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Almolla RM, Almalki YE, Basha MAA, Mohamed Farag MAEA, Metwally MI, Nada MG, Libda YI, Zaitoun MMA, Abdalla AAEHM, Yousef HY, Abd Elhamed ME, Elsheikh AM, Alduraibi SK, Eldib DB, Khater HM, Mahmoud HF, Elkayal ES, Alshehri SHS, Aldhilan AS, Basha AMA, Hassan HA. MRI-Based Classification for Tibial Spine Fracture: Detection Efficacy, Classification Accuracy, and Reliability. Acad Radiol 2024; 31:1480-1490. [PMID: 37914624 DOI: 10.1016/j.acra.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 11/03/2023]
Abstract
RATIONALE AND OBJECTIVES Recently, a new MRI-based classification for evaluating tibial spine fractures (TSFs) was developed to aid in treating these injuries. Our objective was to assess the detection efficacy, classification accuracy, and reliability of this classification in detecting and grading TSFs, as well as its impact on treatment strategy, compared to the Meyers and McKeever (MM) classification. MATERIALS AND METHODS A retrospective study included 68 patients with arthroscopically confirmed TSFs. All patients had plain radiography and conventional MRI of the affected knee before arthroscopy. Three experienced radiologists independently reviewed all plain radiographs and MRI data and graded each patient according to MM and MRI-based classifications. The detection efficacy, classification accuracy, and inter-rater agreement of both classifications were evaluated and compared, using arthroscopic findings as the gold standard. RESULTS The final analysis included 68 affected knees. Compared to the MM classification, the MRI-based classification produced 22.0% upgrade of TSFs and 11.8% downgrade of TSFs. According to the reviewers, the fracture classification accuracy of the MRI-based classification (91.2-95.6%) was significantly higher than that of the MM classification (73.5-76.5%, p = 0.002-0.01). The fracture detection rate of MRI-based classification (94.1-98.5%) was non-significantly higher than that of the MM classification (83.8-89.7%, p = 0.07-0.4). The soft tissue injury detection accuracy for MRI-based classification was 91.2-94.1%. The inter-rater reliability for grading TSFs was substantial for both the MM classification (κ = 0.69) and MRI-based classification (κ = 0.79). CONCLUSION MRI-based classification demonstrates greater accuracy and reliability compared to MM classification for detecting and grading TSFs and associated soft tissue injuries.
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Affiliation(s)
- Rania Mostafa Almolla
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Yassir Edrees Almalki
- Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran, Kingdom of Saudi Arabia (Y.E.A.)
| | - Mohammad Abd Alkhalik Basha
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.).
| | | | - Maha Ibrahim Metwally
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Mohamad Gamal Nada
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Yasmin Ibrahim Libda
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Mohamed M A Zaitoun
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Ahmed A El-Hamid M Abdalla
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Hala Y Yousef
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Marwa E Abd Elhamed
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Amgad M Elsheikh
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
| | - Sharifa Khalid Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia (S.K.A., A.S.A.)
| | - Diaa Bakry Eldib
- Department of Radio-diagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt (D.B.E., H.M.K.)
| | - Hamada M Khater
- Department of Radio-diagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt (D.B.E., H.M.K.)
| | - Hossam Fathi Mahmoud
- Department of Orthopedic Surgery and Traumatology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (H.F.M.)
| | - Engy S Elkayal
- Department of Radio-diagnosis, Faculty of Human Medicine, Fayoum University, Fayoum, Egypt (E.S.E.)
| | - Shaker Hassan S Alshehri
- Department of Orthopedic Surgery, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia (S.H.S.A.)
| | - Asim S Aldhilan
- Department of Radiology, College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia (S.K.A., A.S.A.)
| | - Ahmed M A Basha
- Faculty of General Medicine, Tyumen State Medical University, Tyumen, Russian Federation (A.M.A.B.)
| | - Hanan A Hassan
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt (R.M.A., M.A.A.B., M.I.M., M.G.N., Y.I.L., M.M.A.Z., A.A.E-H.M.A., H.Y.Y., M.E.A.E., A.M.E., H.A.H.)
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Benes G, Badin D, Marrache M, Lee RJ. Thinner Tibial Spine Fracture Fragments Are Associated With Risk of Fixation Failure. Arthrosc Sports Med Rehabil 2024; 6:100878. [PMID: 38328533 PMCID: PMC10844939 DOI: 10.1016/j.asmr.2023.100878] [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: 08/15/2023] [Accepted: 12/20/2023] [Indexed: 02/09/2024] Open
Abstract
Purpose To determine the rate of and risk factors for failure of tibial spine fracture (TSF) repair. Methods This was a retrospective review of patients aged 18 years or younger with TSF who underwent arthroscopic repair performed by a single orthopaedic surgeon at a large tertiary academic hospital between 2015 and 2022. Demographic, clinical, injury, fracture, and surgical characteristics were collected. Coronal length and sagittal length and height of the fracture fragment were measured on preoperative plain radiographs and magnetic resonance imaging of the knee. Results Of 25 patients who underwent arthroscopic reduction with internal fixation of TSFs, 2 (8%) experienced fixation failure. In 16 (64%), internal fixation was performed with suture anchors, whereas 8 (32%) underwent internal fixation with screws. There were 19 male patients (76%). There were no differences in demographic factors (age, race, sex, and body mass index), injury characteristics (laterality, mechanism of injury, and activity causing injury), modified Meyers-McKeever fracture classification, or method of internal fixation between the group with fixation failure and the group without failure. Coronal length (14.2 mm vs 18 mm, P = .17) and sagittal length (13.9 mm vs 18.7 mm, P = .17) of the fracture fragment also did not differ significantly between groups. Sagittal height of the fracture fragment was thinner in patients with failure of fixation (4.3 mm) than in those without failure (8 mm) (P = .02). Conclusions Decreased bone thickness of the displaced fragment was associated with an increased likelihood of fixation failure. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Gregory Benes
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Daniel Badin
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Majd Marrache
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Rushyuan Jay Lee
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, 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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Zanna L, Del Prete A, Benelli G, Turelli L. Knee central pivot bicruciate avulsion and proximal anterior cruciate ligament tear primary repair: A rare case report. Trauma Case Rep 2021; 32:100406. [PMID: 33665303 PMCID: PMC7905071 DOI: 10.1016/j.tcr.2021.100406] [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] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 11/23/2022] Open
Abstract
The knee is susceptible to complex injuries after trauma including fractures, multiple ligamentous lesions and avulsions due to its numerous tendinous, ligamentous and meniscal attachments. The authors describe a rare case of a 33-year-old male patient with a trauma of the right knee following a motorcycle accident, who sustained avulsion of both femoral and tibial insertion sites of anterior cruciate ligament and avulsion of tibial insertion of posterior cruciate ligament without other associated ligament lesions. The patient underwent a clinical-anamnestic and imaging evaluation to identify the lesions. Knee X-rays showed a tibial avulsion of anterior and posterior cruciate ligaments confirmed by CT scan, classified as type 3b according to Meyers and Mckeever. The authors decided for a surgical management: reduction and internal fixation of anterior and posterior cruciate ligament tibial bone fragments and repair of anterior cruciate ligament femoral avulsion using suture pull-out technique. The patient has been followed, with accurate clinical and radiological follow up controls, for 12 months and showed excellent clinical outcomes using Tegner-Lysholm Knee Score (95/100 points) and good range of motion and knee stability.
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Affiliation(s)
- Luigi Zanna
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1, 50139 Florence, Italy
| | - Armando Del Prete
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1, 50139 Florence, Italy
| | - Giovanni Benelli
- Orthopaedic and Traumatology, Ospedale di Prato, Asl Toscana Centro, Via Suor Niccolina Infermiera, 20/22, 59100 Prato, PO, Italy
| | - Luca Turelli
- Orthopaedic and Traumatology, Ospedale di Pescia, Asl Toscana Centro, Via Cesare Battisti, 2, 51017 Pescia, Italy
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