The arthroscopic treatment of displaced tibial spine fractures in children and adolescents using Meniscus Arrows®

Abstract

PurposeThis article summarises the results of a newly developed technique that utilises Meniscus Arrows® for the arthroscopic fixation of displaced tibial spine fractures in children and adolescents.MethodTwelve tibial spine fractures in the knees of eleven children between 6 and 15 years old, with an average age of 12 years, were arthroscopically fixed with Meniscus Arrows®, after a reduction of their fractures. This was followed by 5 weeks immobilisation in a plaster of Paris. Postoperative follow-up included radiographs, Lachmann tests on all of the children’s knees and KT-1000 tests of eight out of twelve of the children’s knees. The postoperative follow-up time ranged from 3 to 10 years, with patients being seen for an average of 4 years.ResultsAll of the fractures consolidated uneventfully, and all of the patients returned unrestricted to their previous activity level. The Lachmann tests revealed no, or a non-functional, laxity in any of the patients’ knees. The KT-1000 tests showed a difference between the operated side, and non-operated side, of between 3 mm in the first knee operated on and an average of 1 mm in the remaining knees.ConclusionThe arthroscopic fixation of tibial spine fractures using Meniscus Arrows® showed that this minimally invasive procedure resulted in the uneventful consolidation of all twelve of the fractures, with excellent results, and without the need for a second, hardware removal, operation. Level of Evidence: Level IV

Tibial eminence fractures in the paediatric population: A systematic review

“…Meniscal arrows have a diameter of 1.1 mm and, therefore, can be used for small fractures fragments and young patients [26]. …”

“…There was no differentiation in the literature between a younger and an adolescent age group. Traditionally, falling off of a bicycle has been thought to be the main mode of injury [ 3 , 5 , 11 , 19 – 26 ]. More recently, increasing modes of injury for tibial eminence fractures have been reported, including sport, motor vehicle accidents (MVA) and skiing [ 1 – 6 , 20 – 25 , 27 , 28 ].…”

“…The most common outcome scores were the International Knee Documentation Committee (IKDC), the Tegner Activity Score (TAS) and the Lysholm Knee Score (LKS) [ 1 , 5 , 6 , 9 , 10 , 14 – 16 , 20 , 21 , 23 , 27 , 30 , 32 , 35 ]. The most common objective test was the KT1000 for measuring knee laxity [ 1 , 6 , 7 , 9 , 15 , 21 , 22 , 24 , 26 – 28 , 32 , 35 ].…”

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

“…The results show that arthroscopically assisted cannulated screw fixation is an effective and safe method for tibial eminence fracture in pediatric patients. Previous studies have described that fixation with a relatively large screw, compared to the small avulsed fragment, is technically demanding and can cause comminution of the bony fragment [ 28 , 37 , 38 ]. However, this complication was not found in this study.…”

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

“…18,62 Suture-based techniques are also popular and include absorbable suture, [63][64][65] nonabsorbable suture, 14,19,20,53,[66][67][68][69][70][71][72][73][74][75] suture anchors, 74,76,77 suture bridge and cortical button constructs, [78][79][80] lasso, 81 and meniscus arrow. 82 Those who prefer metal screws report reliability and procedural simplicity. Additionally, Pan et al found that patients that underwent metal screw fixation versus suture fixation had higher International Knee Documentation Committee (IKDC) scores, less pivot-shift laxity, and shorter operative times.…”