Tibial tubercle fractures are sports injuries in male adolescents with a considerable risk of complications and reoperations: a systematic review

Abstract

Purpose There is growing interest in tibial tubercle fractures in pediatric and adolescent population within the last decade. However, there is limited evidence in the existing literature. Therefore, the purpose of this systematic review was to analyze and provide up-to-date data that may prove valuable in decision making and management of these injuries in the general as well as the athletic population. Methods A systematic review of the literature in PubMed, Cochrane library and Virtual Health Library was conducted using the "Preferred Reporting Items for Systematic Reviews and Meta-Analysis" (PRISMA) guidelines. Articles published in English or Spanish, during the past 20 years, reporting outcomes of tibial tubercle fracture management in patients younger than 18 years old, with a mean follow-up of at least 6 months reporting outcomes, type of management and classiication were included. Results A total of 919 patients with 956 fractures in 25 retrospective cohort studies were included. The mean age was 14.4 ± 0.6 years while 766 [83%] were males and 740 [81%] of the injuries were sports-related. Associated injuries were reported in 91[10%] cases, most common being patellar tendon avulsion. Surgical management was chosen for 845[88%] of the cases, the vast majority being open reduction internal ixation (ORIF) with screws. Union was achieved in 954 [99.8%] cases. Complications and re-operations rate stood at 172[18%] and 161 [19% of the operations], respectively. Return to play (RTP) was reported in 11 [44%] of the studies standing at an average of 98.9% ± 3.6. Conclusion Essentially, this is an adolescent sports knee injury that needs careful planning before decision making because it may afect both RTP and joint preservation. Although union was achieved in almost all patients, there is a high risk of associated injuries, complications and reoperations. The surgeon should be conident to perform fracture ixation as well as addressing associated knee soft tissue injuries to achieve optimal outcomes. Level of evidence Level IV.

WITHDRAWN: Classification and Treatment of Tibial Tubercle Fractures in Adults

“…Several classifications were proposed focusing on adolescent tibial tubercle fractures; however, they are unsuitable for adults [1,2]. Among the classification systems widely used for tibial plateau fractures in adults, the Schatzker classification and three/four column classification do not highlight tibial tubercle injury [3][4][5][6].…”

“…The copyright holder for this this version posted October 28, 2023. ; https://doi.org/10.1101/2023.10.27.23297691 doi: medRxiv preprint fractures; however, they are unsuitable for adults [1,2]. Among the classification systems widely used for tibial plateau fractures in adults, the Schatzker classification and three/four column classification do not highlight tibial tubercle injury [3][4][5][6].…”

Utilizing Suture Anchors in Addition to Screws for Treatment of Tibial Tubercle Avulsion Fracture: A Case Report

“…No screw heads were exposed prior to wound closure. Symptomatic hardware has been reported in the literature to be about 6%, and the present method is thought to be an advantage in lowering the complication, which may require device removal [ 8 , 10 , 14 ]. There are various other ways to use suture anchors.…”

“…Regardless of the surgical technique, the reports were mostly successful. Kalifis et al reported fracture union in 99.8% of cases, regardless of the fracture type and treatment [ 14 ]. Furthermore, the overall complication rate is low, and the outcomes are considered excellent [ 6 , 16 ].…”

The Immature Pediatric Appendicular Skeleton

“…59 Currently, there is no consensus regarding whether or not overuse injury (e.g., Osgood-Schlatter disease) predisposes patients to avulsion fractures, but both processes share the same culprit mechanism of forceful quadriceps contraction (often associated with kicking, sprinting, or jumping) transmitted to the immature tibial tubercle by the attaching patellar tendon. [60][61][62] Osgood-Schlatter disease is generally a clinical diagnosis and patients are treated conservatively. 63 But in those with atypical symptoms or concern for superimposed avulsions, imaging assessment starts with radiographs.…”