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Alakkas E, Drager J, Kerrigan A, Carsen S. Arthroscopic suture fixation of tibial spine fractures. J ISAKOS 2024; 9:415-417. [PMID: 38518894 DOI: 10.1016/j.jisako.2024.02.012] [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: 06/27/2023] [Revised: 02/11/2024] [Accepted: 02/21/2024] [Indexed: 03/24/2024]
Abstract
A tibial spine fracture refers to an intraarticular fracture of the osseous insertion of the anterior cruciate ligament at the proximal tibia, commonly seen in pediatric and adolescent patients. This fracture is classified based on the degree of displacement and the presence or absence of an intact posterior hinge point. For significantly displaced fractures, surgical reduction and fixation are often recommended. Both open and arthroscopic approaches have been described. This technical note describes our technique for arthroscopic-assisted reduction and fixation of tibial spine fractures using trans-osseous tunnels and suture fixation over a bone bridge. This technique restores native anatomy, provides fracture compression, and has favorable biomechanical properties, allowing for early range of motion.
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Affiliation(s)
- Eyad Alakkas
- Orthopedic Division, Children's Hospital of Eastern Ontario, Ottawa, K1H 8L1, Canada.
| | - Justin Drager
- Orthopedic Division, Children's Hospital of Eastern Ontario, Ottawa, K1H 8L1, Canada
| | - Alicia Kerrigan
- Orthopedic Division, Children's Hospital of Eastern Ontario, Ottawa, K1H 8L1, Canada
| | - Sasha Carsen
- Orthopedic Division, Children's Hospital of Eastern Ontario, Ottawa, K1H 8L1, Canada
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2
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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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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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Turati M, Rigamonti L, Giulivi A, Gaddi D, Accadbled F, Zanchi N, Bremond N, Catalano M, Gorla M, Omeljaniuk RJ, Zatti G, Piatti M, Bigoni M. Management of anterior cruciate ligament tears in Tanner stage 1 and 2 children: a narrative review and treatment algorithm guided by ACL tear location. J Sports Med Phys Fitness 2023; 63:1218-1226. [PMID: 34609098 DOI: 10.23736/s0022-4707.21.12783-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The incidence of anterior cruciate ligament (ACL) tears in skeletally immature patients has acutely increased over the last 20 years, yet there is no consensus on a single "best treatment." Selection of an optimal treatment is critical and based on individual circumstances; consequently, we propose a treatment-selection algorithm based on skeletal development, ACL tear location, type, and quality, as well as parental perspective in order to facilitate the decision-making process. We combined our surgical group's extensive case histories of ACL tear management in Tanner Stage 1 and 2 patients with those in the literature to form a consolidated data base. For each case the diagnostic phase, communication with patient and parents, treatment choice(s), selected surgical techniques and rehabilitation schedule were critically analyzed and compared for patient outcomes. MRI-imaging and intraoperative tissue quality assessment were preeminent in importance for selection of the optimal treatment strategy. Considerations for selecting an optimal treatment included: associated lesions, the child/patient and parent(s)' well-informed and counseled consent, biological potential, and the potential for successful ACL preservative surgery. Complete ACL tears were evaluated according to tear-location. In type I and II ACL tears with remaining good tissue quality, we propose primary ACL repair. In type III and IV ACL tears we propose physeal-sparing reconstruction with an iliotibial band graft. Finally, in the case of a type V ACL tear, we propose that the best treatment be based on the Meyers-McKeever classification. We present a facile decision-making algorithm for ACL management in pediatric patients based on specific elements of tissue damage and status.
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Affiliation(s)
- Marco Turati
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy -
- Department of Orthopedics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy -
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy -
- Couple Enfant Hospital, Grenoble, France -
- Department of Pediatric Orthopedic Surgery, Couple Enfant Hospital, Grenoble Alpes University, Grenoble, France -
| | - Luca Rigamonti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andrea Giulivi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
| | - Diego Gaddi
- Department of Orthopedics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
| | - Franck Accadbled
- Department of Orthopedics, Children's Hospital, CHU de Toulouse, Toulouse, France
| | - Nicolò Zanchi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
| | - Nicolas Bremond
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
- Department of Pediatric Orthopedic Surgery, Couple Enfant Hospital, Grenoble Alpes University, Grenoble, France
| | - Marcello Catalano
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
| | - Massimo Gorla
- Department of Orthopedics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
| | - Robert J Omeljaniuk
- Department of Orthopedics, Children's Hospital, CHU de Toulouse, Toulouse, France
- Department of Biology, Lakehead University, Thunder Bay, ON, Canada
| | - Giovanni Zatti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Orthopedics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
| | - Massimiliano Piatti
- Department of Orthopedics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
| | - Marco Bigoni
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Orthopedics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
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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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Sanders E, Policicchio AL, Phillips L. High Incidence of Soft Tissue Injury in Pediatric Proximal Tibia Fractures: A Systematic Review. Arthrosc Sports Med Rehabil 2023; 5:100771. [PMID: 37576909 PMCID: PMC10415616 DOI: 10.1016/j.asmr.2023.100771] [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: 02/02/2023] [Accepted: 06/04/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose The purpose of this study was to describe the incidence of soft tissue injuries associated with pediatric proximal tibial fractures (PPTF) and the frequency that magnetic resonance imaging (MRI) was used before surgery in this patient population. Methods A systematic review of English literature, using EMBASE and PubMed, was completed. Articles reporting on soft tissue injury in PPTFs between 1980 and 2021 were identified. Associated pathology (meniscal tear, meniscal entrapment, cruciate ligament injury, extensor mechanism injury, and chondral injury) and use of MRI at time of diagnosis, were assessed in these studies. Twenty-three articles were included. Results Extraction of data revealed 1046 patients and 1057 fractures, with a mean age of 12.3 ± 1.7 at the time of injury. Most patients were male (n = 757 [72.3%]). Most fractures were tibial eminence fractures (TEF) (n = 747 [70.7%]), followed by tibial tubercle (n = 218 [20.6%]) and then tibial plateau fractures (n = 92 [8.7%]). Associated soft tissue injuries were found in 58.8% (n = 621) of fractures overall. Meniscal entrapment was the most common, occurring in 22.1% (n = 234) of cases. Meniscal tears occurred in 18.6% of cases (n = 197), followed by ligament injury in 9.4% (n = 99), chondral injury in 6.5% (n = 69), and extensor mechanism injury in 2.1% (n = 22) of cases. All cases of tendinous extensor mechanism injury were seen in tibial tubercle fractures, with 22 injuries occurring in 10.1% of tibial tubercle fractures. At time of injury just 24.3% (n = 257) of fractures had an MRI performed before surgery. Conclusions PPTFs are associated with a high incidence of associated injury (58.8%), particularly in TEFs (63.5%) and TPFs (100%). Level of Evidence Systematic Review of Level III-IV studies.
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Affiliation(s)
- Ethan Sanders
- Cumming School of Medicine, University of Calgary, Calgary, Albert, Canada
| | | | - Lisa Phillips
- Cumming School of Medicine, University of Calgary, Calgary, Albert, Canada
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O’Donnell R, Lemme NJ, Piana L, Aoyama JT, Ganley TJ, Fabricant PD, Green DW, McKay SD, Schmale GA, Mistovich RJ, Baghdadi S, Yen YM, Ellis HB, Cruz AI. Fixation Strategy Does Not Affect Risk of Growth Disturbance After Surgical Treatment of Pediatric Tibial Spine Fracture. Arthrosc Sports Med Rehabil 2023; 5:100739. [PMID: 37645394 PMCID: PMC10461139 DOI: 10.1016/j.asmr.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/20/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose To characterize growth abnormalities after surgical treatment of tibial spine fractures and to investigate risk factors for these abnormalities. Methods A retrospective analysis of children who underwent treatment of tibial spine fractures between January 2000 and January 2019 was performed, drawing from a multicenter cohort among 10 tertiary care children's hospitals. The entire cohort of surgically treated tibial spine fractures was analyzed for incidence and risk factors of growth disturbance. The cohort was stratified into those who were younger than the age of 13 years at the time of treatment in order to evaluate the risk of growth disturbance in those with substantial growth remaining. Patients with growth disturbance in this cohort were further analyzed based on age, sex, surgical repair technique, implant type, and preoperative radiographic measurements with χ2, t-tests, and multivariate logistic regression. Results Nine patients of 645 (1.4%) were found to have growth disturbance, all of whom were younger than 13 years old. Patients who developed growth disturbance were younger than those without (9.7 years vs 11.9 years, P = .019.) There was no association with demographic factors, fracture characteristics, surgical technique, hardware type, or anatomic placement (i.e., transphyseal vs physeal-sparing fixation) and growth disturbance. Conclusions In this study, we found an overall low incidence of growth disturbance after surgical treatment of tibial spine fractures. There was no association with surgical technique and risk of growth disturbance. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Ryan O’Donnell
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, U.S.A
| | - Nicholas J. Lemme
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, U.S.A
| | - Lauren Piana
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, U.S.A
| | - Julien T. Aoyama
- Division of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Theodore J. Ganley
- Division of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Peter D. Fabricant
- Pediatric Orthopaedic Surgery Service, Hospital for Special Surgery, New York, New York, U.S.A
| | - Daniel W. Green
- Pediatric Orthopaedic Surgery Service, Hospital for Special Surgery, New York, New York, U.S.A
| | - Scott D. McKay
- Department of Orthopedics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, U.S.A
| | - Gregory A. Schmale
- Division of Pediatric Orthopaedics and Sports Medicine, Seattle Children’s Hospital, Seattle, Washington, U.S.A
| | - R. Justin Mistovich
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Soroush Baghdadi
- Division of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Yi-Meng Yen
- Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, U.S.A
| | - Henry B. Ellis
- Department of Orthopedics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, U.S.A
| | - Aristides I. Cruz
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, U.S.A
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Jääskelä M, Turati M, Lempainen L, Bremond N, Courvoisier A, Henri A, Accadbled F, Sinikumpu J. Long-term Outcomes of Tibial Spine Avulsion Fractures After Open Reduction With Osteosuturing Versus Arthroscopic Screw Fixation: A Multicenter Comparative Study. Orthop J Sports Med 2023; 11:23259671231176991. [PMID: 37359980 PMCID: PMC10286196 DOI: 10.1177/23259671231176991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/22/2023] [Indexed: 06/28/2023] Open
Abstract
Background More information is needed regarding return to preinjury sport levels and patient-reported outcomes after tibial spine avulsion (TSA) fracture, which is most common in children aged 8 to 12 years. Purpose To analyze return to play/sport (RTP), subjective knee-specific recovery, and quality of life in patients after TSA fracture treated with open reduction with osteosuturing versus arthroscopic reduction with internal screw fixation. Study Design Cohort study; Level of evidence, 3. Methods This study included 61 patients <16 years old with TSA fracture treated via open reduction with osteosuturing (n = 32) or arthroscopic reduction with screw fixation (n = 29) at 4 institutions between 2000 and 2018; all patients had at least 24 months of follow-up (mean ± SD, 87.0 ± 47.1 months; range, 24-189 months). The patients completed questionnaires regarding ability to return to preinjury-level sports, subjective knee-specific recovery, and health-related quality of life, and results were compared between treatment groups. Univariate and multivariate logistic regression analyses were conducted to determine variables associated with failure to return to preinjury level of sport. Results The mean patient age was 11 years, with a slight male predominance (57%). Open reduction with osteosuturing was associated with a quicker RTP time than arthroscopy with screw implantation (median, 8.0 vs 21.0 weeks; P < .001). Open reduction with osteosuturing was also associated with a lower risk of failure to RTP at preinjury level (adjusted odds ratio, 6.4; 95% CI, 1.1-36.0; P = .035). Postoperative displacement >3 mm increased the risk of failure to RTP at preinjury level regardless of treatment group (adjusted odds ratio, 15.2; 95% CI, 1.2-194.9; P = .037). There was no difference in knee-specific recovery or quality of life between the treatment groups. Conclusion Open surgery with osteosuturing was a more viable option for treating TSA fractures because it resulted in a quicker RTP time and a lower rate of failure to RTP as compared with arthroscopic screw fixation. Precise reduction contributed to improved RTP.
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Affiliation(s)
- Maija Jääskelä
- Department of Pediatric Orthopaedics and Surgery, Oulu University Hospital; Research Unit of Clinical Medicine, University of Oulu; and Medical Research Center, Oulu, Finland
| | - Marco Turati
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Ripoll y De Prado FIFA Medical Centre of Excellence, Madrid, Spain
| | - Lasse Lempainen
- Ripoll y De Prado FIFA Medical Centre of Excellence, Madrid, Spain
- FinnOrthopaedics/Hospital Pihlajalinna, Turku, Finland
- Department of Physical Activity and Health, Paavo Nurmi Centre, University of Turku, Turku, Finland
| | - Nicolas Bremond
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Paediatric Orthopaedic Surgery, Hospital Couple Enfant, Grenoble Alpes University, Grenoble, France
| | - Aurelien Courvoisier
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Paediatric Orthopaedic Surgery, Hospital Couple Enfant, Grenoble Alpes University, Grenoble, France
| | - Antoine Henri
- Unité de Médecine du Sport, Centre Hospitalier Francois Mitterand de Pau, Pau, France
| | - Franck Accadbled
- Department of Orthopaedic Surgery, Hôpital des Enfants, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jaakko Sinikumpu
- Department of Pediatric Orthopaedics and Surgery, Oulu University Hospital; Research Unit of Clinical Medicine, University of Oulu; and Medical Research Center, Oulu, Finland
- Hospital TerveysTalo, Oulu, Finland
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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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10
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Cruz AI, Lee RJ, Kushare I, Baghdadi S, Green DW, Ganley TJ, Ellis HB, Mistovich RJ. Tibial Spine Fractures in Young Athletes. Clin Sports Med 2022; 41:653-670. [DOI: 10.1016/j.csm.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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11
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Nguyen JC, Guariento A, Williams BA, Lawrence JTR, Ganley TJ, Venkatesh TP, Sze RW. MRI evaluation of pediatric tibial eminence fractures: comparison between conventional and "CT-like" ultrashort echo time (UTE) images. Skeletal Radiol 2022; 51:1603-1610. [PMID: 35112140 DOI: 10.1007/s00256-022-04000-0] [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] [Received: 12/14/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE UTE MRI offers a radiation-free alternative to CT for bone depiction, but data on children is lacking. The purpose of this study was to determine whether UTE images improve detection and characterization of pediatric tibial eminence fractures. METHODS Fifteen MRIs with UTE from 12 children (10 boys, 2 girls; mean age: 12.6 ± 3.3 years) with tibial eminence fractures (2018-2020) and 15 age-matched MRIs without fractures were included. After randomization, 5 readers reviewed images without and with UTE, at least 1 month apart, and recorded the presence of fracture and preferred images. If fracture is present, radiologists also recorded fragment size, number, and displacement; surgeons assigned Meyers-McKeever grade and management. Disagreements on management were resolved through consensus review. Kappa and intra-class correlation (ICC), sensitivity, and specificity were used to compare agreement between readers and fracture detection between images without and with UTE. RESULTS For fracture detection, inter-reader agreement was almost perfect (κ-range: 0.91-0.93); sensitivity and specificity were equivalent between images without and with UTE (range: 95-100%). For fracture characterization, UTE improved agreement on size (ICC = 0.88 to 0.93), number (ICC = 0.52 to 0.94), displacement (ICC = 0.74 to 0.86), and grade (ICC = 0.92 to 0.93) but reduced agreement on management (κ = 0.68 to 0.61), leading to a change in consensus management in 20% (3/15). Radiologists were more likely to prefer UTE for fracture and conventional images for non-fracture cases (77% and 77%, respectively, p < 0.001). CONCLUSION While UTE did not improve diagnosis, it improved agreement on characterization of pediatric tibial eminence fractures, ultimately changing the preferred treatment in 20%.
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Affiliation(s)
- Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Andressa Guariento
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Brendan A Williams
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - J Todd R Lawrence
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Theodore J Ganley
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tanvi P Venkatesh
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- University of Pennsylvania Undergraduate Program, Philadelphia, PA, USA
| | - Raymond W Sze
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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12
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Shimberg JL, Leska TM, Cruz AI, Ellis HB, Patel NM, Yen YM, Schmale GA, Mistovich RJ, Fabricant PD, Ganley TJ, Green DW, Johnson B, Kushare I, Lee RJ, McKay SD, Milbrandt TA, Rhodes J, Sachleben B, Traver JL. Is Nonoperative Treatment Appropriate for All Patients With Type 1 Tibial Spine Fractures? A Multicenter Study of the Tibial Spine Research Interest Group. Orthop J Sports Med 2022; 10:23259671221099572. [PMID: 35677019 PMCID: PMC9168882 DOI: 10.1177/23259671221099572] [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: 01/31/2022] [Accepted: 03/09/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Type 1 tibial spine fractures are nondisplaced or ≤2 mm–displaced fractures
of the tibial eminence and anterior cruciate ligament (ACL) insertion that
are traditionally managed nonoperatively with immobilization. Hypothesis: Type 1 fractures do not carry a significant risk of associated injuries and
therefore do not require advanced imaging or additional interventions aside
from immobilization. Study Design: Case series; Level of evidence, 4. Methods: We reviewed 52 patients who were classified by their treating institution
with type 1 tibial spine fractures. Patients aged ≤18 years with
pretreatment plain radiographs and ≤ 1 year of follow-up were included.
Pretreatment imaging was reviewed by 4 authors to assess classification
agreement among the treating institutions. Patients were categorized into 2
groups to ensure that outcomes represented classic type 1 fracture patterns.
Any patient with universal agreement among the 4 authors that the fracture
did not appear consistent with a type 1 classification were assigned to the
type 1+ (T1+) group; all other patients were assigned to the true type 1
(TT1) group. We evaluated the rates of pretreatment imaging, concomitant
injuries, and need for operative interventions as well as treatment outcomes
overall and for each group independently. Results: A total of 48 patients met inclusion criteria; 40 were in the TT1 group,
while 8 were in the T1+ group, indicating less than universal agreement in
the classification of these fractures. Overall, 12 (25%) underwent surgical
treatment, and 12 (25%) had concomitant injuries. Also, 8 patients required
additional surgical management including ACL reconstruction (n = 4), lateral
meniscal repair (n = 2), lateral meniscectomy (n = 1), freeing an
incarcerated medial meniscus (n = 1), and medial meniscectomy (n = 1). Conclusion: The classification of type 1 fractures can be challenging. Contrary to prior
thought, a substantial number of patients with these fractures (>20%)
were found to have concomitant injuries. Overall, surgical management was
performed in 25% of patients in our cohort.
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Affiliation(s)
- Jilan L. Shimberg
- Investigation performed at University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Tomasina M. Leska
- Investigation performed at University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Aristides I. Cruz
- Investigation performed at University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Henry B. Ellis
- Investigation performed at University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Neeraj M. Patel
- Investigation performed at University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Yi-Meng Yen
- Investigation performed at University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Gregory A. Schmale
- Investigation performed at University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - R. Justin Mistovich
- Investigation performed at University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Peter D. Fabricant
- Investigation performed at University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Theodore J. Ganley
- Investigation performed at University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Daniel W. Green
- Investigation performed at University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Benjamin Johnson
- Investigation performed at University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Indranil Kushare
- Investigation performed at University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - R. Jay Lee
- Investigation performed at University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Scott D. McKay
- Investigation performed at University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Todd A. Milbrandt
- Investigation performed at University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Jason Rhodes
- Investigation performed at University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Brant Sachleben
- Investigation performed at University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Jessica L. Traver
- Investigation performed at University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
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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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14
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Shimberg JL, Leska TM, Cruz AI, Patel NM, Ellis HB, Ganley TJ, Johnson B, Milbrandt TA, Yen YM, Mistovich RJ. A Multicenter Comparison of Open Versus Arthroscopic Fixation for Pediatric Tibial Spine Fractures. J Pediatr Orthop 2022; 42:195-200. [PMID: 35067605 DOI: 10.1097/bpo.0000000000002049] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND When operative treatment is indicated, tibial spine fractures can be successfully managed with open or arthroscopic reduction and internal fixation (ARIF). The purpose of the study is to evaluate short-term treatment outcomes of tibial spine fractures in patients treated with both open and arthroscopic fracture reduction. METHODS We performed an Institutional Review Board (IRB)-approved retrospective cohort study of pediatric tibial spine fractures presenting between January 1, 2000 and January 31, 2019 at 10 institutions. Patients were categorized into 2 cohorts based on treatment: ARIF and open reduction and internal fixation (ORIF). Short-term surgical outcomes, the incidence of concomitant injuries, and surgeon demographics were compared between groups. RESULTS There were 477 patients with tibial spine fractures who met inclusion criteria, 420 of whom (88.1%) were treated with ARIF, while 57 (11.9%) were treated with ORIF. Average follow-up was 1.12 years. Patients treated with ARIF were more likely to have an identified concomitant injury (41.4%) compared with those treated with ORIF (24.6%, P=0.021). Most concomitant injuries (74.5%) were treated with intervention. The most common treatment complications included arthrofibrosis (6.9% in ARIF patients, 7.0% in ORIF patients, P=1.00) and subsequent anterior cruciate ligament injury (2.1% in ARIF patients and 3.5% in ORIF, P=0.86). The rate of short-term complications, return to the operating room, and failure to return to full range of motion were similar between treatment groups. Twenty surgeons with sports subspecialty training completed 85.0% of ARIF cases; the remaining 15.0% were performed by 12 surgeons without additional sports training. The majority (56.1%) of ORIF cases were completed by 14 surgeons without sports subspecialty training. CONCLUSION This study demonstrated no difference in outcomes or nonunion following ARIF or ORIF, with a significantly higher rate of concomitant injuries identified in patients treated with ARIF. The majority of identified concomitant injuries were treated with surgical intervention. Extensive surgical evaluation or pretreatment magnetic resonance imaging should be considered in the workup of tibial spine fractures to increase concomitant injury identification. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | - Aristides I Cruz
- Warren Alpert Medical School of Brown University, Providence, RI
| | - Neeraj M Patel
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Henry B Ellis
- Texas Scottish Rite Hospital for Children, Dallas, TX
| | | | - Ben Johnson
- Texas Scottish Rite Hospital for Children, Dallas, TX
| | | | | | - R Justin Mistovich
- Case Western Reserve University
- University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH
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15
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MRI of the Knee Meniscus. Magn Reson Imaging Clin N Am 2022; 30:307-324. [DOI: 10.1016/j.mric.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Qu H, Meng Q, Sun Q, Du D, Zhang Q. Arthroscopic fixation for tibial eminence fractures: A clinical retrospective study of cannulated screws versus transosseous anchor knot fixation techniques with suture anchors. Knee 2022; 35:105-113. [PMID: 35305496 DOI: 10.1016/j.knee.2022.02.002] [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] [Received: 12/01/2020] [Revised: 09/05/2021] [Accepted: 02/04/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND A variety of different techniques or methods for treatment of tibial eminence fracture (TEF) have been reported, but there is still controversy on the optimum choice for treating TEFs. The aim of the current work was to compare the clinical outcomes of arthroscopic cannulated screw fixation and a new arthroscopic anchor fixation technique for tibial eminence fracture. METHODS We included 69 isolated tibial eminence fracture patients from June 2012 to February 2017; 36 patients received the cannulated screw fixation and 33 received the transosseous anchor knot (TAK) fixation under arthroscopy. The two techniques were performed by two different high-volume surgeons. The clinical efficacies of the two techniques were assessed by radiographs, extension deficit, flexion deficit, anterior drawer test (ADT), Lachman test, Lysholm scores and International Knee Documentation Committee (IKDC) scores in follow ups. RESULTS Patients were followed up for 35.8 months on average (range, 24-54 months). There were 40 (58%) males and 29 (42%) females included, and four (6%) patients were <18 years old. Asymptomatic grade II laxity was found in two patients in the CS group and three patients in the TAK group from the results of Lachman test. Postoperative radiographs in all patients showed anatomic reductions and bony unions were achieved within 12 weeks. There were no significant differences in extension deficit, flexion deficit, ADT, Lachman test, Lysholm scores and IKDC scores between groups (P > 0.05). CONCLUSIONS The TAK technique shows satisfactory clinical and radiological outcomes equal to the cannulated screw fixation, which is applicable for TEFs as a reliable effective method.
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Affiliation(s)
- Huazheng Qu
- Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, PR China; Department of Joint Surgery, The Third Hospital of Jinan, Jinan, Shandong, PR China
| | - Qingjun Meng
- Department of Joint Surgery, The Third Hospital of Jinan, Jinan, Shandong, PR China
| | - Qibin Sun
- Department of Joint Surgery, The Third Hospital of Jinan, Jinan, Shandong, PR China
| | - Daodong Du
- Department of Joint Surgery, The Third Hospital of Jinan, Jinan, Shandong, PR China
| | - Qiang Zhang
- Department of Orthopedics, General Hospital of PLA (People's Liberation Army), Beijing, PR China.
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Choufani E, Pesenti S, Launay F, Jouve JL. Treatment of knee sprains in children. Orthop Traumatol Surg Res 2022; 108:103120. [PMID: 34673266 DOI: 10.1016/j.otsr.2021.103120] [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: 10/30/2020] [Revised: 11/18/2020] [Accepted: 01/14/2021] [Indexed: 02/03/2023]
Abstract
The incidence of knee sprains in children is steadily increasing. Skeletal immaturity and anatomical features of the child's ligamentous structures explain the frequency of bone avulsions in young children. Peripheral ligament injuries are the most common and often benign. Nevertheless, associated injuries of the cruciate or patellofemoral ligament(s) are not rare and must not be missed. Age is a determining factor in diagnostic guidance. Anterior intercondylar tibial eminence fractures, otherwise known as tibial spine fractures (TSF), usually occur in young children. Ligamentous distension at the time of the accident would explain the residual laxity that can affect the prognosis of these fractures. The treatment of interstitial ruptures of the ACL follows recommendations that are becoming clearer through multicentric studies. Reparation techniques, historically rejected as ineffective, have again become topical under specific conditions with the aim of preserving the native ACL and its proprioceptive receptors, which are essential in children. ACL reconstruction techniques have made progress in children, especially with techniques adapted from adults. Preservation of growth plates remains pertinent, especially at the femur to avoid growth disorders, thus highlighting the important role paediatric orthopaedic surgeons have in the management of these knee sprains.
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Affiliation(s)
- Elie Choufani
- AP-HM, Service d'orthopédie pédiatrique, hôpital Timone-Enfants, 264, rue St-Pierre, 13005 Marseille, France; Aix-Marseille université, faculté de médecine, 27, boulevard Jean-Moulin, 13005 Marseille, France.
| | - Sébastien Pesenti
- AP-HM, Service d'orthopédie pédiatrique, hôpital Timone-Enfants, 264, rue St-Pierre, 13005 Marseille, France; Aix-Marseille université, faculté de médecine, 27, boulevard Jean-Moulin, 13005 Marseille, France
| | - Franck Launay
- AP-HM, Service d'orthopédie pédiatrique, hôpital Timone-Enfants, 264, rue St-Pierre, 13005 Marseille, France; Aix-Marseille université, faculté de médecine, 27, boulevard Jean-Moulin, 13005 Marseille, France
| | - Jean-Luc Jouve
- AP-HM, Service d'orthopédie pédiatrique, hôpital Timone-Enfants, 264, rue St-Pierre, 13005 Marseille, France; Aix-Marseille université, faculté de médecine, 27, boulevard Jean-Moulin, 13005 Marseille, France
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18
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Prasad N, Aoyama JT, Ganley TJ, Ellis HB, Mistovich RJ, Yen YM, Fabricant PD, Green DW, Cruz AI, McKay S, Kushare I, Schmale GA, Rhodes JT, Jagodzinski J, Sachleben BC, Sargent MC, Lee RJ. A Comparison of Nonoperative and Operative Treatment of Type 2 Tibial Spine Fractures. Orthop J Sports Med 2021; 9:2325967120975410. [PMID: 33553452 PMCID: PMC7841676 DOI: 10.1177/2325967120975410] [Citation(s) in RCA: 3] [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: 06/22/2020] [Accepted: 07/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Tibial spine fractures (TSFs) are typically treated nonoperatively when nondisplaced and operatively when completely displaced. However, it is unclear whether displaced but hinged (type 2) TSFs should be treated operatively or nonoperatively. Purpose: To compare operative versus nonoperative treatment of type 2 TSFs in terms of overall complication rate, ligamentous laxity, knee range of motion, and rate of subsequent operation. Study Design: Cohort study; Level of evidence, 3. Methods: We reviewed 164 type 2 TSFs in patients aged 6 to 16 years treated between January 1, 2000, and January 31, 2019. Excluded were patients with previous TSFs, anterior cruciate ligament (ACL) injury, femoral or tibial fractures, or grade 2 or 3 injury of the collateral ligaments or posterior cruciate ligament. Patients were placed according to treatment into the operative group (n = 123) or nonoperative group (n = 41). The only patient characteristic that differed between groups was body mass index (22 [nonoperative] vs 20 [operative]; P = .02). Duration of follow-up was longer in the operative versus the nonoperative group (11 vs 6.9 months). At final follow-up, 74% of all patients had recorded laxity examinations. Results: At final follow-up, the nonoperative group had more ACL laxity than did the operative group (P < .01). Groups did not differ significantly in overall complication rate, reoperation rate, or total range of motion (all, P > .05). The nonoperative group had a higher rate of subsequent new TSFs and ACL injuries requiring surgery (4.9%) when compared with the operative group (0%; P = .01). The operative group had a higher rate of arthrofibrosis (8.9%) than did the nonoperative group (0%; P = .047). Reoperation was most common for hardware removal (14%), lysis of adhesions (6.5%), and manipulation under anesthesia (6.5%). Conclusion: Although complication rates were similar between nonoperatively and operatively treated type 2 TSFs, patients treated nonoperatively had higher rates of residual laxity and subsequent tibial spine and ACL surgery, whereas patients treated operatively had a higher rate of arthrofibrosis. These findings should be considered when treating patients with type 2 TSF.
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Affiliation(s)
| | - Niyathi Prasad
- Investigation performed at The Johns Hopkins University, Baltimore, Maryland, USA
| | - Julien T Aoyama
- Investigation performed at The Johns Hopkins University, Baltimore, Maryland, USA
| | - Theodore J Ganley
- Investigation performed at The Johns Hopkins University, Baltimore, Maryland, USA
| | - Henry B Ellis
- Investigation performed at The Johns Hopkins University, Baltimore, Maryland, USA
| | - R Justin Mistovich
- Investigation performed at The Johns Hopkins University, Baltimore, Maryland, USA
| | - Yi-Meng Yen
- Investigation performed at The Johns Hopkins University, Baltimore, Maryland, USA
| | - Peter D Fabricant
- Investigation performed at The Johns Hopkins University, Baltimore, Maryland, USA
| | - Daniel W Green
- Investigation performed at The Johns Hopkins University, Baltimore, Maryland, USA
| | - Aristides I Cruz
- Investigation performed at The Johns Hopkins University, Baltimore, Maryland, USA
| | - Scott McKay
- Investigation performed at The Johns Hopkins University, Baltimore, Maryland, USA
| | - Indranil Kushare
- Investigation performed at The Johns Hopkins University, Baltimore, Maryland, USA
| | - Gregory A Schmale
- Investigation performed at The Johns Hopkins University, Baltimore, Maryland, USA
| | - Jason T Rhodes
- Investigation performed at The Johns Hopkins University, Baltimore, Maryland, USA
| | - Jason Jagodzinski
- Investigation performed at The Johns Hopkins University, Baltimore, Maryland, USA
| | - Brant C Sachleben
- Investigation performed at The Johns Hopkins University, Baltimore, Maryland, USA
| | - M Catherine Sargent
- Investigation performed at The Johns Hopkins University, Baltimore, Maryland, USA
| | - R Jay Lee
- Investigation performed at The Johns Hopkins University, Baltimore, Maryland, USA
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19
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Classification and Treatment of Pediatric Tibial Spine Fractures: Assessing Reliability Among a Tibial Spine Research Interest Group. J Pediatr Orthop 2021; 41:e20-e25. [PMID: 32991493 DOI: 10.1097/bpo.0000000000001654] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treatment decisions for patients with tibial spine fractures depend heavily on radiographic measurements. The purpose of this study was to determine whether existing classification systems and radiographic measurements are reliable among a multicenter tibial spine research interest group. A secondary purpose was to evaluate agreement in treatment of tibial spine fractures. METHODS Using a deidentified radiographic imaging series and identical imaging software, we examined the interobserver and intraobserver reliability of the Meyers and McKeever classification, as well as a cohort of measurements of tibial spine fractures and treatment recommendations. Forty patients were included based on previous reliability studies. Interobserver and intraobserver data were analyzed using kappa and intraclass correlation coefficient reliability measures for categorical and continuous variables, respectively. RESULTS Good interobserver reliability was seen with superior displacement measurements of the anterior portion of the tibial spine fracture (0.73, 0.78) and excellent intraobserver reliability with an intraclass correlation coefficient of 0.81. Several measurements demonstrated moderate interobserver and intraobserver reliability including posterior-proximal displacement, and length and height of the tibial spine fracture. Moderate intraobserver reliability was seen with a majority of measurements and classification schemata (0.42 to 0.60) except for a poor agreement in posterior-sagittal displacement (0.27). Classifying tibial spine fractures according to the original Meyers and McKeever classification demonstrated fair agreement [κ=0.35, 0.33 (inter); 0.47 (intra)]. When combining Type III and IV, agreement increased for both reviews [κ=0.42, 0.44 (inter); 0.52 (intra)]. A total of 24 (60%) fractures were classified as 3 different types. There was fair agreement in both reviews regarding open reduction (either open or arthroscopic) versus closed reduction for initial treatment [κ=0.33, 0.38 (inter); 0.51 (intra)]. CONCLUSIONS Measurement of superior displacement of the anterior portion of tibial spine fractures on the lateral images is the only radiographic assessment with good interobserver and intraobserver reliability. Reliability of radiographic measurements and a modified classification for tibial spine fractures remains fair, and perhaps unacceptable, even among a group of pediatric sports medicine specialty-trained surgeons. LEVEL OF EVIDENCE Level III-diagnostic reliability study of nonconsecutive patients.
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Shimberg JL, Aoyama JT, Leska TM, Ganley TJ, Fabricant PD, Patel NM, Cruz AI, Ellis HB, Schmale GA, Green DW, Jagodzinski JE, Kushare I, Lee RJ, McKay S, Rhodes J, Sachleben B, Sargent C, Yen YM, Mistovich RJ. Tibial Spine Fractures: How Much Are We Missing Without Pretreatment Advanced Imaging? A Multicenter Study. Am J Sports Med 2020; 48:3208-3213. [PMID: 32970957 DOI: 10.1177/0363546520957666] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a high rate of concomitant injuries reported in pediatric patients with tibial spine fractures, ranging from 40% to 68.8%. Many tibial spine fractures are treated without initial magnetic resonance imaging (MRI). PURPOSE To understand rates of concomitant injury and if the reported rates of these injuries differed among patients with and without pretreatment MRI. STUDY DESIGN Cross-sectional study; level of evidence, 3. METHODS We performed an institutional review board-approved multicenter retrospective cohort study of patients treated for tibial spine fractures between January 1, 2000, and January 31, 2019, at 10 institutions. Patients younger than 25 years of age with tibial spine fractures were included. Data were collected on patient characteristics, injury, orthopaedic history, pretreatment physical examination and imaging, and operative findings. We excluded patients with multiple trauma and individuals with additional lower extremity fractures. Patients were categorized into 2 groups: those with and those without pretreatment MRI. The incidence of reported concomitant injuries was then compared between groups. RESULTS There were 395 patients with a tibial spine fracture who met inclusion criteria, 139 (35%) of whom were reported to have a clinically significant concomitant injury. Characteristics and fracture patterns were similar between groups. Of patients with pretreatment MRI, 79 of 176 (45%) had an identified concomitant injury, whereas only 60 of 219 patients (27%) without pretreatment MRI had a reported concomitant injury (P < .001). There was a higher rate of lateral meniscal tears (P < .001) in patients with pretreatment MRI than in those without. However, there was a higher rate of soft tissue entrapment at the fracture bed (P = .030) in patients without pretreatment MRI. Overall, 121 patients (87%) with a concomitant injury required at least 1 treatment. CONCLUSION Patients with pretreatment MRI had a statistically significantly higher rate of concomitant injury identified. Pretreatment MRI should be considered in the evaluation of tibial spine fractures to improve the identification of concomitant injuries, especially in patients who may otherwise be treated nonoperatively or with closed reduction. Further studies are necessary to refine the indications for MRI in patients with tibial spine fractures, determine the characteristics of patients at highest risk of having a concomitant injury, define the sensitivity and specificity of MRI in tibial spine fractures, and investigate patient outcomes based on pretreatment MRI status.
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Affiliation(s)
- Jilan L Shimberg
- Investigation performed at University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Julien T Aoyama
- Investigation performed at University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Tomasina M Leska
- Investigation performed at University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Theodore J Ganley
- Investigation performed at University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Peter D Fabricant
- Investigation performed at University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Neeraj M Patel
- Investigation performed at University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Aristides I Cruz
- Investigation performed at University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Henry B Ellis
- Investigation performed at University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Gregory A Schmale
- Investigation performed at University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
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- Investigation performed at University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Daniel W Green
- Investigation performed at University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Jason E Jagodzinski
- Investigation performed at University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Indranil Kushare
- Investigation performed at University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - R Jay Lee
- Investigation performed at University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Scott McKay
- Investigation performed at University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Jason Rhodes
- Investigation performed at University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Brant Sachleben
- Investigation performed at University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Catherine Sargent
- Investigation performed at University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Yi-Meng Yen
- Investigation performed at University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - R Justin Mistovich
- Investigation performed at University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
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Lv H, Zhang Q, Chen W, Song Z, Zheng Z, Zhang Y. Epidemiological Study of Tibial Plateau Fractures Combined with Intercondylar Eminence Fractures. Orthop Surg 2020; 12:561-569. [PMID: 32347009 PMCID: PMC7189054 DOI: 10.1111/os.12658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/16/2020] [Accepted: 02/19/2020] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To investigate the epidemiological characteristics of tibial plateau fractures combined with intercondylar eminence fractures and identify the risk factors. METHODS This retrospective study enrolled patients with tibial plateau fractures who were treated in the third hospital of Hebei Medical University from January 2015 to December 2018; 1020 patients (693 [68%] men and 327 [32%] women) meeting the inclusion and exclusion criteria had a mean age of 45.2 ± 13.8 years. In total, 506 (50%) cases were left injuries, 495 (48%) were right injuries, and 19 (2%) were bilateral injuries. Among them, 458 (44.9%) with a mean age of 47.0 ± 13.9 years had intercondylar eminence fractures, including 324 men and 134 women. A total of 562 (55.1%) patients were identified without intercondylar eminence fractures, including 369 (65.7%) men and 193 (34.3%) women with an average age of 43.8 ± 13.6 years. The distribution characteristics of tibial plateau fractures with intercondylar eminence involved were identified. The potential associations among fractures and various other factors, such as age, gender, occupation, and mechanism of injury, were explored. RESULTS The highest proportion age group of tibial plateau fractures included the ages 35-54 years, with more men than women for both age groups. For males, the highest proportion age group was 35-44 years, and for females, it was 55-64 years (χ 2 = 71.336, P < 0.01). According to Schatzker classification, type IV tibial plateau fractures had the highest risk of intercondylar eminence being involved (70.6%) without significance with type V (69.5%) and VI (68.2%) but with greater significance with types I (11.9%), II (39.2%), and III (9.4%, χ 2 = 280.187, P < 0.01). Multiple analysis showed that simple fractures, including types I, II, and III (OR 0.108, 95% CI: 0.080-0.145), were less likely to involve intercondylar eminence fractures than complex fractures, including types IV, V, and VI. Patients aged >74 years were more likely to have intercondylar eminence fractures compared with other age groups. Retired patients (OR 4.332, 95% CI: 1.147-16.362) were more likely to have fractured intercondylar eminence. CONCLUSION The current study revealed the characteristics of tibial plateau fractures, especially those involving intercondylar eminence fractures, as well as their proportion, distribution, and risk factors, which can be used as reference data for clinical assessment and surgical protocol selection.
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Affiliation(s)
- Hongzhi Lv
- Editorial DepartmentThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Qi Zhang
- Editorial DepartmentThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Wei Chen
- Editorial DepartmentThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Zhaohui Song
- Editorial DepartmentThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Zhanle Zheng
- Editorial DepartmentThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Yingze Zhang
- Editorial DepartmentThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
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Abstract
The aim of this article is to discuss the diagnosis, management and pitfalls of bony injuries around the skeletally immature knee. Each within their own right is a relatively uncommon injury but associated with potential complications. Distal femoral physeal fractures can result in growth arrest and vascular injury. Tibial spine avulsions can result in an unstable knee. Tibial tubercle fractures can be associated with compartment syndrome and pose a risk to the extensor mechanism of the knee. Fixation can be complicated by growth arrest and subsequent recurvatum deformity. Finally, patella sleeve injuries are often missed and this can also threaten the extensor mechanism. We discuss the approach to clinical and radiological assessment of these injuries, and evidence based recommendations as to how they are best managed to avoid complications.
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Pailhé R, Bauer T, Flecher X, Bonnevialle N, Roussignol X, Saragaglia D, Ehlinger M. Better functional outcomes for ORIF in tibial eminence fracture treatment: a national comparative multicentric study of ORIF vs ARIF. Knee Surg Sports Traumatol Arthrosc 2020; 28:653-657. [PMID: 31797020 DOI: 10.1007/s00167-019-05785-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Tibial eminence fractures can occur in adults and are equivalent to an acute ACL rupture. The purpose of this retrospective study was to compare the therapeutic outcomes of ARIF versus ORIF in tibial eminence fractures. Our hypothesis was that ARIF does not offer better results. METHODS A retrospective national multicentric study was conducted in five university hospitals between 2010 and 2015. A total of 65 consecutive patients were included. 33 patients were treated with ARIF and 32 with ORIF. Clinical functional outcomes were assessed using the Lysholm score and IKDC score. Radiographic findings were recorded, and a statistical analysis carried out. RESULTS IKDC score at the mean last follow-up of 68.8 ± 11.8 months was significantly higher in the ORIF group with a mean difference of 20.2 points ± 8.9 (p = 0.028). There were early osteoarthritis findings in 12 patients (18.4%). At last follow-up, 7 patients (10.7%) presented complications. CONCLUSION In this retrospective multicentric study, better functional outcomes were observed in the ORIF group. This difference needs to be carefully interpreted as many confounding factors exist. In terms of complications, the results for both ORIF and ARIF are similar at midterm follow-up. ORIF should remain gold standard for tibial eminence fracture treatment. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Régis Pailhé
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, Avenue de Kimberley, BP 338, 38434, Échirolles Cedex, France. .,Service de Chirurgie Orthopédique, Hôpital Sud Grenoble, Grenoble Cedex, France.
| | - Thomas Bauer
- Hôpitaux Universitaires Paris Ile-de-France Ouest, Assistance Publique-Hôpitaux de Paris, 92100, Boulogne-Billancourt, France
| | - Xavier Flecher
- Institute for Locomotion, Aix-Marseille University, Marseille, France.,Department of Orthopedics and Traumatology, St Marguerite Hospital, Marseille, France
| | - Nicolas Bonnevialle
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
| | - Xavier Roussignol
- Department of Orthopaedics Surgery and Traumatology, Rouen University Hospital, Rouen, France
| | - Dominique Saragaglia
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, Avenue de Kimberley, BP 338, 38434, Échirolles Cedex, France
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique Et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098, Strasbourg Cedex, France
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Cannamela PC, Quinlan NJ, Maak TG, Adeyemi TF, Aoki SK. Knee Extension Does Not Reliably Reduce Acute Type II Tibial Spine Fractures: MRI Evaluation of Displacement During Extension Versus Resting Flexion. Orthop J Sports Med 2019; 7:2325967119860066. [PMID: 31360733 PMCID: PMC6640064 DOI: 10.1177/2325967119860066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: Type II tibial spine avulsion (TSA) fractures have traditionally been managed by first attempting to achieve closed reduction with extension and immobilization, with surgical indications reserved for those who fail to reduce within 3 mm. However, the frequency with which appropriate reduction can be achieved is largely unknown. Purpose: To evaluate changes in displacement of type II TSA fractures by comparing magnetic resonance imaging (MRI) scans obtained with the knee in flexion and in extension. Study Design: Case series; Level of evidence, 4. Methods: Ten patients with type II TSA fractures were identified. Fracture displacement was measured using 3 images for each patient: (1) initial lateral view radiography, (2) sagittal-plane MRI of the knee in resting flexion, and (3) sagittal-plane MRI of the knee in passive extension. Maximum displacement of the bony fragment was measured in the 2 MRI studies for all patients, and the corresponding change in displacement was calculated. Displacement in flexion was compared with displacement in extension using a paired-sample t test. Statistical significance was set at P < .05. Results: The displacement distance of the bony fragment was reduced by a mean of 0.97 mm on MRI when the knee was in extension compared with flexion in patients with type II TSA fractures (P = .02). Mean displacement with extension was 6.14 mm, with no fractures reduced below 4 mm. The largest reduction observed was 2.80 mm. The displacement distance increased in 2 knees with extension. The intermeniscal ligament (IML) was entrapped in 4 of 10 patients; however, the amount of reduction achieved did not differ based on the presence of IML entrapment (P = .85). Conclusion: While the amount of tibial spine displacement warranting surgical treatment can be debated, the study findings suggest that knee extension is not reliable in obtaining adequate closed reduction for type II TSA fractures. Management decisions may need to be based on the initial displacement distance of the fracture, with a lower threshold for operative treatment than previously recognized.
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Affiliation(s)
| | - Noah J Quinlan
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Travis G Maak
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Temitope F Adeyemi
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Stephen K Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
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