Tibial Spine Research Articles

Perioperative Management of Tibial Spine Fractures in Pediatric Patients: A Delphi Study to Identify Principles of Treatment.

The Delphi technique is a structured, iterative group survey method utilized to reach a consensus among experts in a field regarding topics with evidence-based equipoise. Currently, there are few studies at the highest levels of evidence published on the perioperative tibial spine management, making it an ideal subject to utilize expert opinion to reach consensus decision. The purpose of this study was to utilize a Delphi-method survey to achieve consensus statements regarding the perioperative management of tibial spine fractures. Before study initiation, 3 rounds of surveys were agreed upon, maintaining the traditional Delphi principles. Consensus was defined as 75% agreement or disagreement on a Likert scale. An anonymous survey consisting of 50 statements describing the management of tibial spine fractures preoperative and postoperative in varying scenarios was distributed to a group of 44 pediatric sports medicine orthopaedic surgeons utilizing an electronic survey software system. Of 44 surgeons invited to participate, 24 responded to round 1, 28 responded to round 2, and 25 responded to round 3. Consensus was achieved for the following: use of x-ray to determine initial treatment; casting for a minimum of 3 weeks for nonoperative management, but <3 weeks if treated with surgical fixation; advanced imaging to avoid missing concomitant injury; the necessity of physical therapy, but not continuous passive motion (CPM); and for arthroscopic surgical intervention. It was also agreed that functional testing is important in return-to-play (RTP) decision-making, though the specific timelines and clearance criteria could not be agreed upon. There were statements that displayed continued disagreement, including the role of aspiration, preoperative range of motion management, and the timing of surgical scheduling. Utilizing a Delphi methodology with experienced surgeons on tibial spine treatment, consensus in the management of tibial spine fracture was achieved for definitive management strategies. Further study will be important to optimize our management of this youthful population with tibial spine fractures.

Comparative clinical efficacy of “Figure-8” Banding and double-row anchor suture-bridge fixation in arthroscopic management of tibial intercondylar eminence avulsion fractures

ObjectiveThe objective of this study is to assess and compare the clinical efficacy of “Figure-8” banding and double-row anchor suture-bridge fixation techniques in the arthroscopic management of tibial intercondylar eminence avulsion fractures.MethodA retrospective analysis was conducted on the medical records of 42 patients who underwent arthroscopic surgery for tibial intercondylar eminence fractures at our institution from June 2017 to June 2022. This cohort included 20 cases treated with “Figure-8” banding and 22 cases managed using double-row anchor suture-bridge fixation. Comparative assessments were made regarding operative duration, duration of fracture consolidation, postoperative knee joint range of motion, joint stability as assessed by the Lachman test, Lysholm score, and International Knee Documentation Committee (IKDC) functional score for both treatment groups.ResultsThe mean follow-up duration was 13.8 months. The analysis indicated that the double-row anchor suture-bridge group had a significantly longer operative duration compared to the “Figure-8” banding group (p < 0.05). Postoperative computed tomography (CT) scans confirmed successful reduction in both groups, with fracture consolidation achieved within an average of three months. Both groups showed significant improvements in postoperative knee range of motion, joint stability, and functional scores compared to preoperative measurements (p < 0.05). During the initial two-month post-surgery, the double-row anchor suture-bridge group demonstrated superior knee joint range of motion and functional scores compared to the “Figure-8” banding group (p < 0.05); however, these differences were not statistically significant beyond three months post-surgery (p > 0.05). By the one-year postoperative mark, joint stability outcomes were comparable between the two treatment groups (p > 0.05).ConclusionBoth “Figure-8” banding and double-row anchor suture-bridge fixation techniques in the arthroscopic management of tibial intercondylar eminence avulsion fractures can achieve precise reduction and stable fixation. In addition, the figure-8 suture group has the characteristics of shorter surgery time and less cost. Notably, early postoperative knee function appears to be superior with double-row anchor suture-bridge fixation compared to “Figure-8” banding.

Assessing the Tibial Tubercle–Posterior Intercondylar Eminence Distance as a Superior Indicator for Patellar Instability and Surgical Planning in Tibial Tubercle Osteotomy

Background and Objectives: This study aimed to evaluate the tibial tubercle–posterior intercondylar eminence (TT-IC) distance as a diagnostic tool and surgical guide for correcting extensor apparatus misalignment through tibial tubercle osteotomy. Materials and Methods: A retrospective analysis was conducted on patients with extensor apparatus misalignment. The TT-IC distance was measured using MRI. Patients underwent tibial tubercle osteotomy, guided by the TT-IC distance for correction. Post-operative outcomes, including alignment, pain scores, and functional recovery, were assessed. Results: A significant correlation was found between the TT-IC distance and the degree of extensor apparatus misalignment. Utilizing the TT-IC distance as a surgical guide led to improved alignment in majority of patients. Post-operative outcomes showed reduced pain and enhanced functional recovery. Conclusions: The study established the TT-IC measurement as a valuable tool for determining the need for tibial tuberosity osteotomy in patients with patellar instability, particularly those with trochlear dysplasia, by providing a more precise criterion than the traditional TT-TG distance.

Anatomical variants of the medial synovial fold of the posterior cruciate ligament: morphological classification based on magnetic resonance imaging of the knee.

The medial synovial fold of the posterior cruciate ligament is one of the synovial plicae of the knee joint. The objective of this study was to assess the necessity of reporting the appearance of the medial synovial fold of the posterior cruciate ligament on magnetic resonance imaging of the knee joint and its correlation with side and sex. Patients with normal knee structure on magnetic resonance imaging (MRI) scans between 2018 and 2023 were included in this retrospective study. MRI scans of the knee joints were retrospectively reviewed by two musculoskeletal radiologists independently. The medial synovial fold of the posterior cruciate ligament was divided into three types according to the imaginary line drawn between the lateral border of the medial femoral condyle and the medial tibial intercondylar tubercle. The study included 1147 patients, of whom 478 (41.7%) were female and 669 (58.3%) were male. Among these patients, 580 (50.6%) had a right knee scan, and 567 (49.4%) had a left knee scan. The age range was 15-35 years for both sexes. The frequency of the medial synovial fold types in all patients was as follows: Type A (30.1%), Type B (55.4%) and Type C (14.5%). There was a high level of agreement between the observers. There was a statistically significant difference in the frequency of medial synovial fold types between sexes, with men exhibiting a greater prevalence. Magnetic resonance imaging (MRI) of the knee joint revealed the medial synovial folds of the posterior cruciate ligament (PCL). The most common was Type B (55.4%), followed by Type A (30.1%) and Type C (14.5%) among the MSF types. No statistically significant difference was found between the right and left knees for any of the MSF types.

Early combined arthroscopic and open management of combined ACL and PCL tibial spine avulsion in a knee dislocation: A case report

A 35-year-old man presented with right knee pain following a tree stump landing on his leg two days prior. Evaluation revealed a knee dislocation injury (KD III M) with displaced avulsion fractures of the anterior cruciate ligament and posterior cruciate ligament, with the fragments flipped 180 degrees. Additional injuries identified through preoperative imaging (computer tomography, magnetic resonance imaging) and physical examination included bony medial patellofemoral ligament tear, bony posterolateral corner injury, complete medial collateral ligament tear, and medial/lateral meniscus root bony avulsions. The injury was treated utilizing a single-staged arthroscopic and open ligament repair and reconstruction. Bicruciate avulsion fractures in the setting of a knee dislocation injury is a challenging surgical problem in which arthroscopic management of bicruciate tibial spine injuries can be utilized successfully.

To Manipulate or Not? Management of Pediatric Knee Arthrofibrosis Following Operative Fixation of Tibial Spine Fractures

ObjectivesKnee arthrofibrosis is a common complication after surgical fixation of tibial spine fractures. However, there is no standardized treatment modality for resultant arthrofibrosis, with some surgeons electing for non-operative management, while others prefer manipulation under anesthesia with a possible arthroscopic lysis of adhesions, if indicated. To better understand indications and outcomes from these treatment modalities for arthrofibrosis, we examined patients treated by both approaches. MethodsWe performed a multicenter retrospective case series of patients with arthrofibrosis after tibial spine fracture surgery. Arthrofibrosis was defined as loss of knee extension ≥ 10.0° and/or knee flexion ≥ 25.0° compared to the contralateral, uninjured knee at three months following index surgery. Patients were organized into two cohorts: non-operative and operative treatment. Data was collected for demographics, fracture classification, concomitant injuries, treatment timeline, and knee range of motion. ResultsThere were 16 patients in the operative group and 10 patients in the non-operative group. At the time of diagnosis, the operative group had a mean 10° larger flexion deficit compared to the non-operative group. Both treatment modalities resulted in similar ranges of motion at terminal evaluation. Final flexion was recorded as 130° in the operative group and 127° in the non-operative group. Final extension deficits were 3° in both cohorts. ConclusionsOperative and non-operative treatment modalities can be effective in management of knee arthrofibrosis after fixation of tibial spine fractures. Non-operative treatment may be more suitable for milder range of motion deficits, but further research is necessary to guide clinical practice. Level of EvidenceLevel IV, Case Series;

Bankart knee. Operative treatment of posterior part of lateral tibial condyle fracture with concomitant avulsion injury of anterior cruciate ligament (ACL). Technique and case report

Fractures of the posterolateral part of the tibial plateau (PLTP) are rare and complex fractures among other orthopedic entities. This case report describes a 54-year-old male who suffered a twisting injury of the left knee in a scooter crash. As a result, impaction fracture and displacement of the posterolateral margin of the tibial plateau were diagnosed with concomitant avulsion of the intercondylar eminence of the tibia and medial tibial condyle cleft fracture. The treatment comprised reduction of the medial tibial condyle (MTC) cleft fracture with one cancellous screw, arthroscopic bone-suture of the intercondylar eminence, and reduction of compressed PLTP with fixation of the displaced fragment on a distal radius T-plate working as a “buttress” rather than firm stabilizer. The operative technique of PLTP impaction fracture reduction is described in an instructional manner.

Chiba osteotomy (Tibial condylar valgus osteotomy) for a large tibial varus deformity: Technical note

Chiba osteotomy is an effective technique for advanced knee osteoarthritis (KOA). The principle of the osteotomy is to correct both varus deformity and intra-articular joint congruity through an L-shaped osteotomy from the medial tibial condyle to the lateral intercondylar eminence. Previous studies have demonstrated that Chiba osteotomy is an effective method for alignment correction surgery for severe knee osteoarthritis. However, these reports slightly differ from the original concept of Chiba osteotomy. This report describes the pre-operative planning and surgical technique of Chiba osteotomy for patients with large tibial varus deformity, focusing on the management of early knee osteoarthritis following conditions such as post-traumatic Blount disease and “Pagoda” like proximal tibia varus deformities, as originally described. Level of evidenceIV

Refixation of aposterior medial root lesion in combination with centralization by ameniscotibial suture

Refixation of aposterior root lesion of the medial meniscus via atibial drill tunnel and prevention of extrusion using ameniscotibial suture (centralization). Posterior root lesion of the medial meniscus. Grade4 cartilage damage in the corresponding compartment, uncorrected varus or valgus deformities, symptomatic instabilities, extensive degenerative tears apart from the root region. Knee arthroscopy via the high anterolateral standard portal. Diagnostic arthroscopy to check indication. Locate the insertion zone on the tibial plateau and local debridement until the bone of the tibial plateau is visible. Insertion of atargeting device and drilling of atargeting wire into the center of the insertion zone in the area of the intercondylar eminence. Overdrill the target wire with a4.5 mm drill. Reinforcement of the medial meniscus posterior horn with braided suture material. The reinforcing thread is inserted into the bone tunnel via an eyelet wire with athread loop. Optional additional centralization with incision in the middle part of the meniscus. Reinforcement of the meniscus base with braided suture material using the "outside in" technique and fixation of the inner meniscus base at the edge of the tibial plateau using atransosseous extraction suture or asuture anchor. Six weeks nonweight-bearing (0kg), then gradually increased load. Range of motion: 4weeks E/F 0-0-60°, 2weeks 0-0-90°, optionally use of avalgus brace (varus of < 5°). In root lesions of the medial meniscus, transosseous refixation significantly improves knee function (Lysholm, Hospital for Special Surgery, International Knee Documentation Committee, visual analog scale for pain, Tegner, and Knee Injury and Osteoarthritis Outcome scores) and reduces osteoarthritis progression. However, atransosseous suture alone could not significantly reduce postoperative extrusion. However, previous studies have shown that additional centralization can significantly reduce extrusion.

A Modified Triangular Arthroscopic Suture-Based Fixation for Tibial Eminence Fractures: Technique, Outcome and Literature Review.

Objectives: Tibial eminence fractures account for 2% to 5% of all knee injuries. Low-grade fractures, such as Type I, are typically treated conservatively, whereas high-grade fractures, such as Types III and IV, usually require surgical intervention. This paper describes a modified surgical arthroscopic technique, which employs pull-through triangle suture fixation for Type II and Type III arthroscopic intercondylar eminence avulsion fractures. In addition, we examined the efficacy and complication rate compared to the existing literature. Methods: Data were prospectively collected for knee arthroscopy surgeries and retrospectively analyzed with a minimum two-year follow-up. Twenty-three consecutive adults underwent arthroscopic treatment of displaced intercondylar Type II and Type III eminence fractures, as evidenced by clinical examination and imaging studies between May/2008 and May/2021. The patient's knee evaluation was performed using clinical symptoms and physical examination, along with International Knee Documentation Committee (IKDC) questionnaire and Tegner Activity Score. Compared to the literature, post-hoc power was calculated based on the mean Tegner Activity Score in our analysis. Results: fifteen females and eight males (mean age 33.9 years, range 19-56 years) were enrolled. The average postoperative follow-up was 35.4 months (27-53). The post-hoc power was 95% confidence in terms of the Tegner Activity Score. The mean ± standard deviation postoperative Tegner Activity Score was 8.2 ± 1.7 (6.8-10.0). Fifteen patients were classified as IKDC A (normal), six as IKDC B (nearly normal), and two as IKDC C (abnormal). The mean IKDC subjective score was 72.7 ± 23 (23-100). Twenty-four patients achieved normal flexion degrees compared with the unaffected side, while one patient achieved a flexion of only 0-90°. The group's mean flexion range of motion was 123 ± 16° (90-150°). Conclusion: This study presents a modified surgical arthroscopic suture fixation technique for tibial eminence fractures. The procedure is relatively simple and requires no more than basic arthroscopy equipment. The clinical and radiographic results indicate that this technique is safe, efficient, enables early initiation of rehabilitation, and has a lower complication rate in a variety of aspects compared with other fixation techniques used for tibial eminence fractures.

Poster 354: Tibiofemoral Bone Shape Features Are Associated with Re-Tear after Anterior Cruciate Ligament Reconstruction

Introduction: Knee bony morphology is linked to anterior cruciate ligament (ACL) injury, ACL graft failure, and osteoarthritis (OA) risk, and employing tools such as statistical shape modeling could identify individuals prone to these joint conditions. Re-tear after ACL reconstruction remains a common and devastating complication, and therefore, recognizing patients at high risk of graft failure before primary ACL reconstruction is crucial for potential intervention to reduce failure rates. Magnetic resonance imaging (MRI) is most commonly obtained in the setting of possible ACL injury and before ACL reconstruction surgery, yet currently available MRI-based bone shape assessment methods require high-resolution sequences or manual segmentation, limiting feasibility of large-scale analysis. The development of automated tools for bone shape extraction from clinical MRI could allow for three-dimensional statistical shape modeling across large datasets. We established an automated pipeline for bone segmentation from proton density (PD)-weighted MRI scans, aiming to extract knee bony morphology from preoperative clinical MRIs in patients with ACL injuries. We hypothesized that our segmentation pipeline could uncover specific tibiofemoral joint bone shape features associated with ACL re-tear after reconstruction. Objective: To identify bone shape features prior to initial primary ACL reconstruction in patients with eventual ACL graft re-tear compared to those with a known, intact ACL graft. Methods: Patients who retrospectively experienced a subsequent re-tear after reconstruction within three years of initial injury were compared to those without a re-tear within three years (20 without subsequent re-tear, 22 with subsequent re-tear for distal femur; 22 without subsequent re-tear, 19 with subsequent re-tear for proximal tibia). The control group had MRI scans at 3 years after reconstruction that confirmed an intact ACL graft. An automatic femur and tibia segmentation framework was developed by training two deep convolutional neural networks using clinical, two-dimensional PD-weighted knee MRI sequences (3.5 mm slice thickness) from patients with ACL tears. Using the segmentation pipeline, bone was automatically segmented from preoperative clinical PD-weighted knee MRI sequence (3 mm slice thickness), three-dimensional triangulated meshes were generated, scaled to a reference, and aligned and matched to an atlas using Iterative Closest Point algorithm. Modes of shape variance were extracted from principal component analysis (PCA). The effect of each mode is modeled by three-dimensional surfaces for each specific shape feature. Modes were considered statistically significant if the mean principal component score between groups was p&lt;0.05 using Students T-test. Results: Statistical shape modeling of the femoral condyles using 15 PCA modes reveals significant differences (p &lt; 0.05) in Modes 1 and 4 at the initial injury in patients who subsequently experienced ACL re-tear after reconstruction compared to those without re-tear. Femur Mode 1 is characterized by a narrower intercondylar notch width, a wider medial condylar width, and an increased ratio of femoral condylar offset in patients with ACL re-tear. Femur Mode 4 illustrates a more prominent trochlear sulcus and increased surface area along the lateral femoral condyle relative to the medial condyle in patients with ACL re-tear. The initial 15 PCA modes of the distal femur collectively account for 75.04% of the normalized accumulated total variance. Statistical shape modeling of the tibial plateau with 15 PCA modes reveals that Mode 7 is significantly different (p &lt; 0.05) at the initial injury in patients who experienced subsequent ACL re-tear after reconstruction compared to those without re-tear. Tibia Mode 7 indicates diminished ACL facet prominence, a squared lateral tibial plateau, and a broader, flatter tibial spine in patients with subsequent ACL re-tear. The first 15 PCA modes of the proximal tibia collectively explain 73.60% of the normalized accumulated total variance. Conclusions: Using an automatic bone segmentation pipeline on preoperative clinical MRIs, we identify specific shape features in the tibiofemoral joint associated with ACL re-tear after reconstruction. Patients with subsequent ACL re-tear exhibit a variety of distinct three-dimensional morphology differences, including reduced intercondylar notch width, wider medial condylar width, increased lateral tibial plateau convexity, and broader, lateralized tibial spine, uncovered using statistical shape modeling. Statistical shape modeling identifies three-dimensional morphology patterns, thus capturing differences otherwise unaccounted for by traditional two-dimensional measurements. This approach offers predictive potential for patients at risk of ACL re-tear, improving treatment decisions for those with high-risk morphologic features.

Evaluation of Tibial Slope on Radiographs in Pediatric Patients With Tibial Spine Fractures: An Age- and Sex-Matched Study.

A recent study has reported that the radiographic measurement of posterior tibial slope (PTS) is larger in male pediatric patients with tibial spine fractures (TSF) than in controls. However, they found no difference in PTS between female patients and controls. (1) To identify whether PTS is larger in female pediatric patients with TSF than in female controls and (2) to validate the relationship between PTS and pediatric TSF in male patients. Cross-sectional study; Level of evidence, 3. After an a priori power analysis, 84 pediatric patients with TSF (50 female patients and 34 male patients) and 84 age- and sex-matched controls were enrolled in this study. Demographic information, including sex, age, and race, was recorded. Skeletal maturity was determined based on the stage of epiphyseal union on knee radiographs. PTS was defined as the angle between a line perpendicular to the longitudinal axis of the tibia and the posterior inclination of the medial tibial plateau on standard knee lateral radiographs. The mean age when the TSF occurred was 11.2 ± 2.7 years for female patients and 12.9 ± 2.5 years for male patients. There was no significant difference in skeletal maturity between female patients and female controls or between male patients and male controls. The mean PTS was not significantly different between female patients (8.8°± 2.8°) and female controls (8.3°± 3.1°) (P = .366) or between male patients (9.0°± 2.8°) and male controls (9.3°± 2.6°) (P = .675). Those with a PTS >1 SD (2.9°) above the mean (8.8°) had no greater odds (1.0 [95% CI, 0.4-2.5]; P≥ .999) of having a TSF than others. PTS was not found to be a risk factor for pediatric TSF in female or male patients in this study.

Femorotibial angle on short knee radiographs fails to accurately predict the lower limb mechanical alignment. A systematic review and meta-analysis on different femorotibial angle definitions and short knee radiograph types.

Hip-knee-ankle angle (HKA) on Full Limb Radiographs (FLRs) is the gold standard for coronal knee alignment assessment. Despite the widespread utilization of the more convenient femorotibial angle (FTA) on either antero-posterior (AP) or postero-anterior (PA) short knee radiographs (SKRs), its definition and correlation with HKA remains controversial. This review is the first to systematically investigate FTA-HKA correlation and the effect of different FTA methods and SKRs. Systematic literature search (Pubmed, Scopus, Cochrane Library) followed PRISMA guidelines, to evaluate studies examining the FTA-HKA correlation. Meta-analyses compared the 3 most common FTA methods, knee center determination method and SKR types. 17 studies (2597 patients, 3234 knees) were included. The strongest correlation with HKA (r = 0.78) was found for FTA Method 1 (angle formed by lines drawn from the midpoint of tibial spines to points 10 cm above and below the joint line). No significant differences were observed when grouping the FTA methods by knee center assessment (Group I, r = 0.78; Group II, r = 0.77). AP SKRs showed a trend towards stronger FTA-HKA correlation compared to PA SKRs, in both Method 1 (r = 0.79 vs 0.75) and Method 3 (r = 0.80 vs 0.66). Irrespective of its definition or type of SKR used, FTA lacks reliable accuracy in predicting the HKA in most knees. FLRs should be used whenever precise estimation of the patient's alignment is necessary. Caution is warranted in interpreting studies investigating knee alignment or knee arthroplasty outcomes based on FTA.

Outcomes of isolated medial tibial plateau fractures by fracture morphology

PurposeTo identify a cohort of isolated medial tibial plateau fractures treated with surgical fixation and to categorize them by Moore and Wahlquist classifications in order to determine the rate of complications with each fracture morphology and the predictive value of each classification system. We hypothesized there would be high rates of neurovascular injury, compartment syndrome, and complications overall with a higher incidence of neurovascular injury in Moore type III rim avulsion fractures and Wahlquist type C fractures that enter the plateau lateral to the tibial spines. MethodsPatients who presented to six Level I trauma centers between 2010 and 2021 who underwent surgical fixation for isolated medial tibial plateau fractures were retrospectively reviewed. Data including demographics, radiographs, complications, and functional outcomes were collected. ResultsOne hundred and fifty isolated medial tibial plateau fractures were included. All patients were classified by the Wahlquist classification of medial tibial plateau fractures, and 139 patients were classifiable by the Moore classification of tibial plateau fracture-dislocations. Nine percent of fractures presented with neurovascular injury: 5 % with isolated vascular injury and 6 % with isolated nerve injury. There were no significant differences in neurovascular injury by fracture type (Wahlquist p = 0.16, Moore p = 0.33). Compartment syndrome developed in two patients (1.3 %). The average final range of motion was 0.8–122° with no difference by Wahlquist or Moore classifications (p = 0.11, p = 0.52). The overall complication rate was 32 % without differences by fracture morphology. The overall rate of return to the operating room (OR) was 25 %. ConclusionsIsolated medial tibial plateau fractures often represent fracture-dislocations of the knee and should receive a meticulous neurovascular exam on presentation with a high suspicion for neurovascular injury. No specific fracture pattern was found to be predictive of neurovascular injuries, complications, or final knee range of motion. Patients should be counseled pre-operatively regarding high rates of return to the OR after the index surgery.

Arthroscopic-Assisted Fixation of Tibial Spine Fractures

Tibial spine fractures (TSF) are an avulsion injury of the anterior cruciate ligament (ACL) at the insertion on the tibial plateau. These injuries predominantly affect the pediatric population and are important to treat appropriately as they act similarly to complete ACL injuries. The decision to pursue surgical management is dictated mostly by fracture displacement, but also by various factors such as concomitant injuries, age and level of activity. Multiple fixation strategies are available, ranging from transosseous suture and suture anchors to the use of screws, staples or absorbable nails.This technique paper describes the author's preferred technique involving an arthroscopic assisted reduction of the tibial spine fracture and transosseous suture fixation. High tensile non-absorbable sutures are passed through the base of the ACL which are then passed through two 2.4mm transosseous tunnels tied over a bone bridge on the anterior medial tibia.An arthroscopic approach has been reported to have similar positive outcomes when compared to open reductions. Furthermore, the transosseous suture construct has been described to be advantageous biomechanically and to yield satisfactory results when compared to alternative fixation options.

Impact of treadmill running on distal femoral cartilage thickness: a cross-sectional study of professional athletes and healthy controls

PurposeThis present study aimed to assess the impact of treadmill running on distal femoral cartilage thickness.MethodsProfessional athletes aged 20 to 40 years with a history of treadmill running (minimum 75 min per week for the past three months or more) and age-, sex-, and body mass index (BMI)-matched healthy controls were recruited. Demographics and clinical features of participants were recorded. Athletes were divided into subgroup 1 with less than 12 months of treadmill running and subgroup 2 with 12 months or more of treadmill running. Distal femoral cartilage thicknesses were measured at the midpoints of the right medial condyle (RMC), right intercondylar area (RIA), right lateral condyle (RLC), left medial condyle (LMC), left intercondylar area (LIA), and left lateral condyle (LLC) via ultrasonography.ResultA total of 72 athletes (mean age: 29.6 ± 6.6 years) and 72 controls (mean age: 31.9 ± 6.7 years) were enrolled. Athletes had significantly thinner cartilages in the RLC (2.21 ± 0.38 vs. 2.39 ± 0.31 cm, p = 0.002), LLC (2.28 ± 0.37 vs. 2.46 ± 0.35 cm, p = 0.004), and LMC (2.28 ± 0.42 vs. 2.42 ± 0.36 cm, p = 0.039) compared with the control group. Furthermore, cartilage thickness was significantly thinner in subgroup 2 athletes compared with the control group in the RLC (2.13 ± 0.34 vs. 2.39 ± 0.31 cm, p = 0.001), LLC (2.22 ± 0.31 vs. 2.46 ± 0.35 cm, p = 0.005), and LMC (2.21 ± 0.46 vs. 2.42 ± 0.36 cm, p = 0.027); however, subgroup 1 athletes did not have such differences. There was a weak negative correlation between total months of treadmill running and cartilage thickness in the RLC (r = − 0.0236, p = 0.046) and LLC (r = − 0.0233, p = 0.049). No significant correlation was found between the distal femoral cartilage thickness at different sites and the patients’ demographic features, including age, BMI, speed and incline of treadmill running, and minutes of running per session and week (p > 0.05).ConclusionCompared with healthy controls, professional athletes with a history of long-term high-intensity treadmill running had thinner femoral cartilages. The duration (months) of treadmill running was weakly negatively correlated with distal femoral cartilage thickness. Longitudinal studies with prolonged follow-ups are needed to clarify how treadmill running affects femoral cartilage thickness in athletes.

Case report of a new technique for with posterior cruciate ligament avulsion fractures treated with a mini transverse incision

Posterior cruciate ligament (PCL) is a strong stabilising ligament of the knee joint originating from posterior part of Intercondylar eminence oof tibia and attaches to the anterior part of medial surface of lateral condyle of femur. The PCL plays a major role in knee stabilization, and are statistically one of the rarest injuries around the knee. Due to the surrounding neurovascular elements in the popliteal space, very few open approaches to repair such injury were performed. The ‘‘safe transverse mini-incision approach’’ to PCL avulsion fracture is a simple approach, does not require exploration of the neurovascular elements, and produced satisfactory results in the majority of patients.

Tibial Spine Avulsion Fracture Fixation Using a Re-tensionable All-Suture Construct

Tibial spine avulsion injuries, including fractures, are a variant of anterior cruciate ligament injuries. Treatment historically consisted of open reduction and internal fixation of the avulsion fracture, with anterior cruciate ligament reconstruction considered in cases of failed open reduction and internal fixation or residual laxity. However, improved instrumentation has led to the advancement of various arthroscopic techniques for addressing these injuries. The emergence of newer implants designed for all-suture fixation has also overcome the limitations associated with screw fixation, such as hardware-related complications, challenges in treating comminuted fractures, and potential physeal injury. The purpose of this article is to describe a technique consisting of arthroscopic-assisted reduction and internal fixation of a tibial spine avulsion fracture with a re-tensionable all-suture–based construct using multiple looped cinch stitches and a cortical suspensory suture button device.

Comparison between Outcomes of Open and Arthroscopic Fixation of Tibial Spine Avulsion Fractures

OBJECTIVES This study aimed to compare the functional outcomes of fragment reduction and to measure the rate of postoperative complications between arthrotomy (ORIF) and arthroscopy(ARIF) pediatric tibial spine avulsion fractures using the Lysholm knee scoring system (limp, pain swelling, climbing stairs) and IKDC subjective knee evaluation form. METHODS: This Comparative Study was conducted at the Department of Orthopedic Surgery, Jinnah Hospital Lahore, between 2021-2022. A total of 42 patients who had tibial spine avulsion fracture with follow-up of 6 months were included. Twenty-one patients were treated with ORIF, and 21 were treated with ARIF. Functional outcomes were assessed using the IKDC score and LYSHOLM score (Follow-up rate was 95 %). Radiographic findings of patients were recorded, and a statistical study was done. The level of significance was set at &lt;0.05. RESULTS: The study revealed that out of 42 Participants, 36(85.71%) males and 6 (14.29 %) females participated in the survey with the age range of 8-16 years with a mean age of 12.02± (2.53) years. Out of 42 Participants, 22 (52.4%) had motor vehicle accidents with type 3(38.1%) and 4(54.8%) modified Meyers and Mckeever fracture classification. At the end of the follow-up period, the mean IKDC score was 90.52 + 1.50 (p = 0.00, CI = 95%). The Lysholm score was 90.676.11 compared to the last follow-up (p=0.20, CI = 95%). Compared to ORIF, only 5(11.9%) patients complained of post-op infection or vascular injury. CONCLUSION: This study observed better functional outcomes in arthroscopic reduction and immobilization than in open reduction internal fixation. Arthroscopy for TSAF decreases the risk of arthrofibrosis and minimizes morbidities and better management of symptoms. Compared to OIRF, ARIF showed good content validity for the IKDC and Lysholm scales.

Functional Outcome of Arthroscopic Suture Pull-Out Fixation in Tibial Spine Avulsion of Anterior Cruciate Ligament.

Tibial spine avulsion of the anterior cruciate ligament is a rare intraarticular injury of the knee. In this condition, the tibial attachment site of the anterior cruciate ligament is detached from the knee. The mechanism of the injury is hyperextension of the knee and rotation with valgus force. There are so many treatment options. This study aims to find out the functional outcome of Arthroscopic Suture pull-out fixation in this injury. This is a retrospective study done from August 15, 2019, to August 14, 2022. The outcome was analyzed by comparing the preoperative and 12-month postoperative International Knee Documentation Committee Score, Tegner Lysholm Score, Knee Range of motion, and Visual Analog Scale Score. Twenty-two patients were included with a mean age of 18.95 (13-31). Among them 15(68.2%) were male and 7(31.8%) were female. Arthroscopic suture pull-out fixation was done in all the cases. The knee range of motion was improved from preoperatively 35.00±7.86 to 135.68±3.50 at the final follow-up. The Tegner Lysholm score was improved from preoperatively 34.68±1.28 to 94.54±2.97 at the final follow-up. Preoperatively the VAS score was 8.04±1.27 which improved to 0.60±0.50 at the final follow-up. The IKDC score was 23.86±1.42 preoperatively which improved to 92.72±3.28 at the final follow-up with p-value < 0.001 Conclusions: Arthroscopic Suture pull-out fixation of tibial spine avulsion of the Anterior cruciate ligament is a good technique that restores the functions of the knee and has an excellent outcome Keywords: Anterior cruciate ligament; suture pull-out fixation; tibial spine avulsion.