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Reddy R, Bernard C, Tarakemeh A, Morey T, Mulcahey MK, Vopat BG, Vopat ML. Manipulation Under Anesthesia and Lysis of Adhesions Are the Most Commonly Reported Treatments for Arthrofibrosis of the Knee After Arthroscopy or Anterior Cruciate Ligament Reconstruction in Both Pediatric and Adult Patients. Arthrosc Sports Med Rehabil 2024; 6:100896. [PMID: 38469123 PMCID: PMC10925934 DOI: 10.1016/j.asmr.2024.100896] [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: 02/16/2023] [Accepted: 01/13/2024] [Indexed: 03/13/2024] Open
Abstract
Purpose To systematically review the literature and provide a detailed summary of the current treatments and outcomes for arthrofibrosis following knee arthroscopy and anterior cruciate ligament reconstruction (ACLR) and to compare the treatment strategies in pediatric and adult populations. Methods A systematic review was performed in March 2022 using PubMed, EMBASE, and Cochrane Library Databases per Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Search terms consisted of variations of the following: ("arthrofibrosis" OR "stiffness" OR "stiff" OR "complications") AND ("arthroscopy" OR "arthroscop" OR "ACL" OR "anterior cruciate") AND ("treat" OR "care" OR "management" AND "knee"). The inclusion criteria were studies that were written in English, were published since 2000, and that reported outcomes of knee arthroscopy or ACLR for treatment of arthrofibrosis of the knee. The study quality was assessed, and data about the patients and treatments were recorded. Treatments were compared between pediatric and adult patients. Results A total of 1,208 articles were identified in the initial search, 42 (3.48%) of which met eligibility criteria, involving treatment regimens for arthrofibrosis following knee arthroscopy or ACLR. Of the 42 studies included, 29 (69.0%) were reported data for adults and 13 (31.0%) reported data for pediatric patients. Thirty-nine studies (92.8%) discussed manipulation under anesthesia and/or lysis of adhesions (LOA) as treatment for arthrofibrosis of the knee, whereas 2 (4.8%) described the use of medications. Conclusions Within orthopaedic sports medicine literature, there is variability in the reported treatment options for arthrofibrosis of the knee. Most studies identified manipulation under anesthesia and/or LOA as the treatment among both adult and pediatric patients. Other variants include notchplasty, open posterior arthrolysis, total graft resection, removal of hardware with LOA, dynamic splinting, casting in extension, bracing, and medications. Level of Evidence Level IV, systematic review of Level I-IV studies.
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Affiliation(s)
- Ravali Reddy
- University of Kansas School of Medicine, Kansas City, Kansas, U.S.A
| | | | - Armin Tarakemeh
- University of Kansas School of Medicine, Kansas City, Kansas, U.S.A
| | - Tucker Morey
- University of Kansas School of Medicine, Kansas City, Kansas, U.S.A
| | - Mary K. Mulcahey
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Bryan G. Vopat
- University of Kansas School of Medicine, Kansas City, Kansas, U.S.A
| | - Matthew L. Vopat
- University of Kansas School of Medicine, Kansas City, Kansas, U.S.A
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McGurty SA, Ganley TJ, Kushare I, Leska TM, Aoyama JT, Ellis HB, Johnson B, Baghdadi S, Cruz AI, Fabricant PD, Green DW, Lee RJ, McKay SD, Milbrandt TA, Patel NM, Rhodes JT, Sachleben B, Traver JL, Mistovich RJ, Schmale GA, Cook DL, Yen YM. Anterior Displacement of Tibial Spine Fractures: Does Anatomic Reduction Matter? Orthop J Sports Med 2023; 11:23259671231192978. [PMID: 37655244 PMCID: PMC10467414 DOI: 10.1177/23259671231192978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/14/2023] [Indexed: 09/02/2023] Open
Abstract
Background Operative treatment of displaced tibial spine fractures consists of fixation and reduction of the fragment in addition to restoring tension of the anterior cruciate ligament. Purpose To determine whether residual displacement of the anterior portion of a tibial spine fragment affects the range of motion (ROM) or laxity in operatively and nonoperatively treated patients. Study Design Cohort study; Level of evidence, 3. Methods Data were gathered from 328 patients younger than 18 years who were treated for tibial spine fractures between 2000 and 2019 at 10 institutions. ROM and anterior lip displacement (ALD) measurements were summarized and compared from pretreatment to final follow-up. ALD measurements were categorized as excellent (0 to <1 mm), good (1 to <3 mm), fair (3 to 5 mm), or poor (>5 mm). Posttreatment residual laxity and arthrofibrosis were assessed. Results Overall, 88% of patients (290/328) underwent operative treatment. The median follow-up was 8.1 months (range, 3-152 months) for the operative group and 6.7 months (range, 3-72 months) for the nonoperative group. The median ALD measurement of the cohort was 6 mm pretreatment, decreasing to 0 mm after treatment (P < .001). At final follow-up, 62% of all patients (203/328) had excellent ALD measurements, compared with 5% (12/264) before treatment. Subjective laxity was seen in 11% of the nonoperative group (4/37) and 5% of the operative group (15/285; P = .25). Across the cohort, there was no association between final knee ROM and final ALD category. While there were more patients with arthrofibrosis in the operative group (7%) compared with the nonoperative group (3%) (P = .49), this was not different across the ALD displacement categories. Conclusion Residual ALD was not associated with posttreatment subjective residual laxity, extension loss, or flexion loss. The results suggest that anatomic reduction of a tibial spine fracture may not be mandatory if knee stability and functional ROM are achieved.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yi-Meng Yen
- Investigation performed at Boston Children’s Hospital, Boston, Massachusetts, USA
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3
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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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4
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Lutz PM, Geyer S, Winkler PW, Irger M, Berthold DP, Feucht MJ, Imhoff AB, Forkel P. Reliable ligamentous stability and high return-to-sport rates after arthroscopic reduction and internal fixation of tibial eminence fractures. Arch Orthop Trauma Surg 2022; 142:3623-3631. [PMID: 34009463 PMCID: PMC9596592 DOI: 10.1007/s00402-021-03961-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/14/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE To investigate functional and clinical outcomes, and physical activity after arthroscopic suture fixation of tibial eminence fractures with regard to postoperative stability, range of motion (ROM), complications, and return to sports. METHODS Patients undergoing arthroscopic reduction and internal fixation (ARIF) of tibial eminence fractures using a suture fixation technique were included. Outcome was evaluated retrospectively after a minimum follow-up of 24 months using KT-1000 arthrometer measurements, clinical examination, outcome scores (Lysholm score, Tegner Activity Scale), and a questionnaire about sport activities. RESULTS A total of 23 patients (44% male, 57% female) with a mean age of 25 ± 15 years were included. Mean follow-up was 57 ± 25 months. KT-1000 arthrometer measurements of anterior tibial translation revealed a mean side-to-side difference of 0.9 ± 1.0 mm. Clinical examination showed 100% normal or nearly normal anterior translation of the tibia. Two patients (9%) received an ACL reconstruction due to traumatic ACL re-instability and were, therefore, considered as failures. An extension deficit concerning hyperextension occurred in 29% of patients postoperatively. Further postoperative complications occurred in 14% of patients and included postoperative stiffness with ROM limitations and secondary dislocation of a fragment. Mean postoperative Lysholm score was 89 ± 14. Comparing pre- and postoperative values, no significant change of the Tegner Activity Scale was observed. All patients (failures excluded) returned to high impact sports activities after ARIF. CONCLUSION Excellent reliable ligamentous stability and high rates of return to high impact sports can be expected after ARIF using a suture fixation technique for type II-IV tibial eminence fractures. Complications, such as limitations in ROM, commonly occur in up to 30% after ARIF. Therefore, regular follow-up examinations remain important in this usually young patient cohort. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Patricia M Lutz
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Stephanie Geyer
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Philipp W Winkler
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Markus Irger
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Daniel P Berthold
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Matthias J Feucht
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Andreas B Imhoff
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Philipp Forkel
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Chang CJ, Huang TC, Hoshino Y, Wang CH, Kuan FC, Su WR, Hong CK. Functional Outcomes and Subsequent Surgical Procedures After Arthroscopic Suture Versus Screw Fixation for ACL Tibial Avulsion Fractures: A Systematic Review and Meta-analysis. Orthop J Sports Med 2022; 10:23259671221085945. [PMID: 35400137 PMCID: PMC8990705 DOI: 10.1177/23259671221085945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Although arthroscopic screw fixation and suture fixation are mainstream
interventions for displaced anterior cruciate ligament avulsion fractures of
the tibia, the differences in clinical outcomes between them remain
inconclusive. Purpose: To conduct a meta-analysis comparing the clinical and functional outcomes
between arthroscopic screw fixation and suture fixation for tibial avulsion
fractures. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was conducted following the PRISMA (Preferred Reporting
Items for Systematic Reviews and Meta-Analyses) guidelines and using the
PubMed, Embase, and Cochrane Central Register of Controlled Trials
databases. Inclusion criteria were English-language articles that compared
functional outcomes after screw fixation versus suture fixation for tibial
avulsion fractures and had at least 1-year follow-up. Relevant data were
extracted and analyzed statistically using the Mantel-Haenszel method and
variance-weighted means. Random-effects models were used to generate pooled
relative risk (RR) estimates with confidence intervals (CIs). Results: Of 1395 articles initially identified, we included 5 studies with 184
patients (91 patients with screw fixations and 93 patients with suture
fixations). The pooled results indicated similar postoperative outcomes for
screw fixation and suture fixation: Lysholm score (mean difference [MD],
−0.32 [95% CI, −6.08 to 5.44]; P = .91), proportion of
International Knee Documentation Committee score grade A (74% vs 74%; RR,
0.63 [95% CI, 0.10-3.95]; P = .63), Tegner score (MD, 0.10
[95% CI: −1.73 to 1.92]; P = .92), and Lachman test results
(stable knee joint, 82% vs 82%; RR, 0.99; 95% CI: 0.85-1.16;
P = .90). Patients in the screw fixation group had a
significantly higher overall subsequent surgery rate (46% vs 19%; RR, 2.33;
95% CI,1.51-3.60; P = .0001) and implant removal rate (44%
vs 3%; RR, 8.52; 95% CI, 3.58-20.29; P < .00001)
compared with those in the suture fixation group. Nonimplant-related
subsequent surgery rates were similar for the 2 groups. Conclusion: The findings indicated a higher risk of subsequent surgery (RR, 2.33) and
implant removal (RR, 8.52) after screw fixation when compared with suture
fixation for tibial avulsion fractures. However, there were no significant
differences in clinical outcome scores between the 2 techniques.
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Affiliation(s)
- Chao-Jui Chang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Ching Huang
- National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Chi-Hsiu Wang
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Skeleton Materials and Biocompatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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6
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Anchustegui N, Grimm NL, Milbrandt TA, Rustad A, Shea C, Troyer S, Dingel AB, Ganley TJ, Fabricant PD, Shea KG. Medial and Lateral Posterior Tibial Slope in the Skeletally Immature: A Cadaveric Study. Orthop J Sports Med 2022; 10:23259671221088331. [PMID: 35400135 PMCID: PMC8984849 DOI: 10.1177/23259671221088331] [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: 12/12/2021] [Accepted: 12/31/2021] [Indexed: 11/15/2022] Open
Abstract
Background: An increased posterior tibial slope (PTS) results in greater force on the
anterior cruciate ligament (ACL) and is a risk factor for ACL injuries.
Biomechanical studies have suggested that a reduction in the PTS angle may
lower the risk of ACL injuries. However, the majority of these
investigations have been in the adult population. Purpose: To assess the mean medial and lateral PTS on pediatric cadaveric specimens
without known knee injuries. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 39 pediatric knee specimens with computed tomography scans were
analyzed. Specimens analyzed were between the ages of 2 and 12 years. The
PTS of each specimen was measured on sagittal computed tomography slices at
2 locations for the medial and lateral angles. The measurements were plotted
graphically by age to account for the variability in development within age
groups. The anterior medial and lateral tibial plateau widths were measured.
The distance between the top of the tibial plateau and the physis was
measured. The independent-samples t test and analysis of
variance were used to analyze the measurements. Results: The mean PTS angle for the medial and lateral tibial plateaus was 5.53° ±
4.17° and 5.95° ± 3.96°, respectively. The difference between the PTS angles
of the medial and lateral tibial plateaus was not statistically significant
(P > .05). When plotted graphically by age, no trend
between age and PTS was identified. Conclusion: This data set offers values for the PTS in skeletally immature specimens
without a history of ACL injury and suggests that age may not be an accurate
predictive factor for PTS.
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Affiliation(s)
| | | | - Todd A. Milbrandt
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Audrey Rustad
- George Washington University, Washington, District of Columbia, USA
| | - Cooper Shea
- Stanford University, Stanford, California, USA
| | - Stockton Troyer
- George Washington University, Washington, District of Columbia, USA
| | - Aleksei B. Dingel
- University of Washington School of Medicine, Seattle, Washington, USA
| | | | | | - Kevin G. Shea
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
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7
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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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8
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Callanan M, Allen J, Flutie B, Tepolt F, Miller PE, Kramer D, Kocher MS. Suture Versus Screw Fixation of Tibial Spine Fractures in Children and Adolescents: A Comparative Study. Orthop J Sports Med 2019; 7:2325967119881961. [PMID: 31803786 PMCID: PMC6876177 DOI: 10.1177/2325967119881961] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Tibial spine fractures involve an avulsion injury of the anterior cruciate ligament (ACL) at the intercondylar eminence, typically in children and adolescents. Displaced fractures are commonly treated with either suture or screw fixation. Purpose To investigate differences in various outcomes between patients treated with arthroscopic suture versus screw fixation for tibial spine avulsion fractures in one of the largest patient cohorts in the literature. Study Design Cohort study; Level of evidence, 3. Methods A search of medical records was performed with the goal of identifying all type 2 and type 3 tibial spine avulsion fractures surgically treated between 2000 and 2014 at a pediatric hospital. All patients had a minimum of 12 months clinical follow-up, suture or screw fixation only, and no major concomitant injury. Results There were 68 knees in 67 patients meeting criteria for analysis. There were no differences with regard to postsurgical arthrofibrosis (P = .59), ACL reconstruction (P = .44), meniscal procedures (P = .85), instability (P = .49), range of motion (P = .51), return to sport (P >.999), or time to return to sport (P = .11). Elevation of the repaired fragment on postoperative imaging was significantly greater in the suture group (5.4 vs 3.5 mm; P = .005). Postoperative fragment elevation did not influence surgical outcomes. The screw fixation group had more reoperations (13 vs 23; P = .03), a larger number of reoperations for implant removal (3 vs 22; P < .001), and nearly 3 times the odds of undergoing reoperation compared with suture patients (odds ratio, 2.9; P = .03). Conclusion Clinical outcomes between suture and screw fixation were largely equivalent in our patients. Postoperative fragment elevation does not influence surgical outcomes. Consideration should be given for the greater likelihood of needing a second operation, planned or unplanned, after screw fixation.
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Affiliation(s)
- Mark Callanan
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Judd Allen
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Brett Flutie
- Boston Children's Hospital, Boston, Massachusetts, USA
| | | | | | - Dennis Kramer
- Boston Children's Hospital, Boston, Massachusetts, USA
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9
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Leie M, Heath E, Shumborski S, Salmon L, Roe J, Pinczewski L. Midterm Outcomes of Arthroscopic Reduction and Internal Fixation of Anterior Cruciate Ligament Tibial Eminence Avulsion Fractures With K-Wire Fixation. Arthroscopy 2019; 35:1533-1544. [PMID: 30979622 DOI: 10.1016/j.arthro.2018.11.066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the clinical and radiological outcomes of patients who underwent arthroscopic reduction and internal fixation of a tibial eminence avulsion fracture with Kirshner wires (K-wires) at a mean of 8 years following surgery. METHODS This was a retrospective study with prospectively collected data. Inclusion criteria consisted of patients who underwent arthroscopic reduction and internal fixation of tibial eminence fracture with K-wires between 1989 and 2015 at a minimum of 18 months follow-up. Assessment included the International Knee Documentation Committee Ligament Evaluation, Lysholm Knee Score, and clinical outcomes. Magnetic resonance imaging (MRI) was performed to evaluate the anterior cruciate ligament (ACL) and evidence of osteoarthritis. RESULTS A total of 48 participants met the inclusion criteria, and 32 were reviewed at a mean of 8 years (range, 18-260 months) after surgery. The mean age at the time of surgery was 24.5 years (10-55 years). Subsequent ACL injury occurred in 5 participants (10.4%) on the index knee and in 1 participant also on the contralateral knee; 86% had a normal examination, and no patients had >5-mm side-to-side difference on instrumented testing. The mean International Knee Documentation Committee subjective score at 8 years was 86 (range, 40-100). On MRI scan assessment for osteoarthritic changes at final follow-up, 82% of participants had no evidence of chondral wear on the medial compartment and 73% had no changes in the lateral compartment according to Magnetic Resonance Image Osteoarthritis Knee Score classification. On MRI scan qualitative assessment of ACL and tibial eminence, 7 participants (32%) were found to have high signal at the fracture site. The mean medial tibial eminence height was 9.2 mm (range, 6.3 mm to 1.31 cm) and the lateral tibial eminence height was an average of 6.7 mm (range, 0.38-0.97 mm). Significant kneeling pain was reported by 8 participants (25%). CONCLUSIONS This study indicates that internal fixation with K-wires is an acceptable approach to reduce tibial eminence avulsion fractures, providing excellent clinical and radiological outcomes at a minimum of 18 months of follow-up. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Murilo Leie
- North Sydney Orthopaedic and Sports Medicine Centre, Mater Clinic, Sydney, Australia
| | - Emma Heath
- North Sydney Orthopaedic and Sports Medicine Centre, Mater Clinic, Sydney, Australia
| | | | - Lucy Salmon
- North Sydney Orthopaedic and Sports Medicine Centre, Mater Clinic, Sydney, Australia.
| | - Justin Roe
- North Sydney Orthopaedic and Sports Medicine Centre, Mater Clinic, Sydney, Australia
| | - Leo Pinczewski
- North Sydney Orthopaedic and Sports Medicine Centre, Mater Clinic, Sydney, Australia; School of Medicine, University of Notre Dame, Sydney, Australia
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10
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Melugin HP, Desai VS, Camp CL, Milbrandt TA, Dahm DL, Levy BA, Stuart MJ, Krych AJ. Do Tibial Eminence Fractures and Anterior Cruciate Ligament Tears Have Similar Outcomes? Orthop J Sports Med 2018; 6:2325967118811854. [PMID: 30547044 PMCID: PMC6287315 DOI: 10.1177/2325967118811854] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Avulsion fractures involving the tibial eminence are considered equivalent in terms of the cause to anterior cruciate ligament (ACL) tears; however, there are limited data comparing the outcomes of adolescent patients undergoing surgical fixation of a tibial eminence fracture (TEF) with those undergoing ACL reconstruction. Purpose: To compare the clinical outcomes, subsequent ACL injury rates, and activity levels between adolescent patients who underwent TEF fixation with patients with midsubstance ACL tears who required acute reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: This study included a group of patients with TEFs treated with surgical fixation matched to a group of similar patients with ACL tears treated with reconstruction between the years 2001 and 2015. Data regarding the initial injury, surgical intervention, ACL/ACL graft injury rates, and physical examination findings were recorded. Clinical and functional outcomes were obtained using a physical examination, the International Knee Documentation Committee (IKDC) subjective score, the Lysholm score, and the Tegner activity score. Results: Sixty patients with a mean follow-up of 57.7 months (range, 24-206 months) were included; 20 patients (11 male, 9 female; mean age, 11.9 years [range, 7-15 years]) who underwent surgical fixation for a TEF were matched to a group of 40 patients (23 male, 17 female; mean age, 12.5 years [range, 8-5 years]) who underwent reconstruction for ACL tears. The TEF group demonstrated significantly lower postoperative IKDC scores (TEF group, 94.0; ACL group, 97.2; P = .04) and Lysholm scores (TEF group, 92.4; ACL group, 96.9; P = .02). The TEF group returned to sport 119 days sooner (P < .01), but there was no difference in postoperative Tegner scores (TEF group, 7.3; ACL group, 7.6; P = .16). The TEF group demonstrated increased postoperative anterior laxity (P = .02) and a higher rate of postoperative arthrofibrosis (P = .04). There was no difference in subsequent ACL injuries (P = .41). Conclusion: Both groups demonstrated quality outcomes at a minimum 2-year follow-up. Patients with TEFs demonstrated lower mean clinical outcome scores compared with patients with ACL tears, but the differences were less than reported minimal clinically important difference values. Additionally, the TEF group experienced more postoperative anterior laxity and had a higher rate of postoperative arthrofibrosis. There was no difference in the rate of subsequent ACL injuries. The TEF group returned to sport sooner than the ACL group, but the postoperative activity levels were similar.
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Affiliation(s)
- Heath P Melugin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Vishal S Desai
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Todd A Milbrandt
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Diane L Dahm
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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11
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Vannabouathong C, Ayeni OR, Bhandari M. A Narrative Review on Avulsion Fractures of the Upper and Lower Limbs. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2018; 11:1179544118809050. [PMID: 30450008 PMCID: PMC6236480 DOI: 10.1177/1179544118809050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 09/16/2018] [Indexed: 11/15/2022]
Abstract
Avulsion fractures compromise function and movement at the affected joint. If
left untreated, it can lead to deformity, nonunion, malunion, pain, and
disability. The purpose of this review was to identify and describe the
epidemiology and available treatment options for common avulsion fractures of
the upper and lower extremities. Current evidence suggests that optimal
treatment is dependent on the severity of the fracture. Conservative efforts
generally include casting or splinting with a period of immobilization. Surgery
is typically indicated for more severe cases or if nonoperative treatments fail;
patient demographics or preferences and surgeon experience may also play a role
in decision making. Some avulsion fractures can be surgically managed with any
one of various techniques, each with their own pros and cons, and often there is
no clear consensus on choosing one technique over another; however, there is
some research suggesting that screw fixation, when possible, may offer the best
stability and compression at the fracture site and earlier mobilization and
return to function. Physicians should be mindful of the potential complications
associated with each intervention.
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Affiliation(s)
| | - Olufemi R Ayeni
- Department of Surgery, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
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12
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Liu J, Yue Y, Li Z. [Arthroscopic treatment of anterior cruciate ligament tibial eminence avulsion fracture with double heads compressive cannulated screw fixation in adolescents]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1172-1176. [PMID: 30129349 DOI: 10.7507/1002-1892.201803012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To discuss the effectiveness of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture in adolescents by using double heads compressive cannulated screw fixation. Methods Twenty-four patients with ACL tibial eminence avulsion fractures were treated by arthroscopic reduction and internal fixation with double heads compressive cannulated screw fixation between June 2014 and June 2017. There were 15 males and 9 females with an average age of 12.3 years (range, 5-18 years). The body mass index was 19.3-26.4 kg/m
2 (mean, 23.3 kg/m
2). The injury causes included traffic accident injury in 10 cases, sports injury in 8 cases, and falling injury in 6 cases. According to the Meyers-McKeever classification, there were 19 cases of type Ⅱ and 5 cases of type Ⅲa. All patients’ drawer test and pivot shift test were positive. The interval between injury and operation was 3-14 days (mean, 6.2 days). During the follow-up period, the fracture healing condition of patients were determined by X-ray examination; Lysholm score, International Knee literature Committee (IKDC) score, and Tegner score were used to evaluate the knee function. Results Primary healing of incision was obtained in all patients after operation. All the 24 patients were followed up 6-32 months (mean, 16.4 months). At 6 weeks after operation, 3 patients had difficulty in knee flexion. After the release of the knee joint by manipulation, the knee joint function recovered normally at 6 months after operation. At last follow-up, the X-ray films showed that all the fractures healed and no epiphyseal dysplasia, knee joint deformity, or leg length discrepancy occurred. The Lysholm score, IKDC score, and Tegner score were improved from preoperative 44.3±5.4, 43.7±4.4, and 3.0±1.3 to postoperative 93.1±4.3, 94.6±3.3, and 8.1±1.2, the differences were all significant (
t=25.152,
P=0.000;
t=28.634,
P=0.000;
t=13.226,
P=0.000). Conclusion The arthroscopic reduction and internal fixation with double heads compressive cannulated screw in treatment of ACL tibial avulsion fracture (Meyers-McKeever type Ⅱ and Ⅲ) in adolescents has so many advantages, such as minimal trauma, simple operation, firm fixation, little effect on the epiphyseal plate, and has a good joint function recovery.
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Affiliation(s)
- Juncai Liu
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Yongchuan Yue
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Zhong Li
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000,
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13
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Abstract
Tibial spine fractures are uncommon injuries affecting the insertion of the anterior cruciate ligament on the tibia. They typically occur in skeletally immature patients aged 8 to 14 years and result from hyperextension of the knee with a valgus or rotational force. Diagnosis is based on history, physical examination, and standard radiographs. The use of MRI can identify entrapped soft tissue that may prevent reduction. Open or arthroscopic repair is indicated in patients with partially displaced fractures (>5 mm) with one third to one half of the avulsed fragment elevated, in patients who have undergone unsuccessful nonsurgical reduction and long leg casting or bracing, and in patients with completely displaced fractures. Arthroscopy offers reduced invasiveness and decreased morbidity. Suture fixation and screw fixation have produced successful results. Suture fixation can eliminate the risk of fracture fragment comminution during screw insertion, the risk of neurovascular injury, and the need for hardware removal. Suture fixation is ideal in cases in which existing comminution prevents screw fixation.
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14
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Outcomes after arthroscopic fixation of tibial eminence fractures with bioabsorbable nails in skeletally immature patients. J Pediatr Orthop B 2018; 27:8-12. [PMID: 28368929 DOI: 10.1097/bpb.0000000000000459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this paper is to report the outcomes and any complications with arthroscopic bioabsorbable nail fixation of tibial eminence fractures in skeletally immature patients. We retrospectively reviewed all surgically treated tibial eminence fractures treated by a single surgeon and seven patients were identified with a minimum 2-year follow-up. Mean deficits of flexion and extension were minimal. Satisfactory Tegner levels, Lysholm knee scores, and International Knee Documentation Committee subjective scores were reported. Arthroscopic fixation of tibial eminence fractures with bioabsorbable nails yields satisfactory outcomes for this uncommon injury and obviates the need for future hardware removal.
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15
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Abstract
BACKGROUND Stiffness is a common complication following surgically treated tibial eminence fractures. Fractures can be addressed with either open reduction and internal fixation (ORIF) or arthroscopic reduction and internal fixation (ARIF). We sought to evaluate the effects of surgical approach and other modifiable perioperative factors on postoperative arthrofibrosis. We hypothesized that ARIF would result in a lower risk of arthrofibrosis. METHODS We retrospectively reviewed the records of all patients aged 18 years and below treated for tibial eminence fractures at our institution from 1998 to 2014. All patients were treated by either pediatric or sports fellowship-trained orthopaedic surgeons and followed until radiographic union and return of range of motion or treatment for arthrofibrosis (minimum 3 mo). RESULTS Thirty-one patients were included in our analysis, 13 in the ORIF group and 18 in the ARIF group. The groups were similar in regards to sex, age, fracture type, fixation method, and length of postoperative immobilization. However, when compared with the ORIF group, patients in the ARIF group had significantly longer time from injury to surgery (4.2 vs. 6.3 d, P=0.03), operative time (98 vs. 141 min, P=0.02), and tourniquet time (76 vs. 100 min, P=0.006). In the ARIF group, 6 (33.3%) patients acquired arthrofibrosis compared with only 1 (7.7%) patient in the ORIF group. Delaying surgery ≥7 days from injury [hazard ratio (HR)=4.7, P=0.04] and operative time ≥120 minutes (HR=9.1, P=0.03) were risk factors for arthrofibrosis. ARIF was a risk factor in univariate (HR=4.0, P=0.04), but not in multivariate (1.4, P=0.77) analysis. CONCLUSIONS Delayed surgery (≥7 d from injury) and prolonged operative times (≥120 min) were significant risk factors for arthrofibrosis. Although ARIF was not an independent risk factor, these patients were exposed to markedly longer wait times before surgery and operative times when compared with ORIF patients. ORIF is a reasonable option for treatment of displaced tibial eminence fractures. Surgeons should approach tibial eminence fractures with whichever mode they can accomplish with higher efficiency. LEVEL OF EVIDENCE Level III-therapeutic study.
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16
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Tang HC, Chen IJ, Yeh YC, Weng CJ, Chang SS, Chen ACY, Chan YS. Correlation of parameters on preoperative CT images with intra-articular soft-tissue injuries in acute tibial plateau fractures: A review of 132 patients receiving ARIF. Injury 2017; 48:745-750. [PMID: 28190582 DOI: 10.1016/j.injury.2017.01.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/25/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Tibial plateau fractures often occur in conjunction with soft-tissue injuries of knees. The hypothesis of this study is that parameters of CT imaging can predict intra-articular soft-tissue injuries. PATIENTS AND METHODS Patients who underwent arthroscopically assisted reduction and internal fixation (ARIF) for acute tibial plateau fractures performed by a single orthopedic surgeon between 2005 and 2015 were included in this retrospective study. Patients with concomitant ipsilateral femoral fractures, who had received revision surgery or who had undergone index surgery more than 30days from the event were excluded. We measured lateral plateau depression and widening, medial plateau depression and displacement, and column involvement observed on preoperative CT scans. Intra-articular soft-tissue injuries were diagnosed based on findings from knee arthroscopy. The correlation of imaging parameters with soft-tissue injuries was analyzed by the area under a receiver operating characteristic (AUROC) curve and multivariate logistic regression. RESULTS One-hundred and thirty-two patients were enrolled in the study. The average age was 45.7±13.1 years (range: 18-75 years). Lateral tibial plateau depressions >11mm were significantly associated with increased risk of lateral meniscus tears (p=0.001). However, there was no significant threshold of lateral tibial plateau widening that could be used to predict lateral meniscus tear. Greater risk of anterior cruciate ligament (ACL) avulsion fracture was observed in younger patients, patients with high-energy-pattern tibial plateau fractures, patients with fractures involving anteromedial or posterolateral columns, and patients with medial tibial plateau displacement >3mm (p<0.05). CONCLUSION Measuring lateral tibial plateau depression and column involvement on preoperative CT scans can help predict a higher risk of lateral meniscus tear and ACL avulsion fracture respectively in patients with acute tibial plateau fractures.
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Affiliation(s)
- Hao-Che Tang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - I-Jung Chen
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Orthopaedic Surgery, Division of Sports Medicine Section, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Cheng Yeh
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Orthopaedic Surgery, Division of Sports Medicine Section, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chun-Jui Weng
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Orthopaedic Surgery, Division of Sports Medicine Section, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shih-Sheng Chang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Orthopaedic Surgery, Division of Sports Medicine Section, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Alvin Chao-Yu Chen
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Orthopaedic Surgery, Division of Sports Medicine Section, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yi-Sheng Chan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Orthopaedic Surgery, Division of Sports Medicine Section, Chang Gung Memorial Hospital, Linkou, Taiwan.
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17
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Osti L, Buda M, Soldati F, Del Buono A, Osti R, Maffulli N. Arthroscopic treatment of tibial eminence fracture: a systematic review of different fixation methods. Br Med Bull 2016; 118:73-90. [PMID: 27151952 PMCID: PMC5127426 DOI: 10.1093/bmb/ldw018] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Arthroscopy procedures are the gold standard for the management of tibial spine avulsion. This review evaluates and compares different arthroscopic treatment options for tibial spine fractures. SOURCE OF DATA PubMed, Medline, Ovid, Google Scholar and Embase databases were systematically searched with no limit regarding the year of publication. AREAS OF AGREEMENT An arthroscopic approach compared with arthrotomy reduces complications such as soft-tissue lesions, post-operative pain and length of hospitalization. AREAS OF CONTROVERSY The use of suture techniques, compared to cannulated screw technique, avoids a second surgery for removal of the screws, but requires longer immobilization and partial weight bearing. GROWING POINTS Clinical outcomes and radiographic results do not seem to differ in relation to the chosen method of fixation. AREAS TIMELY FOR DEVELOPING RESEARCH Further studies are needed to produce clear guidelines to define the best choice in terms of clinical outcomes, function and complications.
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Affiliation(s)
- Leonardo Osti
- Unit of Arthroscopy and Sports Medicine, Hesperia Hospital, Via Arquá', Modena, Italy
| | - Matteo Buda
- Department of Orthopedic and Traumatology, University of Ferrara, Via Aldo Moro, Italy
| | - Francesco Soldati
- Department of Orthopedic and Traumatology, University of Ferrara, Via Aldo Moro, Italy
| | - Angelo Del Buono
- Department of Orthopedic and Trauma Surgery, Ospedale Vaio, Fidenza, Italy
| | - Raffaella Osti
- Department of Orthopedic and Traumatology, University of Ferrara, Via Aldo Moro, Italy
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, University of Salerno, Italy Centre for Sports and Exercise Medicine Queen Mary University of London Barts and The London School of Medicine and Dentistry , Mile End Hospital London, UK
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18
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Abstract
PURPOSE OF REVIEW Although tibial eminence fractures are uncommon, their importance cannot be overemphasized in skeletally immature patients because of the fracture's close proximity to both the tibial physis as well as the attachment between the tibial eminence and the anterior cruciate ligament, the latter being a key component in maintaining knee stability. This review focuses on recent trends in treatment concepts and devices. RECENT FINDINGS Recent literature on this topic addresses the existence of a variety of treatment modalities, but the majority of these articles analyzed a limited number of cases and insisted on the merits of their own methods. Nevertheless, some consensus has been reached regarding treatment direction and how much laxity should be considered acceptable. SUMMARY Although the review failed to reveal a gold standard modality in treating tibial eminence fractures, most studies agreed on several issues. Displaced intra-articular fractures should be fixed operatively.
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19
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Ezechieli M, Schäfer M, Becher C, Dratzidis A, Glaab R, Ryf C, Hurschler C, Ettinger M. Biomechanical comparison of different fixation techniques for reconstruction of tibial avulsion fractures of the anterior cruciate ligament. INTERNATIONAL ORTHOPAEDICS 2013; 37:919-23. [PMID: 23456017 DOI: 10.1007/s00264-013-1835-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 02/14/2013] [Indexed: 01/29/2023]
Abstract
PURPOSE The most common fixation techniques for tibial avulsion fractures of the anterior cruciate ligament (ACL) described in the literature are screw and suture fixation. The fixation of these fractures with the TightRope® device might be an alternative. Up to now it has been commonly used in other injuries, such as acromioclavicular joint or syndesmosis ruptures. The purpose of this study was to evaluate the biomechanical properties of different fixation techniques for the reconstruction of tibial avulsion fractures. METHODS Type III tibial avulsion fractures were simulated in 40 porcine knees. Each specimen was randomly assigned to one of four groups: (1) anterograde screw fixation, (2) suture fixation, (3) TightRope® fixation or (4) control group. The initial displacement, strength to failure and the failure mode were documented. RESULTS The maximum load to failure was 1,345 ± 155.5 N for the control group, 402.5 ± 117.6 N for the TightRope® group, 367 ± 115.8 N for the suture group and 311.7 ± 120.3 N for the screw group. The maximum load to failure of the control group was significantly larger compared to all other groups. The initial dislocation was 0.28 ± 0.09 mm for the control group, 0.55 ± 0.26 mm for the TightRope® group, 0.84 ± 0.15 mm for the screw group and 1.14 ± 0.9 mm for the suture group. The initial dislocation was significantly larger for the suture group compared to the TightRope® and control groups. CONCLUSIONS The TightRope® fixation shows significantly lower initial displacement compared to the suture group. The TightRope® fixation might be an alternative for the repair of ACL tibial avulsion fractures that can be used arthroscopically.
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Affiliation(s)
- Marco Ezechieli
- Department of Orthopaedic Surgery, Hannover Medical School (MHH), Anna-von-Borries-Strasse 1-7, 30625, Hannover, Germany
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