Arthroscopic treatment of type III tibial intercondylar imminence avulsion fracture with pullout sutures in skeletally immature patients

Abstract

Study design This was a retrospective study. Objective of the study The objective of this study was to evaluate the results of arthroscopic reduction and internal fixation of type III tibial intercondylar imminence avulsion fracture by pullout nonabsorbable suture technique in skeletally immature patients. Background Tibial intercondylar eminence fracture is an intraarticular avulsion fracture of the anterior cruciate ligament (ACL) insertion. Traditionally, they can be seen between 8 and 14 years of age, and they are rare among those under the age of 8 years. The reported incidence is three per 100 000 children each year. The best functioning results are obtained after arthroscopic reduction and internal fixation by pullout sutures technique. Patients and methods Between March 2010 and March 2012, we received 14 patients referred from the emergency department. There were 10 males and four female patients. The right knee was involved in nine cases and the left knee in five cases. The median age of the patients was 14 years (13–15 years). The time between injury and surgery was 6 days (4–12 days). The inclusion criteria were displaced tibial eminence fractures (type III) in skeletally immature patients. Tibial eminence fractures were defined according to the classification of Meyers and McKeever modified by Zaricznyj. An arthroscopic standard anterolateral portal, an anteromedial portal, and a viewing accessory high anterolateral portal were utilized. The fracture bed is cleared of debris and the fracture fragment is reduced. The ACL tibial guide is utilized to drill two 5-mm tunnels on both sides of the fracture fragment to the upper anteromedial tibia. Two no. 5 Ethibond sutures were passed through the ACL substance close to the bone fragment by suture passing instrument. The sutures were the tied at the anteromedial tibia. Results The median follow-up was 24 months. The mean IKDC score was 91 (range, 87–100). The IKDC grades were A (normal) in 10 (72%) patients and B (nearly normal) in four (28%) patients. The mean preinjury Tegner score was 5 (range, 3–7), and at follow-up evaluation, the mean Tegner score was 4 (range, 3–6). The mean preoperative Lysholm score was 42 (range, 32–56); the mean postoperative Lysholm score was 92 (range, 88–100). Conclusion Arthroscopic reduction and internal fixation of tibial imminence avulsion fracture by pullout nonabsorbable suture technique in skeletally immature patients is a safe and effective method to treat this lesion.