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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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Severyns M, Odri GA, Vendeuvre T, Marchand JB, Germaneau A, Dramé M. Meniscal injuries in skeletally immature children with tibial eminence fractures. Systematic review of literature. INTERNATIONAL ORTHOPAEDICS 2023; 47:2439-2448. [PMID: 36961530 DOI: 10.1007/s00264-023-05787-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/17/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE Although the mechanisms of injury are similar to ACL rupture in adults, publications dealing with meniscal lesions resulting from fractures of the intercondylar eminence in children are much rarer. The main objective was to measure the frequency of meniscal lesions associated with tibial eminence fractures in children. The second question was to determine whether there is any available evidence on association between meniscal tears diagnostic method, and frequencies of total lesions, total meniscal lesions, and total entrapments. METHODS A comprehensive literature search was performed using PubMed and Scopus. Articles were eligible for inclusion if they reported data on intercondylar tibial fracture, or tibial spine fracture, or tibial eminence fracture, or intercondylar eminence fracture. Article selection was performed in accordance with the PRISMA guidelines. RESULTS In total, 789 studies were identified by the literature search. At the end of the process, 26 studies were included in the final review. This systematic review identified 18.1% rate of meniscal tears and 20.1% rate of meniscal or IML entrapments during intercondylar eminence fractures. Proportion of total entrapments was significantly different between groups (17.8% in the arthroscopy group vs. 6.2% in the MRI group; p < .0001). Also, we found 20.9% of total associated lesions in the arthroscopy group vs. 26.1% in the MRI group (p = .06). CONCLUSION Although incidence of meniscal injuries in children tibial eminence fractures is lower than that in adults ACL rupture, pediatric meniscal tears and entrapments need to be systematically searched. MRI does not appear to provide additional information about the entrapment risk if arthroscopy treatment is performed. However, pretreatment MRI provides important informations about concomitant injuries, such as meniscal tears, and should be mandatory if orthopaedic treatment is retained. MRI modalities have yet to be specified to improve the diagnosis of soft tissues entrapments. STUDY DESIGN Systematic review of the literature REGISTRATION: PROSPERO N° CRD42021258384.
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Affiliation(s)
- Mathieu Severyns
- Department of Orthopaedic Surgery, Clinique Porte Océane, CESAL F-85340, Les Sables d'Olonne, France.
| | - Guillaume Anthony Odri
- Department of Orthopaedic Surgery, University Hospital of Lariboisière, 75010, Paris, France
| | - Tanguy Vendeuvre
- Pprime Institut UP 3346, CNRS, University of Poitiers, 86000, Poitiers, France
| | - Jean-Baptiste Marchand
- Department of Orthopaedic Surgery, Clinique Porte Océane, CESAL F-85340, Les Sables d'Olonne, France
| | - Arnaud Germaneau
- Pprime Institut UP 3346, CNRS, University of Poitiers, 86000, Poitiers, France
| | - Moustapha Dramé
- Department of Clinical Research and Innovation, University Hospital of Martinique, 97200, Fort-de-France, France
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Bone fixation techniques for managing joint disorders and injuries: A review study. J Mech Behav Biomed Mater 2021; 126:104982. [PMID: 34852984 DOI: 10.1016/j.jmbbm.2021.104982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 01/14/2023]
Abstract
The majority of surgical procedures treating joint disorders require a technique to realize a firm implant-to-tissue and/or a tissue-to-tissue fixation. Fixation methods have direct effects on survival, performance and integration of orthopedic implants This review paper gives an overview of novel fixation techniques that have been evaluated and optimized for orthopaedic joint implants and could be alternatives for traditional implant fixation techniques or inspirations for future design of joint implantation procedures. METHOD The articles were selected using the Scopus search engine. Key words referring to traditional fixation methods have been excluded to find potential innovative fixation techniques. In order to review the recent anchorage systems, only articles that been published during the period of 2010-2020 have been included. RESULTS A total of 57 studies were analyzed. The result revealed that three main fixation principles are being employed: using mechanical interlockings, employing adhesives, and performing tissue-bonding strategies. CONCLUSION The development of fixation techniques demonstrates a transformation from the general anchoring tools like K-wires toward application-specific designs. Several new methods have been designed and evaluated, which highlight encouraging results as described in this review. It seems that mechanical fixations provide the strongest anchorage. Employing (bio)-adhesives as fixation tool could revolutionize the field of orthopedic surgery. However, the adhesives must be improved and optimized to meet the requirements of an anchorage system. Long-term fixation might be formed by tissue ingrowth approaches which showed promising results. In most cases further clinical studies are required to explore their outputs in clinical applications.
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Colombet P, Silvestre A, Bouguennec N. The capsular line reference, a new arthroscopic reference for posterior/anterior femoral tunnel positioning in anterior cruciate ligament reconstruction. J Exp Orthop 2018; 5:9. [PMID: 29589162 PMCID: PMC5869347 DOI: 10.1186/s40634-018-0125-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/08/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Femoral malposition is the first cause for graft rupture during ACL reconstruction. Arthroscopic landmarks can be difficult to identify. So, landmark has to be found for reliable tunnel placement. A proximal-distal reference was described as "Apex reference" reported by Hart et al. but no posterior/anterior reference exists in the literature. The purpose of this study was to do a 3D CT-scan assessment of the femoral tunnel positioning using the Capsular Line Reference (CLR) as a landmark for posterior/anterior placement in ACL reconstruction. We hypothesized the CLR could provide a precise and reliable antero/posterior femoral tunnel positioning less than 2 mm from the Bernard & Hertel posterior quarter. METHODS Seven cadaveric knee specimens with a mean age of 79.2 ± 11 years were used. Using standard approaches, the CLR was identified corresponding to a white line (the capsule) appearing at the posterior border of the femoral condyle after bony debridement of the medial and posterior part of the lateral femoral condyle. The center of the tunnel was marked. An inside-out technique with anteromedial drilling technique was performed using an 8-mm diameter reamer. The distal femurs were sawed and a CT-scan was done for each specimen to obtain 3-dimensional image reconstructions. These 3D reconstructions were analyzed to measure the position tunnel center on the posterior/anterior axis and the distance from the posterior/anterior quadrant according to the Bernard & Hertel method. RESULTS The mean position for the posterior/anterior axis was 27.0 ± 1.8% (25-28.9) with a median of 26.9%. The position from the first quarter of the Bernard & Hertel method was 0.9 ± 0.8 mm (0-1.8) with a median of 0.8 mm. CONCLUSION The CLR is a reliable and reproducible arthroscopic landmark to place the femoral tunnel for ACL reconstruction in the anterior/posterior axis. Proximal/distal position depends on the choice of the surgeon to reproduce anteromedial or posterolateral fibers.
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Affiliation(s)
- Philippe Colombet
- Clinique du Sport de Bordeaux-Mérignac, 4 Rue Georges Negrevergne, 33700, Mérignac, France
| | - Alain Silvestre
- Clinique du Sport de Bordeaux-Mérignac, 4 Rue Georges Negrevergne, 33700, Mérignac, France
| | - Nicolas Bouguennec
- Clinique du Sport de Bordeaux-Mérignac, 4 Rue Georges Negrevergne, 33700, Mérignac, France.
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