Arthroscopic Management of Tibial Spine Avulsion Fractures: Principles and Techniques. Issue 10 (15th May 2018)

• Record Type: Journal Article
• Authors: Strauss, Eric J.; Kaplan, Daniel James; Weinberg, Maxwell E.; Egol, Jonathan; Jazrawi, Laith M.
• Is Part Of: Journal of the American Academy of Orthopaedic Surgeons. Volume 26:Issue 10(2018)
• Publication Date: 2018-05-15
• Subjects: arthroscopic tibial spine reduction -- arthroscopic reduction and internal fixation -- suture fixation -- tibial spine -- tibial spine reduction -- tibial spine suture; Orthopedics -- Periodicals; Orthopedic surgery -- Periodicals; Joint Diseases -- Periodicals; Orthopedics -- Periodicals; Orthopedic surgery; Orthopedics; Periodicals; 616.7005
• DOI: 10.5435/JAAOS-D-16-00117
• Languages: English
• ISSNs: 1067-151X

Abstract

Abstract : Tibial spine fractures are uncommon injuries affecting the insertion of the anterior cruciate ligament on the tibia. They typically occur in skeletally immature patients aged 8 to 14 years and result from hyperextension of the knee with a valgus or rotational force. Diagnosis is based on history, physical examination, and standard radiographs. The use of MRI can identify entrapped soft tissue that may prevent reduction. Open or arthroscopic repair is indicated in patients with partially displaced fractures (>5 mm) with one third to one half of the avulsed fragment elevated, in patients who have undergone unsuccessful nonsurgical reduction and long leg casting or bracing, and in patients with completely displaced fractures. Arthroscopy offers reduced invasiveness and decreased morbidity. Suture fixation and screw fixation have produced successful results. Suture fixation can eliminate the risk of fracture fragment comminution during screw insertion, the risk of neurovascular injury, and the need for hardware removal. Suture fixation is ideal in cases in which existing comminution prevents screw fixation.