Treatment Of Tibial Eminence Fractures Research Articles

Arthroscopic fixation techniques for tibial eminence fractures in pediatric patients: a review.

The introduction of new internal fixation devices and arthroscopic techniques has led to significant changes in the surgical treatment of tibial eminence fractures (TEFs) in children. In recent years, arthroscopic surgery has arisen as the gold standard for the treatment of TEFs. This popularity of arthroscopic techniques has reduced surgical complications and improved patient prognosis. In this paper, we investigate the current situation of the use of arthroscopic fixation techniques for pediatric TEFs. We searched the PubMed database using the terms "arthroscopic treatment and tibial eminence," "arthroscopic treatment and tibial spine," "tibial eminence avulsion", "tibial spine fracture", with no limit on the year of publication. From these articles, we reviewed the use of various arthroscopic TEFs fixation techniques reported in the current literature. Overall, we found that the choice of fixation method seems to have no effect on clinical outcomes or imaging results. However, if an easy, strong fixation that is less prone to epiphyseal damage is desired, as a junior practitioner, the anchor technique should be mastered first, whereas for senior practitioners, a variety of fixation techniques for TEFs should be mastered, including anchors, sutures, and screws, so that personalized fixation can be achieved with the least amount of trauma, operative time, and complications. Higher quality studies are needed in the future to provide Useful evidence to determine the optimal fixation technique in terms of clinical outcomes, function, and complications.

The Relationship Between Posterior Tibial Slope and Pediatric Tibial Eminence Fractures

Background: Tibial eminence fractures are bony avulsions of the anterior cruciate ligament from its insertion on the intercondylar eminence. Numerous anatomic factors have been associated with anterior cruciate ligament injuries, such as posterior tibial slope, but there are few studies evaluating the association with tibial eminence fracture. Purpose: To compare posterior tibial slope of pediatric patients with and without tibial eminence fractures. We hypothesized that a steeper posterior tibial slope would be associated with tibial eminence fracture. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent surgical treatment of tibial eminence fracture were retrospectively identified between January 2000 and July 2021. Adults aged >20 years and those without adequate imaging were excluded. Controls without gross ligamentous or osseous pathology were identified. Descriptive information and Meyers and McKeever classification were recorded. Posterior tibial slope measurements were obtained by 2 independent orthopaedic surgeons twice, with measurements separated by 3 weeks. Chi-square tests and independent-samples t tests were used to compare posterior tibial slope and patient characteristics. Inter- and intrareviewer variability was determined via the intraclass correlation coefficient. Results: A total of 51 patients with tibial eminence fractures and 57 controls were included. By sex, tibial eminence fractures occurred among 34 male and 17 female patients with a mean age of 10.9 years. The posterior tibial slope among those with tibial eminence fractures (9.7°) was not significantly greater than that of controls (8.8°; P = .07). Male patients with a tibial eminence fracture had significantly steeper slopes compared with controls (10.0° vs 8.4°; P = .006); this difference was not observed between female patients and female controls. Patients with a slope ≥1 SD above the mean (12.0°) had 3.8 times greater odds (95% CI, 1.3-11.6; P = .017) of having a tibial eminence fracture. Male patients with a posterior tibial slope >12° had 5.8 times greater odds (95% CI, 1.1-29.1; P = .034) of having a tibial eminence fracture compared with male controls. Conclusion: Male patients undergoing surgical fixation of a tibial eminence fracture had an increased posterior tibial slope as compared with case-controls. Increased posterior tibial slope may be a risk factor for sustaining a tibial eminence fracture, although the clinical significance of this deserves further investigation.

Arthroscopic fixation for tibial eminence fractures: A clinical retrospective study of cannulated screws versus transosseous anchor knot fixation techniques with suture anchors

BackgroundA variety of different techniques or methods for treatment of tibial eminence fracture (TEF) have been reported, but there is still controversy on the optimum choice for treating TEFs. The aim of the current work was to compare the clinical outcomes of arthroscopic cannulated screw fixation and a new arthroscopic anchor fixation technique for tibial eminence fracture. MethodsWe included 69 isolated tibial eminence fracture patients from June 2012 to February 2017; 36 patients received the cannulated screw fixation and 33 received the transosseous anchor knot (TAK) fixation under arthroscopy. The two techniques were performed by two different high-volume surgeons. The clinical efficacies of the two techniques were assessed by radiographs, extension deficit, flexion deficit, anterior drawer test (ADT), Lachman test, Lysholm scores and International Knee Documentation Committee (IKDC) scores in follow ups. ResultsPatients were followed up for 35.8 months on average (range, 24–54 months). There were 40 (58%) males and 29 (42%) females included, and four (6%) patients were ＜18 years old. Asymptomatic grade II laxity was found in two patients in the CS group and three patients in the TAK group from the results of Lachman test. Postoperative radiographs in all patients showed anatomic reductions and bony unions were achieved within 12 weeks. There were no significant differences in extension deficit, flexion deficit, ADT, Lachman test, Lysholm scores and IKDC scores between groups (P > 0.05). ConclusionsThe TAK technique shows satisfactory clinical and radiological outcomes equal to the cannulated screw fixation, which is applicable for TEFs as a reliable effective method.

Effect of Skeletal Maturity on Fixation Techniques for Tibial Eminence Fractures.

Background:Several fixation methods have been reported for the operative treatment of tibial eminence fractures. Previous biomechanical studies have demonstrated that suture fixation may be a stronger construct; however, the maturity status of these specimens was not scrutinized.Purpose:To examine if suture fixation remains a biomechanically superior fixation method to screw fixation in both skeletally mature and immature specimens.Study Design:Controlled laboratory study.Methods:Sixteen total matched porcine (Yorkshire) knees (8 skeletally immature knees and 8 skeletally mature knees) were procured, and a standardized tibial eminence fracture was created. In each age-matched group of knees, 4 knees underwent randomization to fixation with 2 screws while 4 knees were randomized to fixation using a dual-suture technique. Once fixation was complete, the specimens underwent cyclic loading (200 cycles) in the anteroposterior plane of the tibia and load-to-failure testing, both with the knee positioned at 30° of flexion. Relevant measurements were recorded, and data were analyzed.Results:Among mature specimens, load to failure was 1.9 times higher in the suture fixation group compared with the screw fixation group (1318.84 ± 305.55 vs 711.66 ± 279.95 N, respectively; P = .03). The load to failure was not significantly different between the groups in immature specimens (suture: 470.00 ± 161.91 N vs screw: 348.79 ± 102.46; P = .08).Conclusion:These findings suggest that suture fixation may represent a better construct choice for fixation of tibial eminence fractures in the skeletally mature population. However, in the skeletally immature population, fixation with screws or suture may be equivalent. Displacement after cyclic loading did not appear to differ by fixation method, nor did stiffness.Clinical Relevance:A stronger fixation construct may be beneficial and allow for earlier range of motion to help potentially decrease postoperative stiffness. Clinical studies are warranted to see if these results may be replicated in humans.

ANTERIOR CRUCIATE LIGAMENT TEAR FOLLOWING SURGICAL TREATMENT OF PEDIATRIC TIBIAL EMINENCE FRACTURE IN A MULTICENTER COHORT

Background:While operative treatment of displaced pediatric tibial eminence fractures has generally been shown to be safe, post-operative complications including arthrofibrosis, infection, fixation failure, and postoperative ipsilateral ACL injuries remain prevalent. The purpose of this study was to describe the prevalence of and risk factors for post-operative ACL tears in a cohort of patients surgically treated for tibial eminence fracture.Methods:We performed a retrospective review of children undergoing treatment of a tibial eminence fracture at 10 tertiary children’s hospitals.. The primary outcome was subsequent ACL rupture. Patients with 2 year follow up data and those that had met the primary outcome within the 2 year period, were analyzed for demographics, risk factors and survival analysesResults:385 pediatric patients were reviewed. Overall, 46 patients had either 2 year follow up data or met the primary outcome measure of an ACL tear prior to the 2 year mark. Mean age was 11.2 years old (SD 2.8), and the median follow time was 36.4 months (SD 17.7 months) There was a 21.7% incidence of subsequent ACL tear in the cohort analyzed. Subsequent ACL tears occurred at a median of 10.2 months (SD 19.5 months) postoperatively. There was a statistically significant association with higher Myers & McKeever grade tibial spine fractures (Type III and IV) and subsequent ACL rupture (p=0.006). Subsequent ACL tears occurred in patients who were older when they had their original tibial eminence fracture, 13.4 years old versus 11.3 years old (p=0.035). There was no statistically significant relationship between ipsilateral ACL tear and body mass index, operative time, fixation method used, postoperative weight bearing status, type of postoperative immobilization, contact versus non-contact injury mechanism, type of post-operative physical therapy protocol based on chi-squared or t-test (p>0.05).Conclusion:Subsequent ipsilateral ACL tears following operatively treated pediatric tibial eminence fractures in a large multicenter cohort occurred at a rate of 21.7%. They were associated with completely displaced (Type III or IV) tibial eminence fractures, and older patients. Clinicians should therefore continue to follow patients for at least 2 years after treatment of pediatric tibial eminence fractures in order to track this potential complication.

Anterior Cruciate Ligament Tear Following Operative Treatment of Pediatric Tibial Eminence Fractures in a Multicenter Cohort

Postoperative ipsilateral anterior cruciate ligament (ACL) tears after tibial eminence fracture fixation has been previously noted in the literature. This study aims to describe the prevalence of and risk factors for postoperative ACL tears in a cohort of patients operatively treated for tibial eminence fracture. A retrospective review of children undergoing treatment of a tibial eminence fracture at 10 tertiary care children's hospitals was performed. The primary outcome of interest was subsequent ACL rupture. Incidence of ACL tear was recorded for the entire cohort. Patients who sustained a postoperative ACL tear were compared with those without ACL tear and analyzed for demographics and risk factors. A subgroup analysis was performed on patients with a minimum of 2-year follow-up data or those who had met the primary outcome (ACL tear) before 2 years. A total of 385 pediatric patients were reviewed. 2.6% of the cohort experienced a subsequent ACL tear. The median follow-up time was 6.5 months (SD=6.4 mo). Subsequent ACL tears occurred at a median of 10.2 months (SD=19.5 mo) postoperatively. There was a statistically significant association with higher grade tibial spine fractures (Myers and McKeever type III and IV) and subsequent ACL tear (P=0.01). Patients with a subsequent ACL tear were older on average (13.5 vs. 12.2 y old), however, this difference was not statistically significant (P=0.08). Subgroup analysis of 46 patients who had a 2-year follow-up or sustained an ACL tear before 2 years showed a 21.7% incidence of a subsequent ACL tear. There was a statistically significant association with higher grade tibial spine fractures (Myers and McKeever type III and IV) and subsequent ACL rupture (P=0.006) in this subgroup. Postoperative ACL tears occurred in patients who were older at the time that they sustained their original tibial eminence fracture (13.4 vs. 11.3 y old, P=0.035). Ipsilateral ACL tears following operatively treated pediatric tibial eminence fractures in a large multicenter cohort occurred at a rate of 2.6%. However, in those with at least 2 years of follow-up, the incidence was 21.7%. Subsequent ACL tear was more likely in those with completely displaced (type III or IV) tibial eminence fractures and older patients. Level III-retrospective cohort study.

Arthroscopic treatment of tibial eminence fractures using double-loop endobutton device: Surgical technique and short-term treatment outcomes.

Objectives This study aims to explain the arthroscopic surgical technique of double-loop endobutton device for tibial eminence fractures and share the outcomes of this treatment method.Patients and methods Thirteen patients (10 males, 3 females; mean age 19.9±5.6 years; range, 14 to 34 years) with tibial eminence fractures type II, IIIa, and IIIb were analyzed retrospectively between March 2017 and March 2019. Knee laxity, Tegner Lysholm knee scores, the International Knee Documentation Committee (IKDC) scores, knee mobility, Lachman test, and bone union were analyzed after the arthroscopic fracture fixation with double-loop endobutton device at first and sixth months after surgery.Results First month mean IKDC scores were 38.0±7.0 and mean Tegner Lysholm scores were 50.3±5.8. Sixth month mean IKDC scores were 80.2±4.0 and mean Tegner Lysholm scores were 87.1±5.4. All patients showed negative Lachman test and negative pivot-shift test at final follow-up. Radiological bone union without reduction loss was also seen in all patients.ConclusionUsing double-loop endobutton device provides successful results to fix tibial eminence fractures.

The clinical effect and safety of the treatment of tibia intercondylar eminence fracture with cannulated screw and suture fixation under arthroscope: Protocol for a systematic review and meta-analysis of randomized controlled trials.

Background:The clinical effects and safety over the treatment of tibia intercondylar eminence fracture (TIEF) with cannulated screw and suture fixation were evaluated under arthroscope systematically, providing evidence-based medical support for the selection of surgical methods in terms of minimally invasive arthroscopic treatment for TIEF.Methods:The English databases of PubMed, EMBASE, Cochrane Library, CNKI, SinoMed, VIP, and Wanfang databases were searched by computer. The randomized controlled trials were conducted to compare the clinical effects of TIEF with cannulated screw and suture fixation under arthroscope. The retrieval period is from the beginning of database building to January 2020. There is no language restriction. Chinese databases are searched by keywords, while English databases are searched by the combination of subject words and free words. According to the retrieval strategy, the two evaluators will lead the conforming documents into Note Express for repeated literature screening, and the two evaluators will extract and cross-check the conforming documents according to the pre-designed data extraction table. Two researchers adopted the modified Jadad scale independently to evaluate the quality of the literature. The RevMan 5.3 version software provided by the Cochrane Collaboration Network was adopted for statistical analysis.Results:The study will strictly review and extract the data included in the literature, and scientifically make statistical analysis for the pre-set outcome indicators. All the research processes will be conducted in strict accordance with the guidance of system evaluation. In this study, the differences between cannulated screw fixation and suture fixation under arthroscopy will be evaluated by comparing the relevant outcome indicators. All the results of this study will be published openly in a highly influential professional academic journal.Conclusion:The paper adopted Cochrane system evaluation method to collect and sort out the published literature about the treatment of tibial eminence fracture between cannulated screw fixation and suture fixation under arthroscopy, and to compare the clinical efficacy and safety of the two fixation methods utilizing meta-analysis and comparison of related outcome indicators. Through this study, we will draw a positive conclusion, which will provide a basis for the better treatment of tibial eminence fracture.PROSPERO registration number:PROSPERO CRD42020168433.

Arthroscopic Fixation of Tibial Eminence Fractures: A Biomechanical Comparative Study of Screw, Suture, and Suture Anchor

To compare biomechanical outcomes of 4 different arthroscopic techniques for fixation of tibial eminence fractures. Twenty-four skeletally mature, fresh-frozen cadaveric knees were divided into 4 comparison groups based on the fixation method: screw fixation (group A), traditional sutures fixation with 2 FiberWire sutures (group B), a modified suture technique with 2 FiberWire sutures that created neckwear knots to firmly trap the fracture fragment (group C), or suture anchors which was based on the suture bridge technique primarily used in the shoulder for repair of rotator cuff tears and greater tuberosity fractures (group D). A tibial eminence fracture was created in each knee for subsequent fixation. After fixation, each knee underwent cyclic loading of 100N to assess the displacement change after500 cycles of the fixation construct. Afterward, a single tensile failure test load was performed to assess the ultimate failure load, stiffness, and failure mode for each specimen. All specimens survived cyclic testing and were subsequently loaded to failure. Group C had the highest ultimate failure load (P < .05) and group D had the lowest displacement compared with the other 3 groups (P < .05). Different failure modes were found among the 4 groups. Suture fixation using the neckwear knots technique provides superior fixation with regard to higher ultimate failure load, and absorbable suture anchor fixation with the suture bridge technique provides less displacement under cyclic loading conditions. Both techniques exhibited superior biomechanical properties compared with traditional screw and suture fixation. The new techniques showed satisfactory biomechanical properties and provided more choice for surgeons in the treatment of tibial eminence fractures.

The Surgical Treatment of Tibial Eminence Fractures in Skeletally Immature Children

The Surgical Treatment of Tibial Eminence Fractures in Skeletally Immature Children

Arthroscopic treatment of tibial eminence fracture: a systematic review of different fixation methods.

Arthroscopy procedures are the gold standard for the management of tibial spine avulsion. This review evaluates and compares different arthroscopic treatment options for tibial spine fractures. PubMed, Medline, Ovid, Google Scholar and Embase databases were systematically searched with no limit regarding the year of publication. An arthroscopic approach compared with arthrotomy reduces complications such as soft-tissue lesions, post-operative pain and length of hospitalization. The use of suture techniques, compared to cannulated screw technique, avoids a second surgery for removal of the screws, but requires longer immobilization and partial weight bearing. Clinical outcomes and radiographic results do not seem to differ in relation to the chosen method of fixation. Further studies are needed to produce clear guidelines to define the best choice in terms of clinical outcomes, function and complications.

Treatment of tibial eminence fracture in children; two cases

Treatment of tibial eminence fracture in children; two cases

Treatment and Management Outcomes of Tibial Eminence Fractures in Pediatric Patients

Background: Tibial eminence fractures are rare but occur more frequently in children and adolescents. There are a variety of methods to surgically treat these fractures, but surgeons disagree about the optimal method of reduction and fixation. Hypotheses: Regarding clinical results and complications after treatment in children and adolescent patients with tibial eminence fractures, the authors hypothesize that (1) there is no difference between reduction and fixation with screws versus sutures, (2) there is no difference in arthroscopic versus open reduction and fixation, and (3) outcomes are better in patients with minimally displaced (types I and II) versus completely displaced (types III and IV) fractures. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed studying the treatment of tibial eminence fractures in children and adolescents to determine clinical results, functional outcomes, and complications. A meta-analytic technique on observational studies was used to compare outcomes when sufficient data were available. Results: The review identified 26 articles with extractable clinical results and data on complications: 1 level 3 article and 25 level 4 articles. Ten of 580 tibial eminence fractures identified in the literature had nonunion, with 60% of nonunions occurring in type III fractures treated by nonoperative modalities. Appreciable healing was noted for both open and arthroscopic fixation techniques as well as patients treated by screw or suture fixation. Laxity (P < .001) and loss of range of motion (P = .009) occurred significantly less after the treatment of minimally displaced fractures (types I and II). Conclusion: The level of evidence supporting various treatments of tibial eminence fractures in children and adolescents is low. There is insufficient evidence to conclude the superiority of open versus arthroscopic fixation or screw versus suture fixation techniques. Nonoperative treatment of completely displaced tibial eminence fractures results in higher rates of nonunion. Type III and IV fractures heal with greater laxity and greater loss of range of motion after treatment. Higher level studies are necessary to determine the optimal method of fixation for tibial eminence fractures.

Pediatric Tibial Eminence Fractures: Arthroscopic Treatment Using K-Wire

Fractures of the tibial intercondylar eminence are observed mostly in children and adolescents, often after minimal trauma. The purpose of this paper is to evaluate the use of K-wire fixation for the arthroscopic treatment of tibial eminence fractures in children. From January 2002 through January 2009 ten patients were treated arthroscopically because of the intercondylar eminence fracture in a Department of pediatric surgery, University Hospital Split. Arthroscopically controlled reposition was done, and using mobile X-ray two crossed K-wires were introduced percutaneously from the proximal part of the tibia to the fractured intercondylar eminence. Subjective outcome was obtained using IKDC subjective questionnaire. Average hospitalization time was 11 days. Average duration of treatment was 12.5 weeks. Average follow-up was 42 months. Follow-up radiographs showed union in all cases. The mean IKDC subjective score was 96/100. Clinically, all patients exhibited a solid endpoint on the Lachman test. The global IKDC objective score was normal in eight knees and nearly normal in two knees. Arthroscopic reduction and fixation by Kirschner wires or a small fragment screw is the best way for treatment intercondylar tibial eminence fractures, in the pediatric population, because is not crossing the epiphyseal plate.

Suture Versus Screw Fixation of Displaced Tibial Eminence Fractures: A Biomechanical Comparison

Classification and treatment of tibial eminence fractures are determined by the degree of fragment displacement. A variety of surgical procedures have been proposed to stabilize displaced fractures using both open and arthroscopic techniques. Two common fixation techniques involve use of cannulated screws and sutures tied over an anterior tibial bone bridge. We are unaware of any biomechanical studies that have compared the strength of various techniques of fixation. Biomechanical study in a cadaveric model. Seven matched pairs of fresh-frozen human cadaveric knees were stripped of all soft tissue except the anterior cruciate ligament (ACL). Simulated type III tibial eminence fractures were created using an osteotome. Fragments of each matched pair were randomized to fixation with either a single 4-mm cannulated cancellous screw with a washer or an arthroscopic suture technique using 3 No. 2 Fiberwire sutures (Arthrex, Naples, FL) passed through the tibial base of the ACL and tied over bone tunnels on the anterior tibial cortex. Specimens were then loaded with a constant load rate of 20 mm/min, and load-deformation curves were generated. The ultimate strength and stiffness were computed for each curve. The failure mode for each test was observed. A paired 2-tailed t test was used to determine the statistically significant difference between the two methods. Specimens fixed with Fiberwire had a mean ultimate strength of 319 N with a standard deviation of 125 N. Those fixed with cannulated screws had a mean ultimate strength of 125 N with a standard deviation of 74 N. This difference was statistically significant (P = .0038). There was no significant difference between the mean stiffness of Fiberwire constructs (63 N; SD, 50 N) and the mean stiffness of the cannulated screw constructs (20 N; SD, 32 N). The failure modes of the Fiberwire constructs included 1 ACL failure, 3 failures of suture cutting through the anterior tibial cortex, and 3 of suture cutting through the tibial eminence fragment. The single mode of failure for the cannulated screw constructs was screw pullout of cancellous bone. The initial ultimate strength of Fiberwire fixation of tibial eminence fractures in these specimens was significantly stronger than that of cannulated screw fixation. It appears that Fiberwire fixation of eminence fractures provides biomechanical advantages over cannulated screw fixation and may influence the type of treatment one chooses for patients with tibial eminence fractures.

Tibial eminence fracture with meniscal entrapment

Controversy has existed regarding the treatment of tibial eminence fractures in children. It has been widely assumed that closed manipulation of the knee resulting in radiographic reduction of the fragment is acceptable. We present a case report of a trapped medial meniscus, even after apparent successful closed reduction of an incompletely displaced tibial eminence fracture. The integrity of meniscii cannot be inferred radiographically. Arthroscopic evaluation allows reduction of a trapped meniscus and suture fixation of the fragment is easily accomplished.