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

Mah, Jung Y.; Otsuka, Norman Y.; McLean, Jean

doi:10.1097/01241398-199601000-00024

Cited by 32 publications

(7 citation statements)

References 7 publications

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“…For suture fixation (groups 1 and 3), the physeal-sparing, transepiphyseal technique described by Mah et al 30 was used. Fracture fragments were manually reduced, and a 1.25-mm thread-tip guide wire was inserted into the anterolateral portion of the fragment for provisional fixation.…”

Section: Methodsmentioning

confidence: 99%

“…In skeletally immature children, avoiding the physis during fixation of tibial eminence fractures has been advocated to minimize the risk of iatrogenic growth disturbance. # Although physeal-sparing fixation techniques have been described in the literature, including the use of all-epiphyseal screws, 6,23 transepiphyseal sutures, 30 and all-epiphyseal suture anchors, 20,27,33,51 the best method of fixation has not been determined. Biomechanical studies have determined the fixation properties of non-physeal-sparing techniques**; however, there are no published studies comparing techniques for physeal-sparing fixation.…”

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confidence: 99%

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Biomechanical Evaluation of Physeal-Sparing Fixation Methods in Tibial Eminence Fractures

et al. 2013

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

Biomechanical Evaluation of Physeal-Sparing Fixation Methods in Tibial Eminence Fractures

et al. 2013

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“…For knees assigned to suture fixation, a tibial ACL guide (Arthrex) and 2.4-mm drill-tip guide wire were used to drill 2 medial-entry bony tunnels spaced 1 cm apart and 1 cm distal to the articular surface of the medial tibial plateau, as described in previous studies. 2,22 Bony tunnels exited into both the medial and lateral base of the manually reduced fracture fragment. Drill exit holes at the level of the ACL insertion into the fracture fragment were consistently 1 cm apart and straddled the anteromedial ACL bundle.…”

Section: Methodsmentioning

confidence: 99%

Screws or Sutures? A Pediatric Cadaveric Study of Tibial Spine Fracture Repairs

Johnstone,

Baird,

Cuellar-Montes

et al. 2023

Am J Sports Med

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Background: Tibial spine fractures are common in the pediatric population because of the biomechanical properties of children’s subchondral epiphyseal bone. Most studies in porcine or adult human bone suggest that suture fixation performs better than screw fixation, but these tissues may be poor surrogates for pediatric bone. No previous study has evaluated fixation methods in human pediatric knees. Purpose: To quantify the biomechanical properties of 2-screw and 2-suture repair of tibial spine fracture in human pediatric knees. Study Design: Controlled laboratory study. Methods: Cadaveric specimens were randomly assigned to either 2-screw or 2-suture fixation. A standardized Meyers-Mckeever type 3 tibial spine fracture was induced. Screw-fixation fractures were reduced with two 4.0-mm cannulated screws and washers. Suture-fixation fractures were reduced by passing 2 No. 2 FiberWire sutures through the fracture fragment and the base of the anterior cruciate ligament. Sutures were secured through bony tunnels over a 1-cm tibial cortical bridge. Each specimen was mounted at 30° of flexion. A cyclic loading protocol was applied to each specimen, followed by a load-to-failure test. Outcome measures were ultimate failure load, stiffness, and fixation elongation. Results: Twelve matched pediatric cadaveric knees were tested. Repair groups had identical mean (8.3 years) and median (8.5 years) ages and an identical number of samples of each laterality. Ultimate failure load did not significantly differ between screw (mean ± SD, 143.52 ± 41.9 7 N) and suture (135.35 ± 47.94 N) fixations ( P = .760). Screws demonstrated increased stiffness and decreased elongation, although neither result was statistically significant at the .05 level (21.79 vs 13.83 N/mm and 5.02 vs 8.46 mm; P = .076 and P = .069, respectively). Conclusion: Screw fixation and suture fixation of tibial spine fractures in human pediatric tissue were biomechanically comparable. Clinical Relevance: Suture fixations are not biomechanically superior to screw fixations in pediatric bone. Pediatric bone fails at lower loads, and in different modes, compared with adult cadaveric bone and porcine bone. Further investigation into optimal repair is warranted, including techniques that may reduce suture pullout and “cheese-wiring” through softer pediatric bone. This study provides new biomechanical data regarding the properties of different fixation types in pediatric tibial spine fractures to inform clinical management of these injuries.

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“…Besides several types of different screws [5,28,30,34], wires [26] and folded surgical steels [7] sutures [3,19,21,35] were used.…”

Section: Introductionmentioning

confidence: 99%

“…To date a variety of open and arthroscopic reduction and refixation techniques have been described. Besides several types of different screws [5, 28, 30, 34], wires [26] and folded surgical steels [7] sutures [3, 19, 21, 35] were used.…”

Section: Introductionmentioning

confidence: 99%

Physeal sparing arthroscopic fixation of displaced tibial eminence fractures: a new surgical technique

Hirschmann

Mayer

Kentsch

et al. 2009

Knee Surg Sports Traumatol Arthrosc

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We describe a novel physeal sparing arthroscopic technique for anatomic suture refixation of tibial eminence fractures and assess the mid-term results of six consecutive patients (McKeever type II n = 2, III n = 3 and IV n = 1). The mean follow-up was 5 +/- 2 years. Five of six patients were painfree. All patients returned to their preinjury sport level. Mean passive ipsilateral and contralateral flexion was 143 degrees +/- 5 degrees. The IKDC score was A in five and B in one patients. The mean Lysholm score was 97 +/- 3%. The median Tegner score was 8 (range 6-9) preinjury and at follow-up. The mean Total Knee Society score was 197 +/- 4 points. ACL laxity (KT-1000 134 N) showed a side-to-side difference of 2 +/- 2 mm. Two of six patients underwent a tibial screw removal under local anaesthesia. No loss of reduction or grossly physeal disturbance was observed. The reported surgical technique showed excellent to good clinical and radiological results and may be a physeal sparing alternative to previously described procedures.

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

Cited by 32 publications

References 7 publications

Biomechanical Evaluation of Physeal-Sparing Fixation Methods in Tibial Eminence Fractures

Biomechanical Evaluation of Physeal-Sparing Fixation Methods in Tibial Eminence Fractures

Screws or Sutures? A Pediatric Cadaveric Study of Tibial Spine Fracture Repairs

Physeal sparing arthroscopic fixation of displaced tibial eminence fractures: a new surgical technique

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