Download PDF
J Knee Surg 2017; 30(01): 28-35
DOI: 10.1055/s-0036-1579682
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Arthroscopic Suture Pull-Out Fixation of Displaced Tibial Spine Avulsion Fracture

Vivek Pandey
1   Department of Orthopaedics, Kasturba Medical College, Madhav Nagar, Manipal, Udupi, Karnataka, India
,
Suman CPS
1   Department of Orthopaedics, Kasturba Medical College, Madhav Nagar, Manipal, Udupi, Karnataka, India
,
Kiran Acharya
1   Department of Orthopaedics, Kasturba Medical College, Madhav Nagar, Manipal, Udupi, Karnataka, India
,
Sharath K. Rao
1   Department of Orthopaedics, Kasturba Medical College, Madhav Nagar, Manipal, Udupi, Karnataka, India
› Author Affiliations
Further Information

Publication History

28 May 2015

15 January 2016

Publication Date:
10 March 2016 (online)

   Permissions and Reprints

Abstract

The aim of this study is to assess the clinical and radiological outcomes of arthroscopic reduction and fixation of tibial spine avulsion in patients with either open physis or closed physis, using high strength nonabsorbable sutures utilizing intravenous cannula needle as suture passer and retriever. Twenty-six patients of mean age 24.5 years were included in the study with a mean follow-up period of 31 months. Twelve patients had McKeever type III avulsion fracture and 14 had type IV. A follow-up analysis was performed using fracture union time, range of motion assessment, and Lysholm and IKDC (International Knee Documentation Committee) scores with instrumental (KT-1000 arthrometer) laxity assessment. All avulsion fractures showed union at the end of a 3-month follow-up. Mean (± standard deviation [SD]) postoperative Lysholm and IKDC subjective scores were 97.7 (± 3.62, range, 89–100) and 95.55 (± 4.21, 82.8–100), respectively. All patients were graded IKDC grade A except one with grade B. The Lysholm score of open physis group was better than the closed physis group (99.6 vs. 96.5, p < 0.03), whereas IKDC scores of open versus closed physis group (both subjective and objective) and type III and IV McKeever groups did not reveal any statistical difference. KT-1000 assessment revealed mean (± SD) anterior translation of the tibia as 0.85 (±0.9) mm. At the final follow-up, all patients achieved complete range of movement with no symptom of instability. Two patients underwent adhesiolysis for postoperative stiffness in their knee at 4th month postoperatively. Arthroscopic suture pull-out fixation for type III and IV tibial spine avulsion results in excellent clinical and radiological outcomes in patient with open and closed physis without any significant complications. This is a prospective case series with level of evidence IV.

Keywords

knee - tibial spine - avulsion fracture - arthroscopic reduction - pull-out suture fixation
 

  • References

  • 1 Kendall NS, Hsu SY, Chan KM. Fracture of the tibial spine in adults and children. A review of 31 cases. J Bone Joint Surg Br 1992; 74 (6) 848-852
    PubMedGoogle Scholar
  • 2 Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am 1959; 41-A (2) 209-222
    PubMedGoogle Scholar
  • 3 Zaricznyj B. Avulsion fracture of the tibial eminence: treatment by open reduction and pinning. J Bone Joint Surg Am 1977; 59 (8) 1111-1114
    CrossrefPubMedGoogle Scholar
  • 4 Panni AS, Milano G, Tartarone M, Fabbriciani C. Arthroscopic treatment of malunited and nonunited avulsion fractures of the anterior tibial spine. Arthroscopy 1998; 14 (3) 233-240
    CrossrefPubMedGoogle Scholar
  • 5 Sullivan DJ, Dines DM, Hershon SJ, Rose HA. Natural history of a type III fracture of the intercondylar eminence of the tibia in an adult. A case report. Am J Sports Med 1989; 17 (1) 132-133
    CrossrefPubMedGoogle Scholar
  • 6 Shelbourne KD, Urch SE, Freeman H. Outcomes after arthroscopic excision of the bony prominence in the treatment of tibial spine avulsion fractures. Arthroscopy 2011; 27 (6) 784-791
    CrossrefPubMedGoogle Scholar
  • 7 Koukoulias NE, Germanou E, Lola D, Papavasiliou AV, Papastergiou SG. Clinical outcome of arthroscopic suture fixation for tibial eminence fractures in adults. Arthroscopy 2012; 28 (10) 1472-1480
    CrossrefPubMedGoogle Scholar
  • 8 Furlan D, Pogorelić Z, Biocić M, Jurić I, Mestrović J. Pediatric tibial eminence fractures: arthroscopic treatment using K-wire. Scand J Surg 2010; 99 (1) 38-44
    CrossrefPubMedGoogle Scholar
  • 9 Doral MN, Atay OA, Leblebicioğlu G, Tetik O. Arthroscopic fixation of the fractures of the intercondylar eminence via transquadricipital tendinous portal. Knee Surg Sports Traumatol Arthrosc 2001; 9 (6) 346-349
    CrossrefPubMedGoogle Scholar
  • 10 Wiegand N, Naumov I, Vámhidy L, Nöt LG. Arthroscopic treatment of tibial spine fracture in children with a cannulated Herbert screw. Knee 2014; 21 (2) 481-485
    CrossrefPubMedGoogle Scholar
  • 11 Kobayashi S, Terayama K. Arthroscopic reduction and fixation of a completely displaced fracture of the intercondylar eminence of the tibia. Arthroscopy 1994; 10 (2) 231-235
    CrossrefPubMedGoogle Scholar
  • 12 Oohashi Y. A simple technique for arthroscopic suture fixation of displaced fracture of the intercondylar eminence of the tibia using folded surgical steels. Arthroscopy 2001; 17 (9) 1007-1011
    CrossrefPubMedGoogle Scholar
  • 13 Vega JR, Irribarra LA, Baar AK, Iñiguez M, Salgado M, Gana N. Arthroscopic fixation of displaced tibial eminence fractures: a new growth plate-sparing method. Arthroscopy 2008; 24 (11) 1239-1243
    CrossrefPubMedGoogle Scholar
  • 14 Wouters DB, de Graaf JS, Hemmer PH, Burgerhof JG, Kramer WL. The arthroscopic treatment of displaced tibial spine fractures in children and adolescents using Meniscus Arrows®. Knee Surg Sports Traumatol Arthrosc 2011; 19 (5) 736-739
    CrossrefPubMedGoogle Scholar
  • 15 Huang TW, Hsu KY, Cheng CY , et al. Arthroscopic suture fixation of tibial eminence avulsion fractures. Arthroscopy 2008; 24 (11) 1232-1238
    CrossrefPubMedGoogle Scholar
  • 16 Hunter RE, Willis JA. Arthroscopic fixation of avulsion fractures of the tibial eminence: technique and outcome. Arthroscopy 2004; 20 (2) 113-121
    PubMedGoogle Scholar
  • 17 May JH, Levy BA, Guse D, Shah J, Stuart MJ, Dahm DL. ACL tibial spine avulsion: mid-term outcomes and rehabilitation. Orthopedics 2011; 34 (2) 89
    PubMedGoogle Scholar
  • 18 Tudisco C, Giovarruscio R, Febo A, Savarese E, Bisicchia S. Intercondylar eminence avulsion fracture in children: long-term follow-up of 14 cases at the end of skeletal growth. J Pediatr Orthop B 2010; 19 (5) 403-408
    Google Scholar
  • 19 Wagih AM. Arthroscopic treatment of avulsed tibial spine fractures using a transosseous sutures technique. Acta Orthop Belg 2015; 81 (1) 141-146
    PubMedGoogle Scholar
  • 20 Gans I, Babatunde OM, Ganley TJ. Hybrid fixation of tibial eminence fractures in skeletally immature patients. Arthrosc Tech 2013; 2 (3) e237-e242
    CrossrefPubMedGoogle Scholar
  • 21 Accousti WK, Willis RB. Tibial eminence fractures. Orthop Clin North Am 2003; 34 (3) 365-375
    CrossrefPubMedGoogle Scholar
  • 22 Ahn JH, Yoo JC. Clinical outcome of arthroscopic reduction and suture for displaced acute and chronic tibial spine fractures. Knee Surg Sports Traumatol Arthrosc 2005; 13 (2) 116-121
    CrossrefPubMedGoogle Scholar
  • 23 Berg EE. Comminuted tibial eminence anterior cruciate ligament avulsion fractures: failure of arthroscopic treatment. Arthroscopy 1993; 9 (4) 446-450
    CrossrefPubMedGoogle Scholar
  • 24 Coyle C, Jagernauth S, Ramachandran M. Tibial eminence fractures in the paediatric population: a systematic review. J Child Orthop 2014; 8 (2) 149-159
    CrossrefPubMedGoogle Scholar
  • 25 Anderson CN, Nyman JS, McCullough KA , et al. Biomechanical evaluation of physeal-sparing fixation methods in tibial eminence fractures. Am J Sports Med 2013; 41 (7) 1586-1594
    CrossrefPubMedGoogle Scholar
  • 26 Bong MR, Romero A, Kubiak E , et al. Suture versus screw fixation of displaced tibial eminence fractures: a biomechanical comparison. Arthroscopy 2005; 21 (10) 1172-1176
    CrossrefPubMedGoogle Scholar
  • 27 Eggers AK, Becker C, Weimann A , et al. Biomechanical evaluation of different fixation methods for tibial eminence fractures. Am J Sports Med 2007; 35 (3) 404-410
    CrossrefPubMedGoogle Scholar
  • 28 Hapa O, Barber FA, Süner G , et al. Biomechanical comparison of tibial eminence fracture fixation with high-strength suture, EndoButton, and suture anchor. Arthroscopy 2012; 28 (5) 681-687
    CrossrefPubMedGoogle Scholar
  • 29 Sawyer GA, Anderson BC, Paller D, Schiller J, Eberson CP, Hulstyn M. Biomechanical analysis of suture bridge fixation for tibial eminence fractures. Arthroscopy 2012; 28 (10) 1533-1539
    CrossrefPubMedGoogle Scholar
  • 30 Hsu SY. An easy and effective method for reattaching an anterior cruciate ligament avulsion fracture from the tibial eminence. Arthroscopy 2004; 20 (1) 96-100
    CrossrefPubMedGoogle Scholar
  • 31 Janarv PM, Wikström B, Hirsch G. The influence of transphyseal drilling and tendon grafting on bone growth: an experimental study in the rabbit. J Pediatr Orthop 1998; 18 (2) 149-154
    CrossrefPubMedGoogle Scholar
  • 32 Stadelmaier DM, Arnoczky SP, Dodds J, Ross H. The effect of drilling and soft tissue grafting across open growth plates. A histologic study. Am J Sports Med 1995; 23 (4) 431-435
    CrossrefPubMedGoogle Scholar
  • 33 Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am 1970; 52 (8) 1677-1684
    CrossrefPubMedGoogle Scholar
  • 34 Delcogliano A, Chiossi S, Caporaso A, Menghi A, Rinonapoli G. Tibial intercondylar eminence fractures in adults: arthroscopic treatment. Knee Surg Sports Traumatol Arthrosc 2003; 11 (4) 255-259
    CrossrefPubMedGoogle Scholar
  • 35 Lafrance RM, Giordano B, Goldblatt J, Voloshin I, Maloney M. Pediatric tibial eminence fractures: evaluation and management. J Am Acad Orthop Surg 2010; 18 (7) 395-405
    CrossrefPubMedGoogle Scholar
  • 36 Mitchell JJ, Sjostrom R, Mansour AA , et al. Incidence of Meniscal Injury and Chondral Pathology in Anterior Tibial Spine Fractures of Children. J Pediatr Orthop 2015; 35 (2) 130-135
    CrossrefPubMedGoogle Scholar
  • 37 Muhle C, Thompson WO, Sciulli R , et al. Transverse ligament and its effect on meniscal motion. Correlation of kinematic MR imaging and anatomic sections. Invest Radiol 1999; 34 (9) 558-565
    CrossrefPubMedGoogle Scholar
  • 38 Kogan MG, Marks P, Amendola A. Technique for arthroscopic suture fixation of displaced tibial intercondylar eminence fractures. Arthroscopy 1997; 13 (3) 301-306
    CrossrefPubMedGoogle Scholar
  • 39 Montgomery KD, Cavanaugh J, Cohen S, Wickiewicz TL, Warren RF, Blevens F. Motion complications after arthroscopic repair of anterior cruciate ligament avulsion fractures in the adult. Arthroscopy 2002; 18 (2) 171-176
    CrossrefPubMedGoogle Scholar
  • 40 Kocher MS, Foreman ES, Micheli LJ. Laxity and functional outcome after arthroscopic reduction and internal fixation of displaced tibial spine fractures in children. Arthroscopy 2003; 19 (10) 1085-1090
    CrossrefPubMedGoogle Scholar
  • 41 Perugia D, Basiglini L, Vadalà A, Ferretti A. Clinical and radiological results of arthroscopically treated tibial spine fractures in childhood. Int Orthop 2009; 33 (1) 243-248
    CrossrefPubMedGoogle Scholar
  • 42 Sharma A, Lakshmanan P, Peehal J, David H. An analysis of different types of surgical fixation for avulsion fractures of the anterior tibial spine. Acta Orthop Belg 2008; 74 (1) 90-97
    PubMedGoogle Scholar
  • 43 Patel NM, Park MJ, Sampson NR, Ganley TJ. Tibial eminence fractures in children: earlier posttreatment mobilization results in improved outcomes. J Pediatr Orthop 2012; 32 (2) 139-144
    CrossrefPubMedGoogle Scholar
  • 44 Vander Have KL, Ganley TJ, Kocher MS, Price CT, Herrera-Soto JA. Arthrofibrosis after surgical fixation of tibial eminence fractures in children and adolescents. Am J Sports Med 2010; 38 (2) 298-301
    CrossrefPubMedGoogle Scholar
  • 45 Baxter MP, Wiley JJ. Fractures of the tibial spine in children. An evaluation of knee stability. J Bone Joint Surg Br 1988; 70 (2) 228-230
    PubMedGoogle Scholar