Delayed Anterior Cruciate Ligament Reconstruction in Young Patients With Previous Anterior Tibial Spine Fractures

Abstract

Although an ATSF is a relatively rare injury, our cohort of patients suggests that a subset of young patients with all types of tibial spine fractures will require later ACL reconstruction. There is a need to counsel patients that a delayed ACL rupture is a potential risk after an ATSF, especially as children approach skeletal maturity. Further patient follow-up and prospective studies are required.

Tibial Spine Fractures in Children: Evaluation, Management, and Future Directions

“…Additionally, 50% of the patients who required ACL reconstruction had a sportsrelated cause of ACL failure. 110 This underscores the impor-tance of counseling patients regarding delayed ACL rupture as a potential complication after anterior tibial spine fracture.…”

Unique simultaneous avulsion fracture of both the proximal and distal insertion sites of the anterior cruciate ligament

“…The boy showed excellent recovery at the final follow-up and the prognosis was deemed good, without any particular concerns about future deficiency. It has been reported that the ACL could still have been stretched beyond its physiological properties at the time of injury, although no evident rupture of the ligament could be seen, 19 which could possibly cause persistent instability, even if the fracture healed well. A recent study showed that approximately one-fifth of patients required a delayed ACL reconstruction after suffering a tibial eminence fracture.…”

“…A recent study showed that approximately one-fifth of patients required a delayed ACL reconstruction after suffering a tibial eminence fracture. 19 Similarly, a meta-analysis of studies reporting the incidence of residual laxity following tibial eminence fractures revealed that approximately one-fifth of patients with types I and II fractures had a positive Lachman test after treatment. However, a positive Lachman test was three times more frequent in patients with types III or IV fractures, where the majority reported having a positive test.…”

Traumatic knee pain in a child

“…This may be evidenced on clinical follow-up; however, there is generally little subjective instability 9. In a subset of patients, the stretching may make the ligament prone to delayed rupture, particularly as the juvenile patient reaches skeletal maturity 10. Because of this, surgeons might occasionally “over-reduce the fracture” at the time of surgery by countersinking the fragment and fixing it below its original position, thereby compensating for possible ligament elongation.…”