Tibial Intercondylar Eminence Research Articles

ARTHROSCOPIC FIXATION OF TIBIAL INTERCONDYLAR EMINENCE FRACTURE BY FIBER WIRE SUTURE AND U SCREWS IN ADOLESCENT ATHLETES

Objective: We aimed to present our experience on arthroscopic management of tibial intercondylar eminence fracture in adolescent athletes. Methods: This was a case series of 9 adolescents (7 males, 2 females) aged 10-16 years diagnosed with tibial intercondylar eminence fracture following a sports activity. According to Meyers and McKeever classification, 4 patients had Type IIIA, 3 had Type IIIB, and 2 patients had Type II fracture. Following percutaneous arthroscopic reduction, the fragments of the fracture were fixed internally and anterior cruciate ligament was reconstructed through two 2.4 mm parallel tunnels at the level of anterior tibia by using fiber wire suture and U screws. Anterior tibial displacement was measured by KT-1000 knee arthrometer, and Lysholm Knee Scoring Scale was used for the patient-reported outcomes. Results: The duration of operation was 31.6±8.9 min. The patients were followed up for 37.1±19.1 months. Theanterior tibial displacement relative to the femur was 1.4±0.7 mm. TheLysholm score was 95.8±3.1. None of the patients developed infection. The complete fracture healing was obtained in all patients. Conclusion: Arthroscopic reduction and internal fixation by fiber wire suture and U screws provide perfect anatomic and functional outcome for displaced Type II and Type III tibial intercondylar eminence fracture in adolescent athletes.

HOFFA’S FRACTURE WITH IRREDUCIBLE PATELLAR DISLOCATION: APPROACH TO AVOID COMPLICATIONS IN A RARE INJURY

Hoffa’s fracture is coronal oriented fracture of distal femur with the fracture line extending through the femoral condyles. Hoffa’s fracture is rarely associated with ipsilateral femur and tibia fractures. Proper clinical examination and radiographic evaluation is necessary to diagnose associated injuries around the knee joint with Hoffa’s fracture. Closed reduction of dislocated patella in emergency room and field triage should be avoided to prevent patellar tendon incarcenation, patellar tendon rupture and osteochondral damage. We report a rare case of Hoffa’s fracture with irreducible patellar dislocation and tibial intercondylar eminence fracture following road traffic accident.

Clinical research on suture anchor fixation for the treatment of avulsion fracture of tibial intercondylar eminence under arthroscopy

To evaluate the early clinical effects of suture anchor fixation for the treatment of avulsion fracture of tibial intercondylar eminence under arthroscopy. From July 2012 to January 2015, 22 patients with the avulsion fracture of tibial intercondylar eminence were treated with arthroscopic suture anchor fixation. There were 12 males and 10 females, with an average age of 22.8 years old(ranged, 18 to 33 years old). Nine patients had the fractures in the right knee and 13 patients had the fractures in the left knee. The mean duration from injury to surgery was 6.8 days(ranged, 3 to 11 days). According to the improved Meyers-McKeever classification, 13 cases were type II, 7 cases were type III, and 2 cases were type IV. The clinical outcomes were evaluated by the range of motion, the Lysholm score, the IKDC 2000 subjective knee score, the axial shift test, and the anterior drawer test. All the incisions healed by first intention, and no complications occurred. All the patients were followed up, and the mean duration was 32.8 months (ranged, 18 to 42 months). The knee range of motion was improved from preoperative (49.37±7.69) ° to (126.38±5.58) °at the latest follow-up(P<0.01). Lysholm score was improved from preoperative 43.4±5.6 to 79.2±6.2 at the latest follow-up(P<0.01). And the IKDC 2000 score was improved from preoperative 52.6±6.2 to 81.4±5.7 at the latest follow-up(P<0.01). At the latest follow-up, the patient underwent physical examination. One patient had a positive result of axial shift test at the 18th month after operation with grade II laxity of anterior cruciate ligament. One patient had a weakly positive result of anterior drawer test at the 24th month after operation. Absorbable suture anchor fixation for the treatment of avulsion fracture of tibial intercondylar eminence under arthroscopy can provide accurate reduction and stable fixation, which can be applied to treat all types of fractures including comminuted fracture, and it is not necessary to remove the implant in the second operation.

Improved arthroscopic one-piece excision technique for the treatment of symptomatic discoid medial meniscus

BackgroundDiscoid medial meniscus is an extremely rare abnormality of the knee. During arthroscopic meniscectomy for symptomatic discoid medial meniscus, it is difficult to remove the posterior portion of the meniscus because of the confined working space within the compartment and the obstruction caused by the anterior cruciate ligament and the tibial intercondylar eminence. To overcome these problems, we describe an improved arthroscopic technique for one-piece excision of symptomatic discoid medial meniscus through three unique portals.MethodsThree improved portals were made in the injured knee: a standard anteromedial portal, a central transpatellar tendon portal, and a high anterolateral portal. The anterior side of the discoid medial meniscus was cut 7 mm from the periphery of the meniscus. Next, the anterior portion of the free discoid meniscus fragment was pulled in the anterolateral direction with tension. A curve-shaped cut was made along the longitudinal tear to the posterior horn using basket forceps through the standard anteromedial portal. Then, the anterior portion of the free discoid meniscus was pulled in the anteromedial direction. Pulling the fragment under tension made it easier to cut the posterior side of the discoid meniscus. The posterior side of the discoid meniscus was cut 7 mm from the periphery of the meniscus with straight scissors or basket forceps through the central transpatellar tendon portal.ResultsThis technique resulted in satisfactory results. Excellent visualization of the posterior part of the discoid medial meniscus was gained during the procedure, and it was easy to cut the posterior part of the discoid medial meniscus. No recurrent symptoms were found.ConclusionsThis improved arthroscopic one-piece excision technique for the treatment of symptomatic discoid medial meniscus enables the posterior part of the meniscus to be cut satisfactorily. Moreover, compared with previous techniques, this novel technique causes less formation of foreign bodies and less damage to the anterior cruciate ligament, medial collateral ligament, and cartilage and requires a shorter procedural time.

Observation of curative effect of avulsion fracture of anterolateral ligament of knee joint

Objective To explore the clinical effect of periarticular knee fractures combined with anterolateral ligament (ALL) avulsion fracture. Methods From June 2014 to November 2015, 13 patients with ALL avulsion fracture in periarticular knee fractures were fixed by the star plate, cannulated or screws suture anchor, including 9 male and 3 female with the mean age of 39.5 years (range from 28 to 51 years). 6 patients were diagnosed distal femoral fracture, 4 tibial plateau fracture, and 3 tibial in-tercondylar eminence avulsion fracture which all combined with ALL avulsion fracture. Postoperatively, all patients were treated with the adjustable knee brace for 3 months. Results All patients were followed up for 4-20 months, the mean follow-up time was 13.5 months. The average surgical time was 130 min (range from 90 to 210 min). In all 13 patients, ALL was found and identi-fied. Bone union was obtained in all patients, and the bone union time was 11.4 weeks (10-12 weeks). 7 cases were fixed with star plate, 5 cases were fixed with hollow screw, and 1 case was fixed with anchor. All follow-up patients underwent anteroposterior and lateral X-rays. Pain, swelling and functional recovery of the knee joint were observed. Patients were assessed postoperatively with International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity scale to evaluate the clinical ef-fect. At the last follow-up, all patients had full range of motion of the knee joint which from 0° to approximate 120°. The Lysholm, objective IKDC were 86.5 and 84.6 respectively. Among the 13 patients evaluated, 9 patients were graded A, and 4 patients were graded B by subjective IKDC. The Tegner activity scale at the last follow-up was 6.7. Incision of poor healing in 1 case, and got healed after 32 d cleaning dressing. Conclusion This study confirmed the presence of the ALL. The fixation of ALL avulsion fracture in periarticular knee fractures can be an effective procedure at a minimum follow-up of 13.5 months. Key words: Ligament; Fractures; Fracture fixation, internal

Arthroscopic treatment of displaced tibial eminence fractures using a suspensory fixation.

Background:Avulsion fractures of the tibial intercondylar eminence are fairly common injuries requiring surgery for the optimal functional outcome. The purpose of this study was to assess the clinical and radiological outcomes of an arthroscopic treatment of displaced tibial intercondylar eminence fractures using a suspensory device.Material and Methods:Five patients with type 2 and 3 displaced tibial intercondylar eminence fractures who received an arthroscopically assisted fixation using a double button device were enrolled from 2011 to 2012. Clinical assessment included the patient demographics, cause of injury, the delay before surgery, time for surgery, time to return to work and sport, the International Knee Documentation Committee (IKDC) and Lysholm knee scores. Stability was measured with the KT-2000 arthrometer with a force of 134 N. A side to side difference on the KT-2000 examination superior to 3 mm was considered as a significant and abnormal increase in the anterior translation. Radiological examination consisted of anteroposterior and lateral radiographs, as well as computed tomography (CT) scan of the affected knee. Clinical and radiological followup was done at 1, 2, 3, 6, and 12 months postoperatively and at final followup. CT-scan was performed before surgery and at 3 months followup.Results:The median age of patients was 31 years. Mean followup was 27 ± 5.1 months. The average delay before surgery was 3 days. At final followup, the mean IKDC and Lysholm knee scores were, 93.9 and 94.5 respectively. All patients had a complete functional recovery and were able to return to work and to resume their sport activities. No secondary surgeries were required to remove hardware. No complication was noted. Bony union was achieved in all patients.Conclusion:The arthroscopic treatment of displaced tibial intercondylar eminence fractures using a suspensory system provided a satisfactory clinical and radiological outcome at a followup of 2 years.

A new technique for arthroscopic reduction and fixation of displaced tibial intercondylar eminence fractures, using suture anchor and EndoButton system.

The study aims to describe a less invasive technique for displaced tibial intercondylar eminence fractures, using only one bone tunnel with suture anchor and EndoButton system. Seventeen patients were followed up after arthroscopic fixation for tibial eminence fractures using suture anchor and EndoButton. The patients were followed with clinical examinations such as Lysholm, Tegner, and International Knee Documentation Committee (IKDC) rating scales. Radiographic assessments were also performed during the follow-up for evaluating the healing of the fracture. There were 14 male patients and 3 female patients with 10 right knees, and 7 left knees included. All the fractures healed anatomically at final follow-up. Also, no clinical signs of anterior cruciate ligament deficiency were detected. The mean Lysholm score improved significantly from 74.72 ± 3.24 (range from 70 to 79) to 96.2 ± 2.54 (range from 89 to 98) ( p < 0.001). The IKDC category was abnormal or severely abnormal preoperatively and all the patients improved to normal or nearly normal at final follow-up. The Tegner score also improved significantly postoperatively from 3.45 ± 1.02 to 6.34 ± 1.22 ( p < 0.001). The study demonstrated that the procedure is safe and effective, which can be another option for tibial intercondylar eminence fractures.

Arthroscopic treatment of intercondylar eminence fractures with intraepiphyseal screws in children and adolescents

IntroductionTibial intercondylar eminence fracture rarely occurs in childhood. Its treatment requires anatomic reduction to provide knee stability and a rigid fixation to minimize postoperative immobilization time. HypothesisArthroscopy combined with fluoroscopy with intra-epiphyseal ASNIS screw fixation can meet the requirements of this treatment. Material and methodsThe series comprised 24 patients (mean age: 11 years) with Meyers and McKeever type II tibial intercondylar eminence fractures (n=15) or type III (n=9), operated on between 2011 and 2013. Fixation with 4-mm ASNIS screws was placed arthroscopically. The demographic data, associated lesions, radiological union, stability, functional result, and the Lysholm score were evaluated. ResultsWith a mean follow-up of 2 years, the mean Lysholm score was 99.3 for type II and 98.6 for type III fractures. At the 6th postoperative week, range of motion in the operated knees was identical to the healthy knees. At the 12th postoperative week, there was no sign of anterior laxity. Twelve cases included meniscal entrapment, but no significant difference was observed in the functional results. Discussion, conclusionASNIS screw fixation under arthroscopy can be successfully applied in the treatment of types II and III tibial intercondylar eminence fractures in children. This technique provides excellent stability, allows early weigh-tbearing, and preserves function of the knee and its growth. Level of evidenceIV, retrospective study.

Displaced Double-Layered Lateral Meniscus That Mimicked the Bucket-Handle Tear: a Case Report

Various different types of meniscal abnormalities have been reported in the literature. Among them, the occurrence of a double-layered lateral meniscus is extremely rare. The double-layered lateral meniscus includes both the upper additional and the lower normal meniscus (1) (Fig. 1). As the upper additional meniscus is mobile, although very rare, it can be displaced and flipped over the intercondylar eminence of tibia, mimicking the bucket-handle tear. In the English literature, there is only one previously published report of a displaced double-layered lateral meniscus that mimicked the bucket-handle tear (2). Here, we describe a rare case of displaced double-layered lateral meniscus mimicking the bucket-handle tear, where a displaced upper additional meniscus was observed in the intercondylar notch of the knee. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Received: August 11, 2016 Revised: September 11, 2016 Accepted: September 12, 2016

Cold Limb in Blunt Knee Injury

Case Presentation: A 31-year-old healthy Taiwanese man presented a cold extremity below right knee caused by contusion due to falling down in a traffic accident. Physical examination showed tenderness of right swollen knee with absent pulsation of right popliteal artery (PA) and weak pulsation of right dorsalis pedis artery. Contrast-enhanced multiple-detector computed tomography (MDCT) revealed the fractured bone fragments over medial epicondyle of right femur and intercondylar eminence of right tibia with adjacent hematoma and swelling. The fractured bone fragments of right tibial intercondylar eminence went posteriorly and injured the proximal portion of right PA. Focal occlusion of right PA was about 16 mm in length with collateral circulation filled the distal portion of right PA (Figure 1). The intimal rupture of right PA with acute thrombosis leading to occlusion caused by the fractured bone fragment was found. The emergent vascular repair with resection of the occlusive PA and reconstruction using the great saphenous vein were performed. Discussion: Peripheral vascular injuries account for 4-6% of all major traumas. Popliteal vessel injuries, potentially with limb loss and a relativelyhigh morbidity, remain uncommon with an incidence of 0.2% in all traumas. The mechanisms of blunt PA injuries are secondary to posterior knee dislocation with traction, vascular avulsion, or bony fragments of complex tibial plateau or supracondylar femur fractures [1-4]. The PA injuries associated with blunt trauma have transection, occlusion, laceration, perforation, arteriovenous fistula, or intimal injury [2-4]. Vascular injury can have devastating consequences in patients, as irreversible ischemia can occur in as short as 6 to 8 hours [2,5]. Hard signs of PA injuries, including a pulsatile expanding hematoma, absence of pulse, presence of bruit or thrill, and ischemia of distal limbs, require emergency surgical intervention [1,5]. Early diagnostic images, including MDCT and digital substrate angiography which can confirm the location and severity of vascular injury, with vascular repair are recommended for limb-saving. An endovascular stent offers an alternative modality to traditional surgical repair [1-3,5].

English

Avulsion fractures of tibial intercondylar eminence is a rare injury mainly affecting the pediatric population between 8 to 14 and is even rarer in adults with very few cases reported in literature. It occurs with high energy trauma in adults and may be associated with knee dislocation and neurovascular injuries. A 30 yr old male presented with a painful swollen left knee, limited knee motion, and difficulty with weight bearing after a history of fall from motorcycle. Imaging revealed Type 3 Meyers and McKeever tibial spine avulsion of both ACL and PCL. A two staged surgical procedure was performed: (a) Arthroscopic reduction and fixation with headed cannulated screw of ACL tibial fragment; (b) ORIF with headed cannulated screw of PCL tibial fragment via posterior approach to knee. Good functional outcome and early mobilization was achieved. Diagnostic arthroscopic helps to evaluate the condition of the cruciate ligaments as well as fracture bed. Simultaneously fixation of ACL fragment with cannulated screw can be done, which is a simpler procedure to suture fixation. ORIF of PCL fragment in a staged manner has helped to address the injury in a detailed manner achieving goal of anatomical reduction and early mobilization.

Arthroscopic double strand wire fixation anteriorly and posteriorly to anterior cruciate ligament for tibial intercondylar eminence fracture

To explore the clinical outcomes of arthroscopic double strand wire fixation anteriorly and posteriorly to anterior cruciate ligament (ACL) for tibial intercondylar eminence fracture. From January 2009 to February 2012, 12 patients with tibial intercondylar eminence fracture were selected. There were 4 males and 8 females with an average age of 19.5 ± 10 (10-50) years. Time from injury to operation was 4 days to 2 years. All cases belonged to Meyers-Mekeever type II and type III. Arthroscopic double strand wire compressive fixation was performed anteriorly and posteriorly to ACL. Other measures included postoperative rehabilitation and supports with brace in knee extension when weight-bearing for 4-6 weeks. The average follow-up period was 15.6 (6-30) months. Final clinical results showed good range of motion and good knee stability. On postoperative radiology, there were good reduction of intercondylar eminence fracture and excellent healing. There was no occurrence of wire rupture. Postoperative IKDC and Lysholm scores were excellent (n = 10) and good (n = 2). There was no such complication as fragmentation of intercondylar eminence fracture bone, neurovascular injury or infection. Arthroscopic double strand compressive fixation for tibial intercondylar eminence fracture may be easily performed without injury to ACL substance. The reduction is both stable and reliable. And the clinical outcome is excellent.

Injuries of ACL with Avulsion of Bone Fragment from Tibial Intercondylar Eminence in Children and Adolescents

Experience in arthroscopic treatment of 54 patients aged 5-18 years with ACL injury and bone fragment avulsion from the tibial intercondylar eminence is presented. Type I injury (by Meyers &amp; McKeever - Zaricznyi classification) was diagnosed in 2 %, type II - in 49%, type III - in 40% and type IV - in 9% of patients. In patients with type I injury arthroscopic intervention was performed for concomitant injuries diagnosis and knee joint sanitation. In patients with II-IV types of injury arthroscopic osteosynthesis of tibial intercondylar eminence fractures with wire loop by original technique was performed. Excellent results were achieved in 44 (81.1%), good - in 7 (12.1%) and satisfactory - in 3 (6.8%) patients. Neither complications nor cases of nonunion were noted. Advantages of the proposed technique are the minimal traumatization of tibial growth zone, rigid fracture fixation, possibility to use this method of fixation in comminuted fractures

Injuries of ACL with Avulsion of Bone Fragment from Tibial Intercondylar Eminence in Children and Adolescents

Experience in arthroscopic treatment of 54 patients aged 5-18 years with ACL injury and bone fragment avulsion from the tibial intercondylar eminence is presented. Type I injury (by Meyers &amp; McKeever - Zaricznyi classification) was diagnosed in 2 %, type II - in 49%, type III - in 40% and type IV - in 9% of patients. In patients with type I injury arthroscopic intervention was performed for concomitant injuries diagnosis and knee joint sanitation. In patients with II-IV types of injury arthroscopic osteosynthesis of tibial intercondylar eminence fractures with wire loop by original technique was performed. Excellent results were achieved in 44 (81.1%), good - in 7 (12.1%) and satisfactory - in 3 (6.8%) patients. Neither complications nor cases of nonunion were noted. Advantages of the proposed technique are the minimal traumatization of tibial growth zone, rigid fracture fixation, possibility to use this method of fixation in comminuted fractures

Variable bone mineral density reductions post-unicompartmental knee arthroplasty.

PurposeRadiolucencies are commonly observed in unicompartmental knee arthroplasty (UKA) patients within 1 year of arthroplasty. The objective of the study was to identify how the bone mineral density (BMD) changes up to 1 year post-arthroplasty.MethodsDual X-ray absorptiometry scans were obtained from 11 UKA patients at 10 days and 3, 6, and 12 months post-surgery. Patients were scanned in both anteroposterior and lateral knee orientations.ResultsMost subjects saw a large decline in BMD in the first 6 months following surgery, followed by some recovery in bone mass. The biggest change occurred under the tibial intercondylar eminence, which decreased significantly by an average of 18 % at 6 months and was 15 % at 1 year. The average bone loss under the tibial tray was low; however, the bone loss at the anterior portion was higher with a significant average decrease of 14 %. There was no change in BMD under the tibial keel. There was significant bone loss of 13 % under the femoral component; the regions anterior and posterior to the central femoral implant peg both had significant bone loss of 14 %. The bone response between patients was very variable, with some patients losing bone steadily, and others gaining it rapidly after an early fall.ConclusionsWhile the overall reduction in BMD under both components was low, it was significant and there was substantial individual variation superimposed on this. Improving our understanding of this response to surgery may impact on prosthesis survival.Level of evidenceTherapeutic study: case series with no comparison group, Level IV.

Arthroscopic suture fixation in patients with a tibial intercondylar eminence fracture using a simple device to penetrate the anterior cruciate ligament

Displaced tibial intercondylar eminence fractures require early reduction and stable fixation to prevent nonunion, knee instability, and a lack of extension. Many types of surgical procedure are recommended including arthrotomy or an arthroscopic technique to stabilize the fracture segment using Kirschner wire, screws, staples, and suture fixation. However, contemporary arthroscopic techniques and devices can facilitate intra-articular surgery and have been applied to the treatment of this fracture. In our current report, we describe a simple suture fixation method under arthroscopy for the treatment of tibial intercondylar eminence fractures. We treated eight knees of eight patients. One patient had a Type II fracture and seven patients had a Type III fracture according to Meyer's classification. Following the arthroscopic inspection of concomitant injuries, debridement of hematoma, and reduction of the fragment, two nonabsorbable sutures (Ethibond No. 2, Johnson & Johnson, Somerville, NJ, USA) were advanced through the suture passer device, which is used to penetrate the anterior cruciate ligament (ACL) near to the insertion site of the displaced fragment. Two surgical sutures were pulled out by the suture retriever from the anterior proximal tibia hole and were fixed to the tibia cortex bone with a double-spike plate. At follow-up, radiographic examinations showed that bone union was achieved in all cases. All but one patient could resume normal activities with no restrictions and no ligamentous instability. All knees had a negative Lachman's test and showed a gain of stable ligament function by KT2000 arthrometer evaluation. One patient had an insignificant extension limitation and experienced slight pain after walking but these symptoms were minimal. In conclusion current arthroscopic surgery techniques for tibial intercondylar fractures can be easily performed and reproducibly achieve secure fixation and early mobilization of the knee.

Arthroscopic treatment of tibial spine fracture in children with a cannulated Herbert screw

BackgroundAvulsion fractures of the anterior tibial intercondylar eminence in childhood are rare and are severe injuries of the knee. Since the injury is equivalent in aetiology with ruptures of the anterior cruciate ligament, the treatment requires anatomic reduction and preservation of the stability of the joint. The aim of the study was to demonstrate our experiences with the arthroscopy-guided Herbert-screw fixation in the treatment of displaced tibial eminence fractures in children. MethodsBetween January 2004 and December 2011, a total of eight children were treated surgically with Type II or Type III anterior tibial eminence fractures; another four children with undisplaced, Type I fractures were treated conservatively, applying with cast fixation for 6weeks. Radiological consolidation, stability and functional outcome were assessed during the follow-up examinations. ResultsOn the 12th postoperative week, we did not find instability in any of the patients by physical examination. There were only minimal differences found in the functional outcome, comparing the conservatively and operatively treated groups (Lysholm functional scale, average scores: Type I: 97, Type II: 95 and Type III: 94 points). The range of motion (ROM) of the injured knees was identical with healthy sides on the postoperative 6th week. ConclusionsOur results indicate that the presented method can successfully be applied in the treatment of displaced tibial spine fractures; providing excellent stability and preserving the function of the injured knee in the short-term.

Arthroscopic Suture Bridge Fixation of Tibial Intercondylar Eminence Fractures

Tibial intercondylar eminence fractures that are displaced and non-reducible require open or arthroscopically assisted repair. Ideally, fracture reduction and fixation would be performed with a technique that has low morbidity, allows easy visualization and reduction, provides firm fixation, does not violate the proximal tibial physis, avoids metal hardware, and does not require a second procedure for implant removal. The suture bridge technique, used in the shoulder for rotator cuff tears and greater tuberosity fracture repair, has the ability to produce high contact pressures with rigid fixation. We describe an all-inside and all-epiphyseal arthroscopic suture bridge technique for tibial intercondylar eminence fracture repair performed with PushLock anchors (Arthrex, Naples, FL). One or 2 anchors preloaded with No. 2 FiberWire (Arthrex) are placed in the posterior fracture bed, followed by fracture reduction. The suture limbs are shuttled through and around the anterior cruciate ligament and over the fracture fragment in crossing fashion and are secured by use of additional anchors placed at the anteromedial and anterolateral fracture margin. The anchors are placed obliquely to avoid the proximal tibial physis in the pediatric population. Anatomic reduction and secure fixation allow more aggressive rehabilitation and faster restoration of joint function.

Physeal-sparing Tibial Eminence Fracture Fixation With a Headless Compression Screw

Displaced tibial intercondylar eminence fractures frequently require operative fixation. Surgical techniques for fixation include the use of headed screws or sutures. However, these fractures commonly occur in skeletally immature patients, and current techniques violate the proximal tibial physis to maintain reduction and can result in growth disturbances. The authors present a physeal-sparing method for fixation of noncomminuted displaced tibial eminence fractures using a headless compression screw. They describe 2 skeletally immature adolescents in whom their technique provided maintenance of reduction until union and full return to activities.

Displaced Tibial Intercondylar Eminence Fractures

To review outcomes of 19 patients with tibial eminence fractures. Records of 10 female and 9 male patients with type II (n=3) and type III (n=16) displaced tibial intercondylar eminence fractures were reviewed. Nine of whom were skeletally immature aged 6 to 15 (mean, 12) years; the remaining 10 patients were aged 19 to 55 (mean, 32) years. 14 involved the left knee. All patients presented with a painful haemarthrosis and reduced range of movement. The most common activity causing this injury was skiing (n=7, primarily in adult females [n=5]), followed by cycling or motocrossing (n=6) and falling or other sporting activities (n=6). The injury mechanisms entailed forced flexion with rotation (n=7), hyperextension with rotation (n=7, primarily in skeletally immature males [n=4]), and direct trauma (n=5, primarily in adult males [n=4]). Eight patients (60% of adults and 22% of children) had associated injuries of the knee, which commonly occurred after direct trauma. Two patients were treated in a cast or brace after closed or open reduction without fixation. Two patients underwent arthroscopic reduction and internal fixation, and 15 underwent open reduction and internal fixation (2 after failed arthroscopic reduction and 11 proceeded directly). Postoperatively, 7 patients had a positive Lachman test, but none complained of subjective instability. Ten patients had knee stiffness; all except one had been immobilised for 4 to 6 weeks. Seven patients had extension impingement; 6 of them had been treated with open reduction and internal fixation. Two patients underwent further surgery for debridement and screw removal at years 1 and 3. One patient developed arthrofibrosis and underwent arthrolysis at month 6, but knee stiffness remained. No patient underwent subsequent anterior cruciate ligament reconstruction. Tibial eminence fractures are as common in adults as in children. Female skiers are at higher risk. Stiffness is a more common complication than laxity. Early range-of-motion exercise may reduce stiffness and extension impingement.