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Elghaish MAI, El-Lahham SMAI, Helwo AHSA, Elfekky MMAA, Gawish HM. Double Decker anterior cruciate ligament avulsion. Trauma Case Rep 2024; 52:101053. [PMID: 38974525 PMCID: PMC11225012 DOI: 10.1016/j.tcr.2024.101053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 07/09/2024] Open
Abstract
Distal anterior cruciate ligament avulsion from tibial side is an unusual injury. It can be either bony avulsion, which is more common, or rarely a soft tissue peeling of tibial spine with no bone injury. This case report represents a very infrequent injury of combined soft tissue peeling of distal anterior cruciate ligament along with bony avulsion of tibial spine in a 12-years-old boy after falling from his bike.
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Orellana KJ, Houlihan NV, Carter MV, Baghdadi S, Baldwin K, Stevens AC, Cruz AI, Ellis HB, Green DW, Kushare I, Johnson B, Kerrigan A, Kirby JC, MacDonald JP, McKay SD, Milbrandt TA, Justin Mistovich R, Parikh S, Patel N, Schmale G, Traver JL, Yen YM, Ganley TJ. Tibial Spine Fractures in the Child and Adolescent Athlete: A Systematic Review and Meta-analysis. Am J Sports Med 2024; 52:1357-1366. [PMID: 37326248 DOI: 10.1177/03635465231175674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Tibial spine fractures (TSFs) are uncommon injuries that may result in substantial morbidity in children. A variety of open and arthroscopic techniques are used to treat these fractures, but no single standardized operative method has been identified. PURPOSE To systematically review the literature on pediatric TSFs to determine the current treatment approaches, outcomes, and complications. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS A systematic review of the literature was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines using PubMed, Embase, and Cochrane databases. Studies evaluating treatment and outcomes of patients <18 years old were included. Patient demographic characteristics, fracture characteristics, treatments, and outcomes were abstracted. Descriptive statistics were used to summarize categorical and quantitative variables, and a meta-analytic technique was used to compare observational studies with sufficient data. RESULTS A total of 47 studies were included, totaling 1922 TSFs in patients (66.4% male) with a mean age of 12 years (range, 3-18 years). The operative approach was open reduction and internal fixation in 291 cases and arthroscopic reduction and internal fixation in 1236 cases; screw fixation was used in 411 cases and suture fixation, in 586 cases. A total of 13 nonunions were reported, occurring most frequently in Meyers and McKeever type III fractures (n = 6) and in fractures that were treated nonoperatively (n = 10). Arthrofibrosis rates were reported in 33 studies (n = 1700), and arthrofibrosis was present in 190 patients (11.2%). Range of motion loss occurred significantly more frequently in patients with type III and IV fractures (P < .001), and secondary anterior cruciate ligament (ACL) injury occurred most frequently in patients with type I and II fractures (P = .008). No statistically significant differences were found with regard to rates of nonunion, arthrofibrosis, range of motion loss, laxity, or secondary ACL injury between fixation methods (screw vs suture). CONCLUSION Despite variation in TSF treatment, good overall outcomes have been reported with low complication rates in both open and arthroscopic treatment and with both screw and suture fixation. Arthrofibrosis remains a concern after surgical treatment for TSF, but no significant difference in incidence was found between the analysis groups. Larger studies are necessary to compare outcomes and form a consensus on how to treat and manage patients with TSFs.
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Affiliation(s)
- Kevin J Orellana
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nathan V Houlihan
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael V Carter
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Soroush Baghdadi
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Keith Baldwin
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Aristides I Cruz
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Henry B Ellis
- Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
| | | | | | | | | | | | | | | | | | - R Justin Mistovich
- University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Shital Parikh
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Neeraj Patel
- Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | | | - Jessica L Traver
- Jessica L. Traver, MD (University of Texas Health Houston, Houston, Texas, USA
| | - Yi-Meng Yen
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Theodore J Ganley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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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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Salvato D, Green DW, Accadbled F, Tuca M. Tibial spine fractures: State of the art. J ISAKOS 2023; 8:404-411. [PMID: 37321295 DOI: 10.1016/j.jisako.2023.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 05/23/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
Tibial spine fractures (TSFs) are avulsion fractures at the site where the anterior cruciate ligament inserts onto the tibial eminence. TSFs typically affect children and adolescents aged 8-14 years. The incidence of these fractures has been reported to be approximately 3 per 100,000 per year, but the rising involvement of paediatric patients in sporting activities is increasing the number of these injuries. TSFs are historically classified on plain radiographs according to the Meyers and Mckeever classification system, which was introduced in 1959, but the renewed interest in these fractures and the increasing use of magnetic resonance imaging led to the recent development of a new classification system. A reliable grading protocol for these lesions is paramount to guide orthopedic surgeons in determining the correct treatment for young patients and athletes. TSFs can be addressed conservatively in the case of nondisplaced or reduced fractures or surgically in the case of displaced fractures. Different surgical approaches and, specifically, arthroscopic techniques have been described in recent years to ensure stable fixation while limiting the risk of complications. The most common complications associated with TSF are arthrofibrosis, residual laxity, fracture nonunion or malunion, and tibial physis growth arrest. We speculate that advances in diagnostic imaging and classifications, combined with greater knowledge of treatment options, outcomes, and surgical techniques, will likely reduce the occurrence of these complications in paediatric and adolescent patients and athletes, allowing them a timely return to sports and everyday activities.
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Affiliation(s)
- Damiano Salvato
- Vita-Salute San Raffaele University, Residency Program in Orthopedic Surgery and Traumatology, Milan, Italy; Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Daniel W Green
- Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Franck Accadbled
- Pediatric Orthopedic Department, Hôpital des Enfants de Toulouse, Toulouse, France
| | - Maria Tuca
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Chile; Department of Orthopedic Surgery, Hospital Clinico Mutual de Seguridad, Santiago de Chile, Chile.
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Khurana K, Pisulkar G. Functional Rehabilitation of Anterior Cruciate Ligament Tear in the Pediatric Population: A Comprehensive Review. Cureus 2023; 15:e49863. [PMID: 38170114 PMCID: PMC10759723 DOI: 10.7759/cureus.49863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
Pediatric sports injuries are a growing concern due to increased youth participation in sports. Effective rehabilitation strategies are essential for ensuring optimal recovery, restoring knee function, and preventing long-term consequences. This research aims to explore and evaluate various functional rehabilitation approaches tailored to pediatric anterior cruciate ligament (ACL) tear injuries. Functional rehabilitation of ACL tears in pediatric sports injuries is an important area of research due to the unique considerations and challenges that arise when treating ACL injuries in young athletes. Over the last 20 years, there has been a well-documented uptick in ACL injuries among pediatric populations. This rise can be attributed to the growing involvement of the younger population in competitive sports, as well as heightened awareness regarding sports-linked injuries. This study highlights the importance of early surgical reconstruction in children to enable a quick return to sports and prevent long-term cartilage and meniscal damage resulting from instability. The use of physeal-sparing ACL reconstruction techniques, particularly hamstring autografts, is recommended for favorable clinical outcomes while minimizing growth disturbances. This study offers valuable insights for healthcare professionals and researchers, serving as a reference to guide optimal approaches in managing pediatric ACL injuries and achieving successful results in this field.
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Affiliation(s)
- Khushi Khurana
- Orthopaedics and Rehabilitation, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gajanan Pisulkar
- Orthopaedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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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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Wang C, Liu SJ, Chang CH. Thickness of simple calcaneal tuberosity avulsion fractures influences the optimal fixation method employed. Bone Joint Res 2023; 12:504-511. [PMID: 37607719 PMCID: PMC10444534 DOI: 10.1302/2046-3758.128.bjr-2023-0060.r1] [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] [Indexed: 08/24/2023] Open
Abstract
Aims This study aimed to establish the optimal fixation methods for calcaneal tuberosity avulsion fractures with different fragment thicknesses in a porcine model. Methods A total of 36 porcine calcanea were sawed to create simple avulsion fractures with three different fragment thicknesses (5, 10, and 15 mm). They were randomly fixed with either two suture anchors or one headless screw. Load-to-failure and cyclic loading tension tests were performed for the biomechanical analysis. Results This biomechanical study predicts that headless screw fixation is a better option if fragment thickness is over 15 mm in terms of the comparable peak failure load to suture anchor fixation (headless screw: 432.55 N (SD 62.25); suture anchor: 446.58 N (SD 84.97)), and less fracture fragment displacement after cyclic loading (headless screw: 3.94 N (SD 1.76); suture anchor: 8.68 N (SD 1.84)). Given that the fragment thickness is less than 10 mm, suture anchor fixation is a safer option. Conclusion Fracture fragment thickness helps in making the decision of either using headless screw or suture anchor fixation in treating calcaneal tuberosity avulsion fracture, based on the regression models of our study.
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Affiliation(s)
- Chunliang Wang
- Material Department, Imperial College London, London, UK
| | - Shih-Jung Liu
- Department of Mechanical Engineering, Chang Gung University, Taoyuan City, Taiwan
| | - Chung-Hsun Chang
- Orthopaedic Department, National Taiwan University Hospital, Taipei City, Taiwan
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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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9
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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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Jain S, Modi P, Dayma RL, Mishra S. Clinical outcome of arthroscopic suture versus screw fixation in tibial avulsion of the anterior cruciate ligament in skeletally mature patients. J Orthop 2023; 35:7-12. [PMID: 36325248 PMCID: PMC9619313 DOI: 10.1016/j.jor.2022.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 09/29/2022] [Accepted: 10/17/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Tibial eminence fracture is an intra-articular fracture of bony attachment of ACL. The displaced fragment could hinder the mobility of the knee and may lead joint instabilty; therefore, requires fixation. Arthroscopic suture and screw fixation are the widely used surgical modalities for eminence fractures of the tibia. Past studies have not yet depicted the superiority of one method over the other. Through this cohort study, comparison of the clinical and functional outcomes of these two surgical methods was done. METHODS A prospective, randomized, interventional study was conducted from December 2019 to January 2022 for comparing the clinical outcome of arthroscopic pull through suture fixation and arthroscopic antegrade cancellous screw fixation in skeletally mature individuals. Ninety patients (45 in each group) were randomly assigned and treated with the above two methods. A comprehensive clinical analysis was done after nine months of surgery for assessment of functional outcome, ligament laxity, range of motion, and complications if any. RESULTS 65.55% of anterior tibial eminence fractures were caused by road traffic accidents followed by sports injuries (28.88%). The postoperative mean subjective IKDC score in the suture group was 91.36 and for the screw fixation group was 85.71 (p = 0.001). After nine months of surgery, the mean LKS was 91.96 in patients treated with suture fixation and 86.00 in patients treated with screw fixation (p = 0.001). Pivot shift grading was grade 3 in one patient of the suture group and in three patients of the screw group (p = 0.319). Seven patients who had screw fixation required re-surgery for removal of the implant; however, no such complication was seen in the suture fixation group. CONCLUSION Arthroscopic pull-through suture fixation of tibial avulsion of ACL in skeletally mature patients seems to be a superior intervention over arthroscopic screw fixation with the benefits of better clinical and functional outcomes and decreased chances of re-surgery.
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Affiliation(s)
- Siddharth Jain
- Department of Orthopaedics, S.M.S. Medical College, Jaipur, Rajasthan, India
| | - Prashant Modi
- Department of Orthopaedics, S.M.S. Medical College, Jaipur, Rajasthan, India
| | - Ratan Lal Dayma
- Department of Orthopaedics, S.M.S. Medical College, Jaipur, Rajasthan, India
| | - Sonal Mishra
- Department of Anaesthesiology, S.M.S. Medical College, Jaipur, Rajasthan, India
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Czer E, Menzer H, Vij N, Metzger C. Femoral-Sided Avulsion Fracture of the Anterior Cruciate Ligament in a Skeletally Immature Patient: A Case Report. JBJS Case Connect 2022; 12:01709767-202212000-00012. [PMID: 36820644 DOI: 10.2106/jbjs.cc.21.00449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 07/28/2022] [Indexed: 02/24/2023]
Abstract
CASE A 10-year-old boy presented to the clinic with sharp left knee pain after sustaining an injury while hiking. The patient was unable to bear weight. Physical examination demonstrated a moderate effusion and lateral joint line tenderness. Imaging studies revealed a femoral-sided avulsion of the anterior cruciate ligament. Arthroscopic suture fixation of the avulsed fragment resulted in good radiographic and clinical results at the 13-month follow-up. CONCLUSION Physeal-sparing suture-fixation of femoral-sided anterior cruciate ligament avulsion injuries can be performed using an all-arthroscopic approach and may be a viable treatment option.
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Affiliation(s)
- Eric Czer
- Mountain View Regional Medical Center, Las Cruces, New Mexico
| | | | - Neeraj Vij
- University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Charles Metzger
- Mountain View Regional Medical Center, Las Cruces, New Mexico
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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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13
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A Suture Fixation Technique for Tibial Spine Avulsion Injuries. Tech Orthop 2022. [DOI: 10.1097/bto.0000000000000605] [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: 11/25/2022]
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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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Dhillon MS, Rangasamy K, Rajnish RK, Gopinathan NR. Paediatric Anterior Cruciate Ligament (ACL) Injuries: Current Concepts Review. Indian J Orthop 2022; 56:952-962. [PMID: 35669018 PMCID: PMC9123120 DOI: 10.1007/s43465-022-00611-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/09/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Over the past two decades, there has been a documented increase in paediatric ACL injuries because of a rise in younger age sports participation at the competitive level, awareness about sports-related injuries, and advanced imaging modalities. METHODS A PubMed electronic database search was done, which revealed 1366 hits over the last five years (2016 - 2020). Finally, 37 articles that contributed to new findings were included. This review was conducted based on predefined research questions. RESULTS AND CONCLUSION Early surgical reconstruction is recommended in children due to the increasing demand for early return to sports and to prevent the instability that can lead to progressive cartilage and meniscal damage. With the evolution of several "physeal sparing" ACL reconstruction (ACLR) techniques, a favorable clinical outcome with less growth disturbance is achievable. Although different autograft options are available, hamstring autografts are most commonly preferred. A specific pattern of a bone bruise not extending into the metaphysis, and lateral meniscus tears are the most common associated injuries. Following paediatric ACLR, complications like graft rupture and contralateral ACL injuries are two to three folds higher than with adult ACLR. Unprepared early return to sports is one of the reasons for increased complication rates in children; thus, clearance criteria for return to sports need to be standardized, and early return to sports (< 9 months post ACLR) should be avoided. Neuromuscular training protocols are recommended to minimize complications like graft ruptures.
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Affiliation(s)
- Mandeep Singh Dhillon
- grid.415131.30000 0004 1767 2903Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Karthick Rangasamy
- grid.415131.30000 0004 1767 2903Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajesh Kumar Rajnish
- grid.413618.90000 0004 1767 6103Department of Orthopaedics, AIIMS, Bilaspur, India
| | - Nirmal Raj Gopinathan
- grid.415131.30000 0004 1767 2903Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Chang CJ, Huang TC, Hoshino Y, Wang CH, Kuan FC, Su WR, Hong CK. Functional Outcomes and Subsequent Surgical Procedures After Arthroscopic Suture Versus Screw Fixation for ACL Tibial Avulsion Fractures: A Systematic Review and Meta-analysis. Orthop J Sports Med 2022; 10:23259671221085945. [PMID: 35400137 PMCID: PMC8990705 DOI: 10.1177/23259671221085945] [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: 11/17/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Although arthroscopic screw fixation and suture fixation are mainstream
interventions for displaced anterior cruciate ligament avulsion fractures of
the tibia, the differences in clinical outcomes between them remain
inconclusive. Purpose: To conduct a meta-analysis comparing the clinical and functional outcomes
between arthroscopic screw fixation and suture fixation for tibial avulsion
fractures. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was conducted following the PRISMA (Preferred Reporting
Items for Systematic Reviews and Meta-Analyses) guidelines and using the
PubMed, Embase, and Cochrane Central Register of Controlled Trials
databases. Inclusion criteria were English-language articles that compared
functional outcomes after screw fixation versus suture fixation for tibial
avulsion fractures and had at least 1-year follow-up. Relevant data were
extracted and analyzed statistically using the Mantel-Haenszel method and
variance-weighted means. Random-effects models were used to generate pooled
relative risk (RR) estimates with confidence intervals (CIs). Results: Of 1395 articles initially identified, we included 5 studies with 184
patients (91 patients with screw fixations and 93 patients with suture
fixations). The pooled results indicated similar postoperative outcomes for
screw fixation and suture fixation: Lysholm score (mean difference [MD],
−0.32 [95% CI, −6.08 to 5.44]; P = .91), proportion of
International Knee Documentation Committee score grade A (74% vs 74%; RR,
0.63 [95% CI, 0.10-3.95]; P = .63), Tegner score (MD, 0.10
[95% CI: −1.73 to 1.92]; P = .92), and Lachman test results
(stable knee joint, 82% vs 82%; RR, 0.99; 95% CI: 0.85-1.16;
P = .90). Patients in the screw fixation group had a
significantly higher overall subsequent surgery rate (46% vs 19%; RR, 2.33;
95% CI,1.51-3.60; P = .0001) and implant removal rate (44%
vs 3%; RR, 8.52; 95% CI, 3.58-20.29; P < .00001)
compared with those in the suture fixation group. Nonimplant-related
subsequent surgery rates were similar for the 2 groups. Conclusion: The findings indicated a higher risk of subsequent surgery (RR, 2.33) and
implant removal (RR, 8.52) after screw fixation when compared with suture
fixation for tibial avulsion fractures. However, there were no significant
differences in clinical outcome scores between the 2 techniques.
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Affiliation(s)
- Chao-Jui Chang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Ching Huang
- National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Chi-Hsiu Wang
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Skeleton Materials and Biocompatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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17
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Thome AP, O'Donnell R, DeFroda SF, Cohen BH, Cruz AI, Fleming BC, Owens BD. Effect of Skeletal Maturity on Fixation Techniques for Tibial Eminence Fractures. Orthop J Sports Med 2021; 9:23259671211049476. [PMID: 34796240 PMCID: PMC8593322 DOI: 10.1177/23259671211049476] [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: 06/03/2021] [Accepted: 07/14/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Several fixation methods have been reported for the operative treatment of tibial eminence fractures. Previous biomechanical studies have demonstrated that suture fixation may be a stronger construct; however, the maturity status of these specimens was not scrutinized. Purpose: To examine if suture fixation remains a biomechanically superior fixation method to screw fixation in both skeletally mature and immature specimens. Study Design: Controlled laboratory study. Methods: Sixteen total matched porcine (Yorkshire) knees (8 skeletally immature knees and 8 skeletally mature knees) were procured, and a standardized tibial eminence fracture was created. In each age-matched group of knees, 4 knees underwent randomization to fixation with 2 screws while 4 knees were randomized to fixation using a dual-suture technique. Once fixation was complete, the specimens underwent cyclic loading (200 cycles) in the anteroposterior plane of the tibia and load-to-failure testing, both with the knee positioned at 30° of flexion. Relevant measurements were recorded, and data were analyzed. Results: Among mature specimens, load to failure was 1.9 times higher in the suture fixation group compared with the screw fixation group (1318.84 ± 305.55 vs 711.66 ± 279.95 N, respectively; P = .03). The load to failure was not significantly different between the groups in immature specimens (suture: 470.00 ± 161.91 N vs screw: 348.79 ± 102.46; P = .08). Conclusion: These findings suggest that suture fixation may represent a better construct choice for fixation of tibial eminence fractures in the skeletally mature population. However, in the skeletally immature population, fixation with screws or suture may be equivalent. Displacement after cyclic loading did not appear to differ by fixation method, nor did stiffness. Clinical Relevance: A stronger fixation construct may be beneficial and allow for earlier range of motion to help potentially decrease postoperative stiffness. Clinical studies are warranted to see if these results may be replicated in humans.
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Affiliation(s)
- Andrew P Thome
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Ryan O'Donnell
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Steven F DeFroda
- Department of Orthopaedic Surgery, Rush University School of Medicine, Chicago, Illinois, USA
| | - Brian H Cohen
- Orthopedic Associates, Providence, Rhode Island, USA
| | - Aristides I Cruz
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Braden C Fleming
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Brett D Owens
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
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18
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Arthroscopic Fixation of Anterior Cruciate Ligament Avulsion Fracture Using FiberWire Suture With Suture Disc. Arthrosc Tech 2021; 10:e1709-e1715. [PMID: 34336568 PMCID: PMC8322570 DOI: 10.1016/j.eats.2021.03.018] [Citation(s) in RCA: 4] [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: 01/04/2021] [Accepted: 03/09/2021] [Indexed: 02/03/2023] Open
Abstract
Controversy still exists regarding how to reduce and fix a displaced tibial avulsion fracture. Open reduction and internal fixation may lead to morbidity due to soft-tissue injury and arthrotomy. As a result, arthroscopic techniques are increasing in popularity. In the literature, sutures, K wires, and screws are suggested to be used as the fixation devices. Screws cannot be used in small or comminuted fractures, whereas K wires and sutures may not provide strong stability. Recently, with the advent of ultrahigh molecular weight polyethylene sutures like FiberWire, it has become possible to use it as the fixation device in even comminuted avulsion fractures with acceptable reduction stability. In this paper, we describe a simple arthroscopic technique using a FiberWire to manage the displaced tibial eminence avulsion fracture.
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19
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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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20
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Russu OM, Pop TS, Ciorcila E, Gergely I, Zuh SG, Trâmbițaș C, Borodi PG, Incze-Bartha Z, Feier AM, Georgeanu VA. Arthroscopic Repair in Tibial Spine Avulsion Fractures Using Polyethylene Terephthalate Suture: Good to Excellent Results in Pediatric Patients. J Pers Med 2021; 11:jpm11050434. [PMID: 34069562 PMCID: PMC8160716 DOI: 10.3390/jpm11050434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The objective of the arthroscopic treatment in tibial spine avulsion fractures (TSAF) is to achieve firm reduction and strong internal fixation while still having the patient undergo a minimally invasive procedure. Material and methods: The study was performed on 12 young patients with avulsion fracture of the anterior tibial spine. All 12 patients had type 3 Modified Meyers and McKeever fractures. The injury mechanism was direct anterior to posterior trauma in full leg length hyperextension with sport trauma reported in all cases. The physical examination revealed decreased range of motion, extension deficit, and pain during walking. Radiology, MRI, and CT pathologic findings described complete fracture of the anterior tibial spine with no clear signs of callus formation at the time of examination. All patients underwent arthroscopic suture surgical treatment. The Tegner, the Lysholm, and the International Knee Documentation Committee (IKDC) scores were used to evaluate subjective outcomes at three and six months after the surgery. Radiographs were used to assess callus formation and healing status of the fracture. Results: The mean IKDC score was 33.4 ± 23.3 (p = 0.032) preoperatively and 84.2 ± 14.3 at final follow-up (p = 0.0032, CI = 95%). The mean Tegner score improved from 3.8 ± 1.1 pre-operatively to 6.7 ± 2.2 at six months follow-up (p = 0.0231, CI = 95%). The Lysholm score differed significantly at baseline compared to final follow-up (53.7 ± 17.3 vs. 87.7 ± 9.9; p = 0.0066, CI = 95%). In all cases (n = 12), the radiographs taken after six months revealed the healing of the fracture in the anatomic position without secondary displacement. No functional knee instability was detected at the end of the study. Conclusions: The study provides preliminary promising results regarding fracture healing, knee stability, and functional subjective scores. Patient selection was a major factor of success prediction for this technique.
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Affiliation(s)
- Octav Marius Russu
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (I.G.); (S.-G.Z.); (C.T.); (Z.I.-B.); (A.M.F.)
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
| | - Tudor Sorin Pop
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (I.G.); (S.-G.Z.); (C.T.); (Z.I.-B.); (A.M.F.)
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
| | - Emilian Ciorcila
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (I.G.); (S.-G.Z.); (C.T.); (Z.I.-B.); (A.M.F.)
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
- Correspondence: ; Tel.: +40-265213720
| | - István Gergely
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (I.G.); (S.-G.Z.); (C.T.); (Z.I.-B.); (A.M.F.)
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
| | - Sándor-György Zuh
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (I.G.); (S.-G.Z.); (C.T.); (Z.I.-B.); (A.M.F.)
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
| | - Cristian Trâmbițaș
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (I.G.); (S.-G.Z.); (C.T.); (Z.I.-B.); (A.M.F.)
- Department of Anatomy and Embryology, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania
| | - Paul Gabriel Borodi
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
| | - Zsuzsanna Incze-Bartha
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (I.G.); (S.-G.Z.); (C.T.); (Z.I.-B.); (A.M.F.)
- Department of Anatomy and Embryology, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania
| | - Andrei Marian Feier
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (I.G.); (S.-G.Z.); (C.T.); (Z.I.-B.); (A.M.F.)
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
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Anterior Cruciate Ligament Tear Following Operative Treatment of Pediatric Tibial Eminence Fractures in a Multicenter Cohort. J Pediatr Orthop 2021; 41:284-289. [PMID: 33654026 DOI: 10.1097/bpo.0000000000001783] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Postoperative ipsilateral anterior cruciate ligament (ACL) tears after tibial eminence fracture fixation has been previously noted in the literature. This study aims to describe the prevalence of and risk factors for postoperative ACL tears in a cohort of patients operatively treated for tibial eminence fracture. METHODS A retrospective review of children undergoing treatment of a tibial eminence fracture at 10 tertiary care children's hospitals was performed. The primary outcome of interest was subsequent ACL rupture. Incidence of ACL tear was recorded for the entire cohort. Patients who sustained a postoperative ACL tear were compared with those without ACL tear and analyzed for demographics and risk factors. A subgroup analysis was performed on patients with a minimum of 2-year follow-up data or those who had met the primary outcome (ACL tear) before 2 years. RESULTS A total of 385 pediatric patients were reviewed. 2.6% of the cohort experienced a subsequent ACL tear. The median follow-up time was 6.5 months (SD=6.4 mo). Subsequent ACL tears occurred at a median of 10.2 months (SD=19.5 mo) postoperatively. There was a statistically significant association with higher grade tibial spine fractures (Myers and McKeever type III and IV) and subsequent ACL tear (P=0.01). Patients with a subsequent ACL tear were older on average (13.5 vs. 12.2 y old), however, this difference was not statistically significant (P=0.08). Subgroup analysis of 46 patients who had a 2-year follow-up or sustained an ACL tear before 2 years showed a 21.7% incidence of a subsequent ACL tear. There was a statistically significant association with higher grade tibial spine fractures (Myers and McKeever type III and IV) and subsequent ACL rupture (P=0.006) in this subgroup. Postoperative ACL tears occurred in patients who were older at the time that they sustained their original tibial eminence fracture (13.4 vs. 11.3 y old, P=0.035). CONCLUSIONS Ipsilateral ACL tears following operatively treated pediatric tibial eminence fractures in a large multicenter cohort occurred at a rate of 2.6%. However, in those with at least 2 years of follow-up, the incidence was 21.7%. Subsequent ACL tear was more likely in those with completely displaced (type III or IV) tibial eminence fractures and older patients. LEVEL OF EVIDENCE Level III-retrospective cohort study.
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Hiranaka T, Furumatsu T, Tanaka T, Okazaki Y, Kodama Y, Kamatsuki Y, Masuda K, Seno N, Ozaki T. Combining pullout suture and retrograde screw fixation for anterior cruciate ligament tibial eminence avulsion fractures: A case report. J Orthop Surg (Hong Kong) 2021; 28:2309499020918681. [PMID: 32489139 DOI: 10.1177/2309499020918681] [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] [Indexed: 11/15/2022] Open
Abstract
This report describes a novel arthroscopic technique for the treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fractures. A 16-year-old boy who was diagnosed with a left ACL tibial eminence avulsion fracture was treated by arthroscopic fixation. Two bone tunnels were created from the anterior tibial cortex into the fracture bed, and a strong suture passed through the ACL just above its insertion was pulled out through them for reduction and fixation. A retrograde cannulated screw fixation was added for stronger fixation. Weight-bearing and range of motion exercises were started immediately after surgery. Radiographically, bone union was obtained 6 months postoperatively. During second-look arthroscopy (24 months postoperatively), there was no loss of reduction and no subsequent meniscal or cartilage injuries. At that point, the Lysholm score was 95, and the International Knee Documentation Committee score was 96.
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Affiliation(s)
- Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Takaaki Tanaka
- Department of Orthopaedic Surgery, Sumitomo Besshi Hospital, Ehime, Japan
| | - Yuki Okazaki
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Yuya Kodama
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Yusuke Kamatsuki
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Kenji Masuda
- Department of Orthopaedic Surgery, Sumitomo Besshi Hospital, Ehime, Japan
| | - Noritaka Seno
- Department of Orthopaedic Surgery, Sumitomo Besshi Hospital, Ehime, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
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23
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Jaramillo Quiceno GA, Arias Pérez RD, Herrera Mejía AM. Satisfactory clinical outcomes using a novel arthroscopic technique for fixation of tibial spine avulsion fractures: technical note. J ISAKOS 2021; 6:120-123. [PMID: 33832986 DOI: 10.1136/jisakos-2020-000484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 12/15/2020] [Accepted: 12/22/2020] [Indexed: 11/04/2022]
Abstract
This research aims to present a novel arthroscopic fixation technique that uses a double-row suture anchor for tibial spine avulsion and to evaluate its short-term clinical outcomes. The surgical technique is described and a retrospective case series is presented. Patients who presented with tibial spine avulsion type III and IV fractures according to the Meyers and McKeever classification and received the same surgical treatment from 2013 to 2018 in two specialised hospitals in Medellín City were included. All interventions were performed by an experienced surgeon. To determine outcomes during clinical follow-up, the Lysholm score and objective and subjective International Knee Documentation Committee scores were obtained before and at least 12 months after surgery. A total of 24 patients were followed, with a mean age of 31 years; 12 patients were female. The median time between trauma and surgical fixation was 12 days (IQR=7-23), with a median follow-up period of 13.5 months (IQR=9.5-31.5). When comparing patients' state initially and during the postoperative period, statistically significant differences were found in all the scores analysed (p<0.05). Likewise, there were no complications and no reinterventions performed during follow-up, and all patients were satisfied with the outcomes of the procedure. Fixation of tibial spine avulsion fractures using the double-row suture anchor technique results in improvement in patients' function, pain and activity level. The main conclusion is that the procedure is an anatomical technique that requires minimal access and leads to satisfactory clinical evolution of patients. Level of evidence: Level V, case series.
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Affiliation(s)
| | - Rubén Darío Arias Pérez
- Facultad de Ciencias de la Salud, Medicina, Corporacion Universitaria Remington, Medellín, Antioquia, Colombia
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24
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Ye M, Chen J, Hu F, Liu Y, Tan Y. Suture versus screw fixation technique for tibial eminence fracture: A meta-analysis of laboratory studies. J Orthop Surg (Hong Kong) 2020; 28:2309499020907977. [PMID: 32124674 DOI: 10.1177/2309499020907977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The aim of this study was to compare the biomechanical properties between the suture fixation technique and the screw fixation technique for tibial eminence fracture (TEF). METHODS The current study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, Embase, and the Cochrane were searched from inception to January 2019 comparing the suture and the screw fixation technique for TEF. The results of the eligible studies were analyzed in terms of stiffness, ultimate failure load, and displacement after the cyclic testing. RESULTS Six laboratory studies were included with a total of 114 knees: 57 knees were in the FiberWire suture group and 57 knees were in the single-screw group. The suture group had higher stiffness than the screw group, but there was no statistical difference between these two groups. Ultimate failure load in the suture group was statistically higher than that in the screw group. No statistically significant difference existed in displacement after the cyclic testing between the suture group and the screw group. CONCLUSION The FiberWire suture fixation may be biomechanically superior to a single screw fixation in TEF treatment in mature knees regarding ultimate failure load, while no significant difference was found between the two fixations in terms of stiffness and displacement after the cyclic testing.
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Affiliation(s)
- Mao Ye
- Department of Orthopedic Surgery, Xianning Central Hospital, The First Affiliated Hospital Of Hubei University Of Science And Technology, Xianning, China
| | - Jun Chen
- Department of Orthopedic Surgery, Xianning Central Hospital, The First Affiliated Hospital Of Hubei University Of Science And Technology, Xianning, China
| | - Feng Hu
- Department of Orthopedic Surgery, Xianning Central Hospital, The First Affiliated Hospital Of Hubei University Of Science And Technology, Xianning, China
| | - Yanxi Liu
- Department of Orthopedic Surgery, Xianning Central Hospital, The First Affiliated Hospital Of Hubei University Of Science And Technology, Xianning, China
| | - Yang Tan
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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Kuang SD, Su C, Zhao X, Li YS, Xiong YL, Gao SG. "Figure-of-Eight" Suture-Button Technique for Fixation of Displaced Anterior Cruciate Ligament Avulsion Fracture. Orthop Surg 2020; 12:802-808. [PMID: 32351046 PMCID: PMC7307232 DOI: 10.1111/os.12682] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/11/2020] [Accepted: 03/26/2020] [Indexed: 01/13/2023] Open
Abstract
Objective To assess the clinical results of the “figure‐of‐eight” suture‐button technique in the arthroscopic treatment of anterior cruciate ligament (ACL) tibial avulsion fractures. Methods This was a retrospective study reviewing data from September 2013 to June 2019. A total of 27 patients (13 males and 14 females) who underwent arthroscopic “figure‐of‐eight” suture‐button fixation for displaced ACL avulsion fractures were analyzed. The mean age of the patients in the sample was 15.8 years (10–29 years), with a mean follow‐up of 24 months (6–48 months). According to Meyers–McKeever classification, 11 patients were classified as type III and 16 as type IV. All patients were evaluated following the guidelines of the radiological union, the Lysholm knee scoring scale, and the International Knee Documentation Committee (IKDC). Results Fractures were united within 3 months after surgery in all 27 cases. During the last follow‐up, all the anterior drawer and Lachman tests were negative, except in 1 patient whose anterior drawer test was 1° positive. The range of motion was improved from 72.22° ± 27.92° before surgery to 137.78° ± 7.38° at the last follow‐up (P < 0.05); the Lysholm score was improved from 45.81 ± 10.94 before surgery to 93.04 ± 5.66 at the last follow‐up (P < 0.05); and the IKDC score was increased from 43.89 ± 11.16 before surgery to 90.26 ± 5.86 at the last follow‐up (P < 0.05). In 1 patient, an inflammatory reaction was observed at the medial incision of the tibial tubercle; the symptoms disappeared with administration of antibiotics for 1 week. All patients returned to their preinjury physical activities at the last follow‐up. Conclusion The “figure‐of‐eight” suture‐button technique achieves a satisfactory clinical outcome and provides an effective method for the treatment of displaced ACL avulsion fractures.
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Affiliation(s)
- Shi-da Kuang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Chao Su
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Xin Zhao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yu-Sheng Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yi-Lin Xiong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Shu-Guang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China.,Hunan Engineering Research Center of Osteoarthritis, Changsha, China.,National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Callanan M, Allen J, Flutie B, Tepolt F, Miller PE, Kramer D, Kocher MS. Suture Versus Screw Fixation of Tibial Spine Fractures in Children and Adolescents: A Comparative Study. Orthop J Sports Med 2019; 7:2325967119881961. [PMID: 31803786 PMCID: PMC6876177 DOI: 10.1177/2325967119881961] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Tibial spine fractures involve an avulsion injury of the anterior cruciate ligament (ACL) at the intercondylar eminence, typically in children and adolescents. Displaced fractures are commonly treated with either suture or screw fixation. Purpose To investigate differences in various outcomes between patients treated with arthroscopic suture versus screw fixation for tibial spine avulsion fractures in one of the largest patient cohorts in the literature. Study Design Cohort study; Level of evidence, 3. Methods A search of medical records was performed with the goal of identifying all type 2 and type 3 tibial spine avulsion fractures surgically treated between 2000 and 2014 at a pediatric hospital. All patients had a minimum of 12 months clinical follow-up, suture or screw fixation only, and no major concomitant injury. Results There were 68 knees in 67 patients meeting criteria for analysis. There were no differences with regard to postsurgical arthrofibrosis (P = .59), ACL reconstruction (P = .44), meniscal procedures (P = .85), instability (P = .49), range of motion (P = .51), return to sport (P >.999), or time to return to sport (P = .11). Elevation of the repaired fragment on postoperative imaging was significantly greater in the suture group (5.4 vs 3.5 mm; P = .005). Postoperative fragment elevation did not influence surgical outcomes. The screw fixation group had more reoperations (13 vs 23; P = .03), a larger number of reoperations for implant removal (3 vs 22; P < .001), and nearly 3 times the odds of undergoing reoperation compared with suture patients (odds ratio, 2.9; P = .03). Conclusion Clinical outcomes between suture and screw fixation were largely equivalent in our patients. Postoperative fragment elevation does not influence surgical outcomes. Consideration should be given for the greater likelihood of needing a second operation, planned or unplanned, after screw fixation.
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Affiliation(s)
- Mark Callanan
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Judd Allen
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Brett Flutie
- Boston Children's Hospital, Boston, Massachusetts, USA
| | | | | | - Dennis Kramer
- Boston Children's Hospital, Boston, Massachusetts, USA
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Fox JC, Saper MG. Arthroscopic Suture Fixation of Comminuted Tibial Eminence Fractures: Hybrid All-Epiphyseal Bone Tunnel and Knotless Anchor Technique. Arthrosc Tech 2019; 8:e1283-e1288. [PMID: 31890496 PMCID: PMC6926312 DOI: 10.1016/j.eats.2019.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/27/2019] [Indexed: 02/03/2023] Open
Abstract
Tibial eminence fractures most commonly occur in young children and adolescents with open physes. Displaced fractures are typically treated with surgical reduction and fixation. Multiple arthroscopic techniques and fixation constructs have been described. However, many of these techniques violate the physis with a risk of growth disturbance and deformity from asymmetrical physeal growth. This technical note details a surgical technique of arthroscopically assisted suture fixation of a comminuted tibial spine fracture using all-epiphyseal bone tunnels and knotless anchors. In this construct, sutures passing through the substance of the anterior cruciate ligament help to eliminate residual laxity, all-epiphyseal bone tunnels avoid growth disturbance, and suture anchors reduce persistently displaced anterior comminution.
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Affiliation(s)
| | - Michael G. Saper
- Address correspondence to Michael G. Saper, D.O., A.T.C., C.S.C.S., 4800 Sand Point Way NE, Seattle, WA 98105, U.S.A.
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Gigante A, Setaro N, Rotini M, Finzi SS, Marinelli M. Intercondylar eminence fracture treated by resorbable magnesium screws osteosynthesis: A case series. Injury 2018; 49 Suppl 3:S48-S53. [PMID: 30415669 DOI: 10.1016/j.injury.2018.09.055] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/13/2018] [Accepted: 09/29/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Tibial spine avulsion fractures are mostly a paediatric injury which appropriate treatment is currently debated in literature. The choice between conservative and surgical treatment is based on the radiographic classification of Meyers-McKeever. The most diffused surgical techniques involve either internal fixation devices (screws) or bone tunnels fixation with resorbable sutures. Today, a third option is represented by resorbable magnesium screws which could combine the best features of the two classical systems. Objective of this study is to investigate the efficacy of these new devices in the surgical treatment of tibial spine avulsions. MATERIALS AND METHODS Since 2014 we have seen seven patients with tibial eminence fracture. Patients underwent clinical and radiological examination (MRI, CT scan) before surgery. Only 3 patients that presented with a grade III or IV lesion were treated surgically with internal fixation with magnesium resorbable screws. In post-operative follow-up, functional recovery was evaluated at 1, 2, 4, 6 and 12 months, clinically and by X-ray. Lysholm and IKDC scores were submitted at 1, 2, 6 and 12 months. MRI was repeated at 6 and 12 months. RESULTS All three surgical patients showed progressive clinical and functional improvement during the follow-up period. The first case showed a quicker overall recovery rate, which might be due to the lower grade of the lesion. Radiographs and MRI evaluation showed regular healing of the injury. The devices appeared completely resorbed at the 6 months follow-up and replaced by newly formed bone at the 12 months follow-up. CONCLUSIONS The treatment of tibial spine avulsion fractures with arthroscopic reduction and internal fixation (ARIF) technique by magnesium resorbable screws seems to result in an excellent functional recovery without complications related to fixation devices, which were completely resorbed after 6 months and replaced by newly formed bone after 12 months. This new method could be considered as an alternative option to classic techniques by non resorbable fixation devices or bone tunnel fixation. Further studies are needed in order to evaluate the efficacy of these new devices in a wider group of patients.
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Affiliation(s)
- A Gigante
- Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/A, 60126, Ancona, Italy.
| | - N Setaro
- Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/A, 60126, Ancona, Italy.
| | - M Rotini
- Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/A, 60126, Ancona, Italy
| | - S S Finzi
- Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/A, 60126, Ancona, Italy
| | - M Marinelli
- Clinic of Adult and Paediatric Orthopaedic, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
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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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Doral MN, Bilge O. Editorial Commentary: Arthroscopic Fixation of Tibial Eminence Fractures-Which Technique Is the Best Has Not Been Defined Yet! Arthroscopy 2018; 34:1617-1620. [PMID: 29729764 DOI: 10.1016/j.arthro.2018.01.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 01/31/2018] [Indexed: 02/02/2023]
Abstract
The tibial eminence fractures are most frequently observed in children and adolescents increasingly. Their classification and management are mainly made by the displacement of the fracture fragment. The surgical management has evolved from open to arthroscopic techniques. Various fixation techniques have been defined. Mainly, there are 2 types of fixation: screw and suture-based methods. Although recent studies have demonstrated the biomechanical advantages of newer suture-based fixation methods, the best method of fixation has not been defined, yet. Currently, nondisplaced and reducible fractures are managed nonoperatively, and displaced and irreducible fractures are managed operatively. Until the best surgical method is defined by higher level of evidence studies clinically, functionally, radiologically, and biomechanically, the type of fixation will be chosen by considering the experience of the surgeon, the clinical status of the patient, the availability of the implants, and the morphology of these fractures.
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Li J, Yu Y, Liu C, Su X, Liao W, Li Z. Arthroscopic Fixation of Tibial Eminence Fractures: A Biomechanical Comparative Study of Screw, Suture, and Suture Anchor. Arthroscopy 2018; 34:1608-1616. [PMID: 29397286 DOI: 10.1016/j.arthro.2017.12.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 12/09/2017] [Accepted: 12/09/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare biomechanical outcomes of 4 different arthroscopic techniques for fixation of tibial eminence fractures. METHODS Twenty-four skeletally mature, fresh-frozen cadaveric knees were divided into 4 comparison groups based on the fixation method: screw fixation (group A), traditional sutures fixation with 2 FiberWire sutures (group B), a modified suture technique with 2 FiberWire sutures that created neckwear knots to firmly trap the fracture fragment (group C), or suture anchors which was based on the suture bridge technique primarily used in the shoulder for repair of rotator cuff tears and greater tuberosity fractures (group D). A tibial eminence fracture was created in each knee for subsequent fixation. After fixation, each knee underwent cyclic loading of 100 N to assess the displacement change after 500 cycles of the fixation construct. Afterward, a single tensile failure test load was performed to assess the ultimate failure load, stiffness, and failure mode for each specimen. RESULTS All specimens survived cyclic testing and were subsequently loaded to failure. Group C had the highest ultimate failure load (P < .05) and group D had the lowest displacement compared with the other 3 groups (P < .05). Different failure modes were found among the 4 groups. CONCLUSIONS Suture fixation using the neckwear knots technique provides superior fixation with regard to higher ultimate failure load, and absorbable suture anchor fixation with the suture bridge technique provides less displacement under cyclic loading conditions. Both techniques exhibited superior biomechanical properties compared with traditional screw and suture fixation. CLINICAL RELEVANCE The new techniques showed satisfactory biomechanical properties and provided more choice for surgeons in the treatment of tibial eminence fractures.
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Affiliation(s)
- Ji Li
- Department of Orthopedics, General Hospital of PLA, Haidian District, Beijing, China
| | - Yang Yu
- Department of Orthopedics, Chinese PLA 252 Hospital, Baoding, Hebei, China
| | - Chunhui Liu
- Department of Orthopedics, General Hospital of PLA, Haidian District, Beijing, China
| | - Xiangzheng Su
- Department of Orthopedics, General Hospital of PLA, Haidian District, Beijing, China
| | - Weixiong Liao
- Department of Orthopedics, General Hospital of PLA, Haidian District, Beijing, China
| | - Zhongli Li
- Department of Orthopedics, General Hospital of PLA, Haidian District, Beijing, China.
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32
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Outcomes after arthroscopic fixation of tibial eminence fractures with bioabsorbable nails in skeletally immature patients. J Pediatr Orthop B 2018; 27:8-12. [PMID: 28368929 DOI: 10.1097/bpb.0000000000000459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this paper is to report the outcomes and any complications with arthroscopic bioabsorbable nail fixation of tibial eminence fractures in skeletally immature patients. We retrospectively reviewed all surgically treated tibial eminence fractures treated by a single surgeon and seven patients were identified with a minimum 2-year follow-up. Mean deficits of flexion and extension were minimal. Satisfactory Tegner levels, Lysholm knee scores, and International Knee Documentation Committee subjective scores were reported. Arthroscopic fixation of tibial eminence fractures with bioabsorbable nails yields satisfactory outcomes for this uncommon injury and obviates the need for future hardware removal.
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33
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Abdelhamid MM, Bayoumy MA, Elkady HA, Abdelkawi AF. Arthroscopic Reduction and Fixation of Tibial Spine Avulsion Fractures by a Stainless Steel Wiring Technique. Arthrosc Tech 2017; 6:e2289-e2294. [PMID: 29349033 PMCID: PMC5766101 DOI: 10.1016/j.eats.2017.08.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/28/2017] [Indexed: 02/03/2023] Open
Abstract
Several techniques of arthroscopic treatment of tibial spine avulsion fractures have been described in the literature. These techniques include the use of various fixation devices such as screws, K-wires, wiring, sutures, and suture anchors. In this study, we evaluate a new wiring technique for the treatment of these injuries. This technique involves fixation by stainless steel tension wires passed over the fractured spine and tied over a bone bridge. The advantages of this technique are that it aids in reduction, allows for compression of the tibial spine fragment anatomically in its fracture bed, provides stable fixation in difficult comminuted fractures, and allows for early mobilization and weight bearing because of the solid fixation.
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Affiliation(s)
- Mohamed M. Abdelhamid
- Department of Orthopaedic and Traumatology, Assiut University Hospital, Assiut, Egypt,Address correspondence to Mohamed Abdelhamid Morsy, M.D., Department of Orthopaedic and Traumatology, Assiut University Hospital, Assiut University Hospital Street, Assiut 71111, Egypt.Department of Orthopaedic and TraumatologyAssiut University HospitalAssiut University Hospital StreetAssiut71111Egypt
| | | | - Hesham A. Elkady
- Department of Orthopaedic and Traumatology, Assiut University Hospital, Assiut, Egypt
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Sinha S, Meena D, Naik AK, Selvamari M, Arya RK. Arthroscopic Fixation of Tibial Spine Avulsion in Skeletally Immature: The Technique. J Orthop Case Rep 2017; 7:80-84. [PMID: 29600218 PMCID: PMC5868892 DOI: 10.13107/jocr.2250-0685.960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Tibial spine avulsion fracture is more frequent in children than adults. Various methods of fixation have been mentioned, but concern remains about crossing the tibial physis. We present a technique of arthroscopic fixation with non-absorbable suture. CASE REPORT A total of 10 skeletally immature patients with tibial spine avulsion of Meyers and McKeever Type 2 and 3 were included in the study. The knee was arthroscopically cleared of hematoma. The avulsed tibial insertion of anterior cruciate ligament was reduced and held in place with tibial guide. By drilling guide wire through the tibia, reduced fragment, a fiber wire was passed. The avulsed fragment was tied on a suture post on tibia. Outcome was evaluated radiologically and clinically (Lysholm score, pivot shift, and KT 1000) at 12 months after surgery. All cases attained full range of motion, stable knee and could return to previous level of activity. The mean pre-operative Lysholm score of 50.8 ± 1.4 (35-59) improved to 96.3 ± 2.9 (92-100). The mean pre-operative anterior translation of tibia (measured by KT 1000) of 7.6 ± 1.26 improved significantly to mean of 3.3 ± 0.82 mm after surgery. CONCLUSION The presented technique of arthroscopic fixation of avulsed tibial spine is a simple technique that provides reproducible results. It also offers cost-effective secure fixation.
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Affiliation(s)
- Skand Sinha
- Department of Orthopaedics, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Durgashankar Meena
- Department of Orthopaedics, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Ananta K Naik
- Department of Orthopaedics, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - M Selvamari
- Department of Orthopaedics, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Rajendra K Arya
- Department of Orthopaedics, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India
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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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Hardy A, Casabianca L, Grimaud O, Meyer A. Speed-Bridge arthroscopic reinsertion of tibial eminence fracture (complementary to the adjustable button fixation technique). Orthop Traumatol Surg Res 2017; 103:129-132. [PMID: 27871971 DOI: 10.1016/j.otsr.2016.09.024] [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] [Received: 07/13/2016] [Revised: 09/16/2016] [Accepted: 09/23/2016] [Indexed: 02/02/2023]
Abstract
In comminuted fractures of the intercondyloid eminence of the tibial spine, the quality of the reduction and the arthroscopic fixation, notably adjustable suture button fixation, is sometimes disappointing with reduction defects of the anterior bone block. In the Speed-Bridge technique, the two traction sutures of the adjustable button fixation are replaced with two braided sutures of different colors. After the button is placed above the eminence, reduction is obtained by tightening the loop of the button. The accessory communitive fragments are then packed in the depression around the main fragment. A second row provides bone suturing for these accessory fragments; traction sutures of the button are attached anteromedially and laterally with knotless anchors to obtain a Speed-Bridge-type inverted-V bone suture. The Speed-Bridge arthroscopic reinsertion technique of the tibial eminence effectively completes the adjustable button bone suture technique for communitive fractures to obtain better reduction and good stability.
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Affiliation(s)
- A Hardy
- Service de chirurgie orthopédique et traumatologie, hôpital Cochin, université Paris-Descartes, AP-HP, 75014 Paris, France; Université Paris-Descartes, Paris, France.
| | - L Casabianca
- Service de chirurgie orthopédique et traumatologie, hôpital Cochin, université Paris-Descartes, AP-HP, 75014 Paris, France; Université Paris-Descartes, Paris, France
| | - O Grimaud
- Clinique du sport Paris V, 75005 Paris, France
| | - A Meyer
- Clinique du sport Paris V, 75005 Paris, France
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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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Loriaut P, Moreau PE, Loriaut P, Boyer P. Arthroscopic treatment of displaced tibial eminence fractures using a suspensory fixation. Indian J Orthop 2017; 51:187-191. [PMID: 28400665 PMCID: PMC5361470 DOI: 10.4103/0019-5413.201706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Avulsion fractures of the tibial intercondylar eminence are fairly common injuries requiring surgery for the optimal functional outcome. The purpose of this study was to assess the clinical and radiological outcomes of an arthroscopic treatment of displaced tibial intercondylar eminence fractures using a suspensory device. MATERIAL AND METHODS Five patients with type 2 and 3 displaced tibial intercondylar eminence fractures who received an arthroscopically assisted fixation using a double button device were enrolled from 2011 to 2012. Clinical assessment included the patient demographics, cause of injury, the delay before surgery, time for surgery, time to return to work and sport, the International Knee Documentation Committee (IKDC) and Lysholm knee scores. Stability was measured with the KT-2000 arthrometer with a force of 134 N. A side to side difference on the KT-2000 examination superior to 3 mm was considered as a significant and abnormal increase in the anterior translation. Radiological examination consisted of anteroposterior and lateral radiographs, as well as computed tomography (CT) scan of the affected knee. Clinical and radiological followup was done at 1, 2, 3, 6, and 12 months postoperatively and at final followup. CT-scan was performed before surgery and at 3 months followup. RESULTS The median age of patients was 31 years. Mean followup was 27 ± 5.1 months. The average delay before surgery was 3 days. At final followup, the mean IKDC and Lysholm knee scores were, 93.9 and 94.5 respectively. All patients had a complete functional recovery and were able to return to work and to resume their sport activities. No secondary surgeries were required to remove hardware. No complication was noted. Bony union was achieved in all patients. CONCLUSION The arthroscopic treatment of displaced tibial intercondylar eminence fractures using a suspensory system provided a satisfactory clinical and radiological outcome at a followup of 2 years.
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Affiliation(s)
- Philippe Loriaut
- Department of Orthopaedic Surgery and Sports Traumatology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l’Hôpital, 75013 Paris, France,Address for correspondence: Dr. Philippe Loriaut, Department of Orthopaedic Surgery and Sports Traumatology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l’Hôpital, 75013 Paris, France. E-mail:
| | - Pierre-Emmanuel Moreau
- Department of Orthopaedic Surgery and Sports Traumatology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l’Hôpital, 75013 Paris, France
| | - Patrick Loriaut
- Department of Ophthalmology, Quinze-Vingts National Ophthalmology Hospital, 28 rue de Charenton 75012 Paris, France
| | - Patrick Boyer
- Department of Orthopaedic Surgery and Sports Traumatology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l’Hôpital, 75013 Paris, France
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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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Mitchell JJ, Mayo MH, Axibal DP, Kasch AR, Fader RR, Chadayammuri V, Terhune EB, Georgopoulos G, Rhodes JT, Vidal AF. Delayed Anterior Cruciate Ligament Reconstruction in Young Patients With Previous Anterior Tibial Spine Fractures. Am J Sports Med 2016; 44:2047-56. [PMID: 27159316 DOI: 10.1177/0363546516644597] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Avulsion fractures of the anterior tibial spine in young athletes are injuries similar to anterior cruciate ligament (ACL) injuries in adults. Sparse data exist on the association between anterior tibial spine fractures (ATSFs) and later ligamentous laxity or injuries leading to ACL reconstruction. PURPOSE To better delineate the incidence of delayed instability or ACL ruptures requiring delayed ACL reconstruction in young patients with prior fractures of the tibial eminence. STUDY DESIGN Case series; Level of evidence, 4. METHODS We identified 101 patients between January 1993 and January 2012 who sustained an ATSF and who met inclusion criteria for this study. All patients had been followed for at least 2 years after the initial injury and were included for analysis after completion of a questionnaire via direct contact, mail, and/or telephone. If patients underwent further surgical intervention and/or underwent later ACL reconstruction, clinical records and operative reports pertaining to these secondary interventions were obtained and reviewed. Differences between categorical variables were assessed using the Fisher exact test. The association between time to revision ACL surgery and fracture type was assessed by Kaplan-Meier plots. The association between need for revision ACL surgery and age, sex, and mechanism of surgery was assessed using logistic regression. RESULTS Nineteen percent of all patients evaluated underwent delayed ACL reconstruction after a previous tibial spine fracture on the ipsilateral side. While there were a higher proportion of ACL reconstructions in type II fractures, there was not a statistically significant difference in the number of patients within each fracture group who went on to undergo later surgery (P = .29). Further, there was not a significant association between fracture type, sex, or mechanism of injury as it related to the progression to later ACL reconstruction. However, there was a significant association between age at the time of injury and progression to later ACL reconstruction (P = .02). For every year increase in age at the time of injury, the odds of going on to undergo delayed ACL reconstruction were greater by a factor of 1.3 (95% CI, 1.1-1.6). CONCLUSION Although an ATSF is a relatively rare injury, our cohort of patients suggests that a subset of young patients with all types of tibial spine fractures will require later ACL reconstruction. There is a need to counsel patients that a delayed ACL rupture is a potential risk after an ATSF, especially as children approach skeletal maturity. Further patient follow-up and prospective studies are required.
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Affiliation(s)
- Justin J Mitchell
- The Steadman Clinic and Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Meredith H Mayo
- Department of Orthopaedic Surgery, University of Colorado Hospital, Aurora, Colorado, USA
| | - Derek P Axibal
- Department of Orthopaedic Surgery, University of Colorado Hospital, Aurora, Colorado, USA
| | - Anthony R Kasch
- Department of Orthopaedic Surgery, University of Colorado Hospital, Aurora, Colorado, USA
| | - Ryan R Fader
- Department of Orthopaedic Surgery, University of Colorado Hospital, Aurora, Colorado, USA
| | - Vivek Chadayammuri
- Department of Orthopaedic Surgery, University of Colorado Hospital, Aurora, Colorado, USA
| | - E Bailey Terhune
- Department of Orthopedic Surgery, Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Gaia Georgopoulos
- Department of Orthopedic Surgery, Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Jason T Rhodes
- Department of Orthopedic Surgery, Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Armando F Vidal
- Department of Orthopaedic Surgery, University of Colorado Hospital, Aurora, Colorado, USA Department of Orthopedic Surgery, Children's Hospital of Colorado, Aurora, Colorado, USA
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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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43
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Huang TW, Lee CY, Chen SY, Lin SJ, Hsu KY, Hsu RWW, Chan YS, Lee MS. Outcomes and second-look arthroscopic evaluation after combined arthroscopic treatment of tibial plateau and tibial eminence avulsion fractures: a 5-year minimal follow-up. BMC Musculoskelet Disord 2015; 16:311. [PMID: 26490156 PMCID: PMC4618521 DOI: 10.1186/s12891-015-0769-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 10/08/2015] [Indexed: 11/25/2022] Open
Abstract
Background Tibial eminence avulsion fracture often co-occurs with tibial plateau fracture, which leads to difficult concomitant management. The value of simultaneous arthroscopy-assisted treatment continues to be debated despite its theoretical advantages. We describe a simple arthroscopic suture fixation technique and hypothesize that simultaneous treatment is beneficial. Methods Patients with a tibial eminence avulsion fracture and a concurrent tibial plateau fracture who underwent simultaneous arthroscopically assisted treatment between 2005 and 2008 were enrolled in this retrospective study. Second-look arthroscopic evaluation and Rasmussen scores of clinical and radiographic parameters were used to assess simultaneous treatment. Results Forty-one patients (41 knees) met the inclusion criteria. All 41 fractures were successfully united. All patients had side-to-side differences of less than 3 mm and negative findings in Lachman and pivot-shift tests at their final follow-up. The mean postoperative Rasmussen clinical score was 27.3 (range: 19–30), and the mean radiologic score was 16.5 (range: 12–18). Clinical and radiographic outcomes in 98 % of the patients were good or excellent. There were no complications directly associated with arthroscopy in any patient. Conclusions Simultaneous arthroscopic suture fixation of associated tibial eminence avulsion fracture did not interfere with the plates and screws used to stabilize the tibial plateau fracture. It gave the knee joint adequate stability, minimal surgical morbidity, and satisfactory radiographic and clinical outcomes in a minimum follow-up of 5 years and in the arthroscopic second-look assessments.
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Affiliation(s)
- Tsan-Wen Huang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan. .,Chang Gung University, Taoyuan, Taiwan.
| | - Chien-Ying Lee
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
| | - Szu-Yuan Chen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Shih-Jie Lin
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
| | - Kuo-Yao Hsu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Chang Gung University, Taoyuan, Taiwan.
| | - Robert Wen-Wei Hsu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan. .,Chang Gung University, Taoyuan, Taiwan.
| | - Yi-Sheng Chan
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Chang Gung University, Taoyuan, Taiwan.
| | - Mel S Lee
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan. .,Chang Gung University, Taoyuan, Taiwan.
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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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Abstract
PURPOSE OF REVIEW Although tibial eminence fractures are uncommon, their importance cannot be overemphasized in skeletally immature patients because of the fracture's close proximity to both the tibial physis as well as the attachment between the tibial eminence and the anterior cruciate ligament, the latter being a key component in maintaining knee stability. This review focuses on recent trends in treatment concepts and devices. RECENT FINDINGS Recent literature on this topic addresses the existence of a variety of treatment modalities, but the majority of these articles analyzed a limited number of cases and insisted on the merits of their own methods. Nevertheless, some consensus has been reached regarding treatment direction and how much laxity should be considered acceptable. SUMMARY Although the review failed to reveal a gold standard modality in treating tibial eminence fractures, most studies agreed on several issues. Displaced intra-articular fractures should be fixed operatively.
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The role of arthroscopy in articular fracture management: the lower limb. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:807-13. [DOI: 10.1007/s00590-015-1601-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/29/2014] [Indexed: 10/24/2022]
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Complications of tibial eminence and diaphyseal fractures in children: prevention and treatment. J Am Acad Orthop Surg 2014; 22:730-41. [PMID: 25344598 DOI: 10.5435/jaaos-22-11-730] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Fractures of the tibial eminence and of the diaphyseal tibia are common pediatric orthopaedic injuries. Although most tibial fractures can be treated nonsurgically, those that require surgical intervention may encounter specific complications. Surgical treatment of fractures of the tibial eminence may be complicated by failed fixation, knee joint stiffness, and arthrofibrosis of the knee, a complication rarely seen in children but occurring most frequently after tibial eminence injuries. Complications of healing after tibial fractures in pediatric patients are uncommon, although some tibial shaft fractures exhibit delayed union or nonunion, infection, and soft-tissue complications.
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Faivre B, Benea H, Klouche S, Lespagnol F, Bauer T, Hardy P. An original arthroscopic fixation of adult's tibial eminence fractures using the Tightrope® device: a report of 8 cases and review of literature. Knee 2014; 21:833-9. [PMID: 24863950 DOI: 10.1016/j.knee.2014.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 01/03/2014] [Accepted: 02/07/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The objective of this study is to asset the efficiency of the use of the Tightrope® device to treat isolated tibial spine fractures in adults. METHODS All patients treated for isolated tibial spine fracture between November 2007 and February 2011 have been retrospectively included. The main judgment criteria was the post-operative knee laxity measured by Rolimeter® (Aircast) and the secondary criteria were the IKDC scores, the knee mobility, the Lachman test and the bone union. 8 patients have been included. The mean age was 34.2 years (± 12.5). The classification of Meyers and McKeever identified 5 types II, 2 types IIIa and 1 type IIIb. The mean follow-up period was 10 months. RESULTS The mean post-operative anterior knee laxity was 6 ± 2.14 mm for the operated side and 5.6 ± 1.85 mm for the opposite side. No significant difference was found (P=0.73). According to the IKDC classification 3 patients were normal (A), 2 were nearly normal (B), 1 was abnormal (C) and 1 was very abnormal (D). The mean IKDC subjective score was 70.71 ± 17.56. All 8 fractures achieved union without elevation. 3 patients developed motion complications and 2 required an arthroscopic arthrolysis. No other significant complication was noted. The outcome was compared to the different series published during the last 10 years. CONCLUSION The use of the Tightrope® device is a simple technique occurring a rigid fixation, allowing early rehabilitation with a high rate of arthrofibrosis. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Bruno Faivre
- Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, F-92100 Boulogne-Billancourt, France; Université de Versailles Saint-Quentin, F-78035 Versailles, France.
| | - Horea Benea
- Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, F-92100 Boulogne-Billancourt, France; University Clinic of Orthopedics and Traumatology, R-400132 Cluj-Napoca, Romania
| | - Shahnaz Klouche
- Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, F-92100 Boulogne-Billancourt, France; Université de Versailles Saint-Quentin, F-78035 Versailles, France
| | - Florent Lespagnol
- Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, F-92100 Boulogne-Billancourt, France; Université de Versailles Saint-Quentin, F-78035 Versailles, France
| | - Thomas Bauer
- Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, F-92100 Boulogne-Billancourt, France; Université de Versailles Saint-Quentin, F-78035 Versailles, France
| | - Philippe Hardy
- Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, F-92100 Boulogne-Billancourt, France; Université de Versailles Saint-Quentin, F-78035 Versailles, France
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49
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Abstract
As the popularity and intensity of children's athletics have increased, so has the risk for knee injuries. Fractures of the tibial eminence may be treated operatively or nonoperatively depending on fracture classification, but arthrofibrosis is a potentially significant complication. Anterior cruciate ligament rupture presents treatment challenges as regards the optimal timing and method of reconstruction. A number of novel reconstructive techniques have been developed to minimize risks to the physes in this population. Recent studies have focused on the prognosis, surgical indications, and operative techniques for osteochondritis dissecans in children. A number of authors have also sought to better-define the optimal diagnostic testing and management of patellar dislocation. In this review, we provide an update on current concepts for tibial eminence fractures, anterior cruciate ligament injuries, osteochondritis dissecans of the knee, and patellar dislocation in young athletes.
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50
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Parikh SN, Myer D, Eismann EA. Prevention of arthrofibrosis after arthroscopic screw fixation of tibial spine fracture in children and adolescents. Orthopedics 2014; 37:e58-65. [PMID: 24683658 DOI: 10.3928/01477447-20131219-18] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Arthrofibrosis is a major complication of tibial spine fracture treatment in children, potentially resulting in knee pain, quadriceps weakness, altered gait, decreased function, inability to return to sports, and long-term osteoarthritis. Thus, prevention rather than treatment of arthrofibrosis is desirable. The purpose of this study was to evaluate an aggressive postoperative rehabilitation and early intervention approach to prevent permanent arthrofibrosis after tibial spine fracture treatment and to compare epiphyseal and transphyseal screws for fixation. A consecutive series of 24 patients younger than age 18 with displaced type II and III tibial spine fractures who underwent arthroscopic reduction and screw fixation between 2006 and 2011 were retrospectively reviewed. Final range of motion was compared between patients with epiphyseal (n=12) and transphyseal (n=9) screws. One-third (4 of 12) of patients with epiphyseal screws underwent arthroscopic debridement and screw removal approximately 3 months postoperatively; 3 patients lacked 5° to 15° of extension, 1 experienced pain with extension, and 1 had radiographic evidence of screw pullout, loss of reduction, and resultant malunion. In the transphyseal screw group, 3 patients had 10° loss of extension, and all corrected after arthroscopic debridement and screw removal. The two groups did not significantly differ in time to hardware removal or return to sports or final range of motion. No growth disturbances were identified in patients after transphyseal screw removal. An aggressive approach of postoperative rehabilitation and early intervention after arthroscopic reduction and screw fixation of tibial spine fractures in children was successful in preventing permanent arthrofibrosis.
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