Clinical and radiological outcomes of arthroscopically assisted cannulated screw fixation for tibial eminence fracture in children and adolescents

Abstract

BackgroundThe purpose of this study was to determine the efficacy and complications of arthroscopically assisted reduction and fixation with cannulated screws for tibial eminence fracture in skeletally immature patients.MethodsThis was a retrospective case series study. Forty-eight patients who were skeletally immature at the time of tibial eminence fracture were treated in a tertiary children’s hospital between May 2004 and August 2015. Twenty-one patients were excluded due to non-operative treatment (n = 10), other surgical treatments (n = 9), multiple fracture (n = 1), and follow-up < 1 year (n = 1). Twenty-seven knees of 27 patients were analyzed. Avulsed fragment was reduced arthroscopically. One to three cannulated screws (4.0 mm or 5.0 mm in diameter) were used for fixation. Passive knee motion was started in 3–4 weeks. Clinical outcomes were evaluated by Lysholm score, instability of the knee, and complications. Radiological outcomes including nonunion and malunion of the avulsed fragment and physeal growth disturbance were evaluated.ResultsMean age at the time of surgery was 10.1 years (range, 6.2 to 13.8 years). Patients were followed up for a mean of 3.9 years (range, 1.0 to 7.6 years). Fracture types included type III (n = 13), type II (n = 12), and type IV (n = 2) according to Zaricznyj modification of Meyers and McKeever classification. Meniscus was entrapped in five patients. Six patients showed concomitant meniscal tear. Mean Lysholm score at the latest follow-up was 95 (range, 78 to 100). Joint instability was not observed in any patient except one (instability of 5–10 mm). All patients showed full range of knee motion except one (10 degrees of flexion contracture). Screw head impingement against intercondylar notch of the femur was observed in two patients during screw removal procedure. Five knees showed prominent tibial eminence without symptoms. The injured lower limb was longer than the contralateral normal side by a mean of 6.2 mm (range, − 4 to 18 mm).ConclusionsArthroscopically assisted reduction and fixation with cannulated screws is an effective and safe surgical option for treating tibial eminence fracture with few complications.

Suture Versus Screw Fixation of Tibial Spine Fractures in Children and Adolescents: A Comparative Study

“…We had 17 concomitant meniscal injuries in 15 (22%) patients in our patient cohort. A recent study 20 found a similar 22% incidence of meniscal tear at the time of tibial spine avulsion repair in a smaller number of overall patients. However, a prior study found concurrent meniscal injury to be as low as 3.8%.…”

“…22 However, an outcome comparison study determined that arthroscopic screw fixation yielded significantly better IKDC scores, lower incidence of postoperative glide pivot shift, and shorter operative times in comparison with suture fixation. 16 A recent study 20 has also determined that screw fixation was an effective method for treatment of tibial spine avulsion fractures with good clinical outcomes and few complications, although 100% of patients in the study (n = 27) underwent planned reoperations for hardware removal. A prior study 23 has also described a notable occurrence (5/13; 38%) of postoperative stiffness with suture fixation of tibial spine avulsion fractures, albeit this was in a young adult population in a small cohort of patients.…”

“…As previously stated, we noted no difference between our 2 groups in the development of postoperative contracture as defined by Fabricant et al 5 (24% suture vs 31% screw fixation). A recent study 20 reported only a 4% incidence (1/27 patients) of postoperative contracture with screw fixation, which was defined as 1 patient with a 10-degree flexion contracture. Another study 17 reported only a 8% incidence (2/26 patients) of contracture after arthroscopic suture fixation, which was documented as 1 patient with a 40-degree loss of extension and 1 patient with a 10-degree flexion contracture.…”

Treatment of Anterior Cruciate Ligament Tibial Avulsion Fracture in Children with Suture Anchor Fixation Outside The Tunnel: A Retrospective study

“…were found in the affected limb; thus, the clinical outcome was satisfactory. The key points of this technique are as follows: (1) synovial tissue and hematoma surrounding the fracture were debrided, and the bone bed was freshened to avoid affecting fracture reduction; (2) xation was performed using ACL tibial xators, with the anterior and medial edges of the fracture as the chosen xation sites. Fine Kirschner wires were used to establish the tunnels, and sutures were guided through the tunnels.…”

“…In adult patients, ACL tibial fractures are currently treated using cannulated screws, suture anchors, steel wires, high-strength sutures, and absorbable screws, with a satisfactory therapeutic e cacy in clinical reports. [2][3][4][5] However, as children are still growing and developing, and their treatment principles differ from those of adults, special techniques in fracture reduction and xation, with the aim of avoiding iatrogenic injuries to the epiphysis during surgery when possible, need to be developed. The suture binding technology is widely used for ACL tibial avulsion fracture at present.…”