393567 DOI: 10.1097/bpo.0000000000000356] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Displaced tibial spine fractures are frequently treated with surgical reduction and fixation, but no comparison studies have been performed. This study was undertaken to compare fragment reduction and adverse outcomes between open arthrotomy [open reduction and internal fixation (ORIF)], arthroscopy [arthroscopic-assisted internal fixation (AAIF)], and closed management [closed management and casting (CMC)] of pediatric tibial spine fractures. METHODS A retrospective review of children treated for displaced tibial spine fractures from 2003 to 2011 was performed after categorizing into the 3 treatment groups. Demographics, mechanism of injury, radiographic measures (plain film and computed tomography), treatment, duration of immobilization and follow-up, final range of motion, and complications were recorded. Families were contacted to obtain long-term Lysholm scores, return to activity, pain, and satisfaction with treatment. RESULTS Seventy-six children (mean age, 12.4 y) met criteria with 29 ORIF, 28 AAIF, and 19 CMC. Radiographic measurements between x-ray and computed tomography scans found a mean error of 1 mm (SD=1.33 mm; inter-class coefficient = 0.977, P < 0.001). Initial fracture displacement was similar between AAIF and ORIF, 10.3 ± 4.4 mm and 10.8 ± 3.9 mm; but, less in CMC group (5.3 ± 2.6 mm). The mean reduction amount was 8.6 ± 4.7, 9.1 ± 4.0, and 2.3 ± 2.6 mm, respectively. A Bonferroni post hoc analysis revealed a difference between surgical and nonoperative reduction (P < 0.001), but not between AAIF and ORIF (P=0.9). Arthrofibrosis occurred with equal frequency in surgical cohorts (AAIF 12.5%, ORIF 11.1%), compared with none in the CMC group. Yet, the CMC group had a 16.7% risk for reoperation secondary to instability, loose bodies, or impingement. Twenty-four percent of each cohort was available (at mean 6.0 y) for interview with mean (median) Lysholm score: ORIF 97.4 (99), AAIF 95 (100), and CMC 86 (97.5), P = 0.35. CONCLUSIONS Open or arthroscopic treatment of displaced tibial spine fractures affords a better reduction than closed management, but with higher risk for arthrofibrosis. Closed management may be successful when displacement is < 5 mm, and advanced imaging may not be necessary to delineate the amount of displacement.
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Affiliation(s)
- Eric W Edmonds
- *Department of Orthopedic Surgery, Rady Children's Hospital and Health Center †Department of Orthopedic Surgery, University of California San Diego, San Diego, CA ‡Department of Orthopedic Surgery, Montefiore Medical Center, Bronx, NY §Department of Orthopedic Surgery, Boston University School of Medicine, Boston, MA
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Brunner S, Vavken P, Kilger R, Vavken J, Rutz E, Brunner R, Camathias C. Absorbable and non-absorbable suture fixation results in similar outcomes for tibial eminence fractures in children and adolescents. Knee Surg Sports Traumatol Arthrosc 2016; 24:723-9. [PMID: 26520645 DOI: 10.1007/s00167-015-3844-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/22/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate efficacy and safety of extraphyseal tibial eminence avulsion fracture repair with absorbable sutures and a distal bone bridge fixation in comparison to previously described technique with non-absorbable sutures and distal screw fixation. METHODS In a physeal-sparing technique, tibial eminence fractures (n = 25; McKeever type II/III n = 11/14) were either treated in group A (n = 15, follow-up 28.1 months) using an absorbable suture fixed over a bone bridge or in group B (n = 10, follow-up 47.4 months) with a non-absorbable suture wrapped around an extraarticular tibial screw. IKDC and Lysholm scores were assessed, and the difference between the surgical and contralateral knee in anteroposterior (AP) translation, measured with a Rolimeter. RESULTS There was no significant difference between group A and group B in IKDC and Lysholm scores with 90.1 points ± 10.2 and 94.1 points ± 8.1, respectively (n.s.). AP translation did not differ between groups (n.s.). Eight of ten screws in group B had to be removed in a second intervention. A total of four arthrofibroses were counted (three in group A). CONCLUSION Extraphyseal tibial eminence repair with absorbable sutures and a distal bone bridge fixation results in similar rates of radiographic and clinical healing at 3 months after surgery as non-absorbable sutures tied around a screw, while avoiding the need for hardware removal. The minimal invasive technique to fix an eminence fracture without any permanent sutures or hardware is advantageous for children. To our knowledge, this is the first study that compares non-absorbable with absorbable sutures for a physeal-sparing technique. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Stefan Brunner
- Paediatric Orthopaedic Department, University Children's Hospital Basle (UKBB), Spitalstrasse 33, 4056, Basel, Switzerland
| | - Patrick Vavken
- Paediatric Orthopaedic Department, University Children's Hospital Basle (UKBB), Spitalstrasse 33, 4056, Basel, Switzerland.,Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Julia Vavken
- Orthopaedic Department, University Hospital Basel, 4003, Basel, Switzerland
| | - Erich Rutz
- Paediatric Orthopaedic Department, University Children's Hospital Basle (UKBB), Spitalstrasse 33, 4056, Basel, Switzerland
| | - Reinald Brunner
- Paediatric Orthopaedic Department, University Children's Hospital Basle (UKBB), Spitalstrasse 33, 4056, Basel, Switzerland
| | - Carlo Camathias
- Paediatric Orthopaedic Department, University Children's Hospital Basle (UKBB), Spitalstrasse 33, 4056, Basel, Switzerland. .,Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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Treatment of avulsion fractures of the intercondylar eminence by medial parapatellar approach, open reduction and cross wire fixation. J Pediatr Orthop B 2015; 24:321-5. [PMID: 25856279 DOI: 10.1097/bpb.0000000000000177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Avulsion fractures of the intercondylar eminence in children and adolescents are relatively uncommon and can lead to significant disability with improper union. Many operative techniques have been developed to fixate these fractures, most of them utilizing sophisticated fixation modes. In this study, a small medial parapatellar approach was used with open reduction and percutaneous cross Kirschner wire fixation. The aim of this study was to evaluate the effectiveness of this method. From 2007 to 2012, eight children were treated, mean age 11.8 years (range 10-14 years). All underwent open reduction by a medial parapatellar incision and fixation by two cross Kirschner wires introduced in an oblique crossed manner from the medial and lateral aspects of the proximal tibia. Fractures were classified as Meyers and McKeever type III and were not candidates for conservative treatment. All operated limbs were immobilized postoperatively in a circular cast in extension for 6 weeks and allowed partial weight bearing from day 1 after the procedure. Outcomes were evaluated clinically and through radiographs taken during follow-up. All fractures were successfully reduced and healed, with no occurrences of malunion or nonunion. At follow-up, all patients had full knee range of motion, there was no gross laxity of the knee compared with the contralateral knee, and good functional outcome was achieved. On the basis of our experience, we believe that the procedure that we used is a simple, low-tech, and minimally invasive technique for the treatment of these fractures, with good functional outcome.
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Cases and current concepts in pediatric sports medicine. J Pediatr Orthop 2015; 34 Suppl 1:S49-56. [PMID: 25207737 DOI: 10.1097/bpo.0000000000000287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Archibald-Seiffer N, Jacobs J, Zbojniewicz A, Shea K. Incarceration of the intermeniscal ligament in tibial eminence injury: a block to closed reduction identified using MRI. Skeletal Radiol 2015; 44:717-21. [PMID: 25283983 DOI: 10.1007/s00256-014-2014-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 09/13/2014] [Accepted: 09/16/2014] [Indexed: 02/02/2023]
Abstract
Tibial eminence fractures are a relatively uncommon injury, but most frequently occur in children and adolescents with open physes. Entrapment of the intermeniscal ligament or the meniscus itself can occur in the setting of a tibial eminence fracture and when present, poses a significant obstacle to successful closed or surgical reduction. Identification of these entrapped structures on preoperative imaging may be helpful to the physicians caring for these patients and assist with preoperative planning. We present a case of a 13-year-old male who sustained a tibial eminence fracture while playing football. Review by the orthopedic surgeon identified entrapment of the intermeniscal ligament. Subsequently, a closed reduction attempt under anesthesia prior to surgery was unsuccessful and arthroscopy was needed to remove the entrapped intermeniscal ligament and reduce the tibial eminence fracture. Pre-operative knowledge of entrapped soft tissue structures under the fracture plane, particularly the meniscus and intermeniscal ligament, provides the surgeon with valuable insight as to how to best counsel patients on the success of treatment options, how to best prepare for operative treatment, and can guide the surgeon during open reduction to maximize treatment success.
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