Tibial Spine Fractures in Young Athletes

Cruz, Aristides I.; Lee, Rushyuan Jay; Kushare, Indranil; Baghdadi, Soroush; Green, Daniel W.; Ganley, Theodore J.; Ellis, Henry B.; Mistovich, R. Justin

doi:10.1016/j.csm.2022.05.006

Cited by 10 publications

(10 citation statements)

References 51 publications

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“…The extension (or lack thereof) of the fracture bed into the weightbearing surfaces of the tibial plateau was marked as seen on coronal slices (Figure 1). The weightbearing surface was defined by (1) fractures between the anterior and posterior horns of the meniscus on the sagittal view and (2) fractures lateral or medial to the outer margin of the tibial eminence. 7 Patients with imaging obtained in the original data pull who were excluded due to not having a TSF were used as controls for measurement of the ACL insertion.…”

Section: Methodsmentioning

confidence: 99%

“…5 TSFs are typically secondary to trauma or sports injuries in pediatric patients 2 ; the incidence of TSFs is estimated at approximately 3 per 100,000 per year, and they account for 2% to 5% of adolescent knee arthrosis. These fractures typically occur around age 11 to 12 years, 1 and they have been found to more commonly occur in pediatric patients with wider tibial eminences and underdeveloped intercondylar notches. 4,8,12 The mechanism of injury is typically similar to the one that causes ACL tears in adults, in which the tensile force applied to the cruciate ligament results in intrasubstance lesion.…”

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Extension of Tibial Spine Fractures Beyond the Tibial Spine: An MRI Analysis of 54 Patients

et al. 2023

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Background: To the authors’ knowledge, no previous study has thoroughly described the anteroposterior dimensions of tibial spine fractures (TSFs) on 3-dimensional imaging. The extension of TSFs into weightbearing regions of the tibial plateau, posterior extension within the epiphysis, and potential association between fracture size and patient age may have implications for treatment strategies and clinical outcomes. Hypothesis: TSF fragments would commonly involve weightbearing regions of the tibial plateau, would be larger in younger patients, and would extend more posteriorly than the anatomic footprint of the tibial spine. Study Design: Case series; Level of evidence, 4. Methods: Consecutive magnetic resonance imaging studies obtained between 2012 and 2020 in patients 5 to 18 years of age at the time of imaging for TSFs were included, measured, and classified via the Green and Tuca grading system. Anteroposterior fracture dimensions were measured and normalized to anteroposterior midepiphyseal length, as was fracture height to epiphyseal height. Extension into the weightbearing surface of the tibial plateau was recorded. Intraclass correlation coefficient and kappa values were calculated. Mean fracture bed size was compared using independent-samples t tests between older and younger patients based on median age and sex. Results: Of 54 TSFs, 1 (2%), 28 (52%), and 25 (46%) were grades 1, 2, and 3, respectively. Fracture beds spanned 45% of the anteroposterior midepiphysis, and 54% of the TSF beds extended to the posterior third of the epiphysis. Younger and female patients, on average, had larger anteroposterior dimensions to TSF beds ( P = .018 and .006, respectively). The medial and lateral weightbearing surfaces of the tibial plateau were affected 57% and 25% of the time, respectively. Conclusion: This study demonstrated that TSF beds were larger in younger patients, extended to the posterior third of the epiphysis in 54% of cases, and should be examined carefully for extension into weightbearing regions of the tibial plateau. In pediatric patients, the TSF often involves more of the tibial plateau than the anatomic footprint of the tibial spine, and clinicians should be aware of the potential for extension posteriorly and into the weightbearing surfaces.

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Section: Methodsmentioning

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Extension of Tibial Spine Fractures Beyond the Tibial Spine: An MRI Analysis of 54 Patients

et al. 2023

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“…Unfortunately, the above literature did not provide a clear answer regarding which fixation technique has the best efficacy, but we can consider it in the context of knee fibrosis, which is the most common postoperative complication ( 5 ). The Tibial Spine Research Interest Group showed that the risk factors for arthrofibrosis include prolonged braking time after surgery, combined ACL injury, age younger than 10 years, more severe injury, delayed time from injury to surgery, and screw fixation (compared to suture fixation) ( 43 ). Therefore, the optimal approach should be easy, strong, and less prone to epiphyseal damage technique, which would reduce operative time and immobilization time, or even eliminate the need for immobilization postoperatively.…”

Section: Comparison Of Different Fixation Techniquesmentioning

confidence: 99%

Arthroscopic fixation techniques for tibial eminence fractures in pediatric patients: a review

Li,

Huang,

Yang

et al. 2024

Front. Pediatr.

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The introduction of new internal fixation devices and arthroscopic techniques has led to significant changes in the surgical treatment of tibial eminence fractures (TEFs) in children. In recent years, arthroscopic surgery has arisen as the gold standard for the treatment of TEFs. This popularity of arthroscopic techniques has reduced surgical complications and improved patient prognosis. In this paper, we investigate the current situation of the use of arthroscopic fixation techniques for pediatric TEFs. We searched the PubMed database using the terms “arthroscopic treatment and tibial eminence,” “arthroscopic treatment and tibial spine,” “tibial eminence avulsion”, “tibial spine fracture”, with no limit on the year of publication. From these articles, we reviewed the use of various arthroscopic TEFs fixation techniques reported in the current literature. Overall, we found that the choice of fixation method seems to have no effect on clinical outcomes or imaging results. However, if an easy, strong fixation that is less prone to epiphyseal damage is desired, as a junior practitioner, the anchor technique should be mastered first, whereas for senior practitioners, a variety of fixation techniques for TEFs should be mastered, including anchors, sutures, and screws, so that personalized fixation can be achieved with the least amount of trauma, operative time, and complications. Higher quality studies are needed in the future to provide Useful evidence to determine the optimal fixation technique in terms of clinical outcomes, function, and complications.

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“…The primary urgent indication for a young pediatric knee to undergo arthroscopy is for a septic knee. 1 Other indications may include synovectomy, such as in a target joint of a hemophiliac, synovial biopsy, treatment of patellofemoral instability, anterior cruciate ligament (ACL) tear, discoid meniscus or other symptomatic meniscus tear, reduction and fixation of a tibial imminence fracture, removal of an intra-articular foreign body or loose body, or treatment of osteochondritis dissecans or other osteochondral abnormalities. 2 One important consideration is equipment, particularly if special equipment is needed for a pediatric knee.…”

Section: Video Transcriptmentioning

confidence: 99%

Pediatric Knee Arthroscopy: The Basics of Pediatric Knee Arthroscopy from a Collection of Pediatric Sports Medicine Experts

Kirby,

Johnson,

Millewski

et al. 2023

Video Journal of Sports Medicine

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Background/Objective: To share technical pearls of a basic knee arthroscopy in a pediatric patient by presenting tips and tricks used by experienced pediatric arthroscopists. Indications: Knee arthroscopy is a common procedure performed by most orthopedic surgeons. However, technical considerations and equipment should be considered before performing this procedure in a pediatric patient. This video provides information on indications, equipment, and patient positioning, as well as outlining a systematic approach to diagnostic arthroscopy and pertinent pediatric anatomy. Discussion/Conclusion: This video provides an excellent overview as well as specific pathology-dependent considerations for the inexperienced orthopedic surgeon, or the orthopedic surgeon who rarely performs knee arthroscopy. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

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Tibial Spine Fractures in Young Athletes

Cited by 10 publications

References 51 publications

Extension of Tibial Spine Fractures Beyond the Tibial Spine: An MRI Analysis of 54 Patients

Extension of Tibial Spine Fractures Beyond the Tibial Spine: An MRI Analysis of 54 Patients

Arthroscopic fixation techniques for tibial eminence fractures in pediatric patients: a review

Pediatric Knee Arthroscopy: The Basics of Pediatric Knee Arthroscopy from a Collection of Pediatric Sports Medicine Experts

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