Arthroscopic treatment for avulsed fracture of tibial intercondylar eminence with suturing anchors in pediatric patients

Abstract

Objective To evaluate the clinical efficacies of arthroscopy-assisted fixation of tibial intercondylar eminence avulsion fracture with suturing anchors in pediatric patients. Methods A total of 23 hospitalized patients with avulsed fracture of tibial intercondylar eminence between January 2012 and September 2014 were collected retrospectively.There were 16 males and 7 females with a mean age of 14.5(8-17) years. Their mean time from injury to surgery was 6.0 (1-12) days.All patients underwent arthroscopic operations via suturing anchors. Follow-up examinations included radiograph, magnetic resonance imaging (MRI), Lysholm score and International Knee Documentation Committee (IKDC) rating scale. Results Follow-ups were conducted for a mean period of 29.1(25-33) months. Postoperative MRI showed the position of suturing anchors was satisfactory and suturing anchors did not reach the growth plate. Radiographic examinations demonstrated bone union in all cases and the average healing time was 8.7(6-12) weeks. At the end of follow-ups, radiographic examination demonstrated epiphyseal line was visible without physeal injuries in 19 cases. And radiograph of 4 cases showed a fuzzy epiphyseal line. It hinted at closure of epiphysis, but there was no obviously abnormal bone morphology. Satisfactory range-of-motion recovery was achieved without varus, valgus knee deformity or leg length discrepancy. Anterior drawer, Lachman and pivot shift tests were all negative. Mean Lysholm scores improved from preoperative 53.5±11.4 to 92.4±6.7 at the final follow-up (P<0.05). The mean International Knee Documentation Committee (IKDC) scores improved preoperatively from 54.1±8.8 to 93.1±6.4 at the final follow-up (P<0.05). Conclusions Arthroscopy-assisted fixation with suturing anchors is efficacious for avulsed fracture of tibial intercondylar eminence. It offers the advantages of operative simplicity, minimal trauma, reliable fixation and damaging no growth plate. Key words: Tibial fractures; Epiphyses; Arthroscopes; Child