An Arthroscopic Technique for the Reduction and Fixation of Tibial-Eminence Fractures

Abstract

A technique of arthroscopic reduction and fixation of type III tibial-eminence fractures is described. After reduction of the fracture, polyglactin (Vicryl) suture was passed into the knee with the use of the arthroscope to fix the fracture. Early mobilization of the patients was begun after 2 weeks. Two patients (aged 10 and 13 years old), with 2 years follow-up after treatment of their fracture with this technique, had full range of motion of the knee with no sign of instability. Arthroscopic reduction and fixation of type III tibial-eminence fractures is a technique that can reduce hospital stay, rehabilitation, and the morbidity associated with the use of an arthrotomy for treatment.

Tibial Eminence Fractures in Children: Prevalence of Meniscal Entrapment

“…Tibial eminence fractures are seen relatively frequently in children and were once thought to be the pediatric equivalent of midsubstance ACL tears in adults. 2,3,7,9,10,12–14,22,23,25,26…”

“…The appropriate treatment of tibial eminence fractures in children is controversial, with techniques advocated that include cast immobilization, 12,19 closed reduction with immobilization, 22,26 open reduction with immobilization, 19 open reduction with internal fixation, 20,22 arthroscopic reduction with immobilization, 16 arthroscopic reduction with suture fixation, 11–14 and arthroscopic reduction with wire 1 or screw fixation. 3,12,16…”

Laparoscopic Suturing Using the ‘Looped Knot’

“…Arthroscopic screw or suture fixation of tibial spine fractures proves difficult, with a steep learning curve. [3][4][5] We suggest a technique, which is quick, effective and simple. Although we identified no such problems, previous reports of suture anchor failure must be noted and caution taken with this approach.…”

Hybrid Fixation of Tibial Eminence Fractures in Skeletally Immature Patients

“…6 Several arthroscopic techniques have been reported in the literature that use various means for fixation such as metal screws, [12][13][14][15][16][17] staples, 18 K-wires 6,19 and sutures only, 18,[21][22][23][24][25]33 and anchors only. 28,29 Success in treating tibial eminence fractures is dependent on secure fixation, which can allow for early postoperative knee mobilization, decreased risk of arthrofibrosis, and a more rapid return to full activity.…”

“…For markedly displaced fractures, immediate anatomic reduction and fixation of the fragments are generally recommended to allow early return to range of motion and prevent arthrofibrosis. 10,11 Several arthroscopic techniques have been reported, such as metal screw fixation, [12][13][14][15][16][17] staple fixation, 18 K-wire fixation, 6,19,20 suture fixation, 18,[21][22][23][24][25][26][27] and anchor fixation. 28,29 However, a number of these techniques violate the growth plate, and in the case of metal screw fixation, retained hardware can result in the need to reoperate to remove hardware.…”