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

Callanan, Mark; J, Allen; Flutie, Brett; Tepolt, Francis; Miller, Patricia E.; Kramer, Dennis E.; Kocher, Mininder S.

doi:10.1177/2325967119881961

Cited by 51 publications

(92 citation statements)

References 24 publications

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“…This finding could be affected by the small cohort. Nonetheless other studies with large cohorts showed no differences regarding postsurgical arthrofibrosis, instability, range of motion and return to sport [ 10 ]. Furthermore, in our practice, we usually plan prophylactical hardware removal in children, which is not needed in the case of bone suture.…”

Section: Discussionmentioning

confidence: 96%

“…Finally, only 55% patients accepted to be tested with arthrometers. This is an important drawback in our analysis but is a common issue even in other studies investigating this uncommon injury, where loss to follow-up ranged from 17% to 76% [ 10 , 11 , 12 , 37 ]. However, we believe that no significantly different knee laxity is to be detected between children who were tested and children who were not tested, since we did not find any difference in terms of clinical outcomes.…”

Section: Discussionmentioning

confidence: 98%

“…Among the latter, arthrofibrosis is the most frequently reported complication in surgical treatment, while higher rates of malunion or non-union have been described after conservative management. Residual knee laxity has been described after both surgical and nonsurgical management of TSA, but is not always symptomatic [ 5 , 6 , 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Good Subjective Outcomes, Stable Knee and High Return to Sport after Tibial Eminence Avulsion Fracture in Children

et al. 2020

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Avulsion fracture of the tibial spine (TSA) is uncommon in children, although its incidence is increasing with the earlier practice of competitive sport activities. This study aims to report mid to long term outcomes in children who sustained a TSA, with a special focus on a return to sport activities. Skeletally immature patients with a TSA, treated in two orthopedic hospitals, were evaluated for range of motion and knee laxity using KT1000, KiRA and Rolimeter. The pediatric International Knee Documentation Committee score (Pedi-IKDC) and the Hospital for Special Surgery pediatric Functional Activity Brief Scale (Pedi-FABS) questionnaires were recorded during the latest visit. Forty-two children were included. Twenty-six were treated nonoperatively and 16 underwent surgery. At a mean follow-up of 6.9 ± 3.6 years, 36 patients completed the questionnaires and 23 patients were tested with arthrometers. Among them, 96% had normal knee laxity. The Pedi-IKDC score averaged 96.4 ± 5.7 points, while the mean Pedi-FABS was 22.2 ± 5.9 points, without statistically significant differences between groups. Twenty-eight patients (78%) returned to their previous level of sport activity (eight amateur, 13 competitive, seven elite athletes). Eight patients (22%) quit sport, mostly because of re-injury fear. If properly treated, pediatric TSAs achieve a high rate of successful healing, with complete restoration of knee stability and an early return to sport activities.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Good Subjective Outcomes, Stable Knee and High Return to Sport after Tibial Eminence Avulsion Fracture in Children

et al. 2020

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“…The current literature demonstrates successful outcomes for surgical patients treated with open reduction and internal fixation (ORIF) and those treated with arthroscopic reduction and internal fixation (ARIF), and clinical outcomes are comparable for fractures treated with sutures and screws. 2,3,6 ORIF allows for direct visualization of the fracture. ARIF, while requiring additional knowledge of arthroscopic techniques, adds the benefit of being minimally invasive and allows the surgeon to perform a more complete intra-articular assessment of the knee.…”

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confidence: 99%

Tibial Spine Fractures: How Much Are We Missing Without Pretreatment Advanced Imaging? A Multicenter Study

et al. 2020

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Background: There is a high rate of concomitant injuries reported in pediatric patients with tibial spine fractures, ranging from 40% to 68.8%. Many tibial spine fractures are treated without initial magnetic resonance imaging (MRI). Purpose: To understand rates of concomitant injury and if the reported rates of these injuries differed among patients with and without pretreatment MRI. Study Design: Cross-sectional study; level of evidence, 3. Methods: We performed an institutional review board–approved multicenter retrospective cohort study of patients treated for tibial spine fractures between January 1, 2000, and January 31, 2019, at 10 institutions. Patients younger than 25 years of age with tibial spine fractures were included. Data were collected on patient characteristics, injury, orthopaedic history, pretreatment physical examination and imaging, and operative findings. We excluded patients with multiple trauma and individuals with additional lower extremity fractures. Patients were categorized into 2 groups: those with and those without pretreatment MRI. The incidence of reported concomitant injuries was then compared between groups. Results: There were 395 patients with a tibial spine fracture who met inclusion criteria, 139 (35%) of whom were reported to have a clinically significant concomitant injury. Characteristics and fracture patterns were similar between groups. Of patients with pretreatment MRI, 79 of 176 (45%) had an identified concomitant injury, whereas only 60 of 219 patients (27%) without pretreatment MRI had a reported concomitant injury ( P < .001). There was a higher rate of lateral meniscal tears ( P < .001) in patients with pretreatment MRI than in those without. However, there was a higher rate of soft tissue entrapment at the fracture bed ( P = .030) in patients without pretreatment MRI. Overall, 121 patients (87%) with a concomitant injury required at least 1 treatment. Conclusion: Patients with pretreatment MRI had a statistically significantly higher rate of concomitant injury identified. Pretreatment MRI should be considered in the evaluation of tibial spine fractures to improve the identification of concomitant injuries, especially in patients who may otherwise be treated nonoperatively or with closed reduction. Further studies are necessary to refine the indications for MRI in patients with tibial spine fractures, determine the characteristics of patients at highest risk of having a concomitant injury, define the sensitivity and specificity of MRI in tibial spine fractures, and investigate patient outcomes based on pretreatment MRI status.

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“…However, slippage of the sutures may occur to different degrees during knee exion and extension, which may cause cutting to the tunnel, thereby preventing early functional recovery. 14,15 Internal xation with suture anchors is one of the surgical approaches for treating ACL tibial avulsion fracture. In et al used intraarticular suture anchors to x the fractured bone and obtained a satisfactory clinical e cacy.…”

Section: E Cacy Evaluationmentioning

confidence: 99%

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

Chen

Xiao

Wang

2020

Preprint

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Background: Anterior cruciate ligament (ACL) tibial avulsion fractures are a special ACL injury type, classified as intra-articular fractures. Presently, the main treatment method is arthroscopic surgery, and various fixation methods are available, including use of steel wires, high-strength sutures, cannulated screws, anchors, Kirschner wires, etc. Joint fixation using wire binding could cut through the bone tunnel. We aimed to evaluate the clinical efficacy of a novel method involving suture anchor fixation outside the tunnel to treat anterior cruciate ligament (ACL) tibial avulsion fractures in children.Methods: This retrospective study analyzed the data of 42 pediatric patients (26 boys and 16 girls; age: 7–13 years) with ACL tibial avulsion fractures. Based on the Meyers–McKeever–Zaricznyj classification of fractures, 22, 14, and 6 patients had types II, III, and IV fractures, respectively. All patients underwent arthroscopic surgery for ACL tibial avulsion fracture; during surgery, double tibial tunnels were established, and high-strength sutures were passed through the tunnels and fixed externally with an anchor. The clinical outcome was evaluated by assessing the pre- and post-operative knee joint range of motion (ROM) and by using the Lysholm knee function score and International Knee Documentation Committee (IKDC) score. Post-operative computed tomography and magnetic resonance images were reviewed to determine the status of fracture displacement, healing, and epiphyseal damage.Results: All 42 patients were followed up for 20–36 months (average of 27.8 months). Knee ROM increased from 48.2°±21.7° pre-operatively to 131.6°±8.7° at the final follow-up (t=23.119, P=0.000). The Lysholm knee function score increased from 37.6±5.2 points pre-operatively to 90.1±6.3 points post-operatively, representing a significant improvement (t=41.651, P=0.000). The IKDC score improved from 43.3±7.5 points pre-operatively to 91.3±5.7 points post-operatively (t=45.521, P=0.000). The imaging findings indicated that the fractures healed with displacement and there was no significant epiphyseal damage.Conclusions: Suture anchor fixation outside the tunnel to treat ACL tibial avulsion fracture in children reduces the cutting action of the sutures on the tunnel, minimizes epiphyseal damage, involves a simple procedure, offers firm fixation, and effectively improves knee function. This approach can enable early functional rehabilitation and achieve satisfactory clinical efficacy.

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

Cited by 51 publications

References 24 publications

Good Subjective Outcomes, Stable Knee and High Return to Sport after Tibial Eminence Avulsion Fracture in Children

Good Subjective Outcomes, Stable Knee and High Return to Sport after Tibial Eminence Avulsion Fracture in Children

Tibial Spine Fractures: How Much Are We Missing Without Pretreatment Advanced Imaging? A Multicenter Study

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

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