ARTHROSCOPIC TREATMENT OF ANTERIOR CRUCIATE LIGAMENT TIBIAL EMINENCE AVULSION FRACTURE IN ADOLESCENTS WITH EPIPHYSEAL UNCLOSURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIUYang , SUNXuebin ,  ZHANGKeyuan , LIGang , NIJiati

Department of Bone Disease and Sports Injury, the First Affiliated Hospital, Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China;

Corresponding?author：

ZHANGKeyuan, Email: sportsinjury@sina.cn

Keywords：

Arthroscopy; Anterior cruciate ligament; Avulsion fracture; Adolescents

DOI：

10.7507/1002-1892.20150156

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Objective To evaluate the clinical results of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fractures in adolescents with epiphyseal unclosure. Methods Between January 2011 and October 2013, 35 knees with ACL tibial eminence avulsion fractures (35 patients with epiphyseal unclosure) were arthroscopically treated with suture fixation. There were 25 males and 10 females, aged 8-16 years (mean, 14.7 years). The causes included sports injury in 24 cases, traffic accident injury in 9 cases, and daily life injury in 2 cases. According to Meyers-McKeever classification criteria, there were 27 cases of type Ⅱ and 8 cases of type Ⅲ. Five cases had meniscus injury. The preoperative the International Knee Documentation Committee (IKDC) score was 48.7±3.2, and Lysholm score was 51.2±4.5. The time from injury to operation was 2-16 days (mean, 5 days). Results Primary healing of incision was obtained in all patients. The mean follow-up time was 22.4 months (range, 12-32 months). Anatomical reduction was achieved in 28 cases and satisfactory reduction in 7 cases. X-ray films showed all fractures healing at last follow-up. There was no limb shortening deformity, varus knee, or valgus knee. Lachman test results were all negative. The other knees had normal range of motion except 1 knee with limited flexion, whose range of motion returned to 0-120° after treatment. At last follow-up, the IKDC score was significantly improved to 93.2±4.1 (t=-53.442, P=0.000), and the Lysholm score was significantly increased to 96.2±2.5 (t=-56.242, P=0.000). Conclusion The arthroscopic fixation technique has satisfactory results for the reduction and fixation of ACL tibial eminence avulsion fracture in the adolescents with epiphyseal unclosure because of little trauma and quick recovery.

Citation： LIUYang, SUNXuebin, ZHANGKeyuan, LIGang, NIJiati. ARTHROSCOPIC TREATMENT OF ANTERIOR CRUCIATE LIGAMENT TIBIAL EMINENCE AVULSION FRACTURE IN ADOLESCENTS WITH EPIPHYSEAL UNCLOSURE. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(6): 725-729. doi: 10.7507/1002-1892.20150156 Copy

1.	Kluemper CT, Snyder GM, Coats AC, et al. Arthroscopic suture fixation of tibial eminence fractures. Orthopedics, 2013, 36 (11):e1401-1406.
2.	Louis ML, Guillaume JM, Launay F, et al. Surgical management of type Ⅱ tibial intercondylar eminence fractures in children. J Pediatr Orthop B, 2008, 17(5):231-235.
3.	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.
4.	Koukoulias NE, Germanou E, Lola D, et al. Clinical outcome of arthroscopic suture fixation for tibial eminence fractures in adults. Arthroscopy, 2012, 28(10):1472-1480.
5.	Ahn JH, Lee YS, Lee DH, et al. Arthroscopic physeal sparing all inside repair of the tibial avulsion fracture in the anterior cruciate ligament:technical note. Arch Orthop Trauma Surg, 2008, 128(11):1309-1312.
6.	Lafrance RM, Giordano B, Goldblatt J, et al. Pediatric tibial eminence fractures:evaluation and management. J Am Acad Orthop Surg, 2010, 18 (7):395-405.
7.	Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg (Am), 1970, 52 (8):1677-1684.
8.	Su WR, Wang PH, Wang HN, et al. A simple, modified arthroscopic suture fixation of avulsion fracture of the tibial intercondylar eminence in children. J Pediatr Orthop B, 2011, 20 (1):17-21.
9.	Bohu Y, Klouche S, Lefevre N, et al. Translation, cross-cultural adaptation and validation of the French version of the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale. Knee Surg Sports Traumatol Arthrosc, 2015, 23(4):1192-1196.
10.	Swart E, Redler L, Fabricant PD, et al. Prevention and screening programs for anterior cruciate ligament injuries in young athletes:a cost-effectiveness analysis. J Bone Joint Surg (Am), 2014, 96(9):705-711.
11.	Kohl S, Stutz C, Decker S, et al. Mid-term results of transphyseal anterior cruciate ligament reconstruction in children and adolescents. Knee, 2014, 21(1):80-85.
12.	Cassard X, Cavaignac E, Maubisson L, et al. Anterior cruciate ligament reconstruction in children with a quadrupled semitendinosus graft:preliminary results with minimum 2 years of follow-up. J Pediatr Orthop, 2014, 34(1):70-77.
13.	Herman S, Lefevre N, Bohu Y. Anterior cruciate ligament tears in children. Journal de Traumatologie du Sport, 2015, 32(2):46-55.
14.	Coyle C, Jagernauth S, Ramachandran M. Tibial eminence fractures in the paediatric population:a systematic review. J Child Orthop, 2014, 8 (2):149-159.
15.	Herman MJ, Martinek MA, Abzug JM. Complications of tibial eminence and diaphyseal fractures in children:prevention and treatment. J Am Acad Orthop Surg, 2014, 22 (11):730-741.
16.	Jang KM, Bae JH, Kim JG, et al. Novel arthroscopic fixation method for anterior cruciate ligament tibial avulsion fracture with accompanying detachment of the anterior horn of the lateral meniscus:three-point suture fixation. Injury, 2013, 44 (8):1028-1032.
17.	Gausden EB, Calcei JG, Fabricant PD, et al. Surgical options for anterior cruciate ligament reconstruction in the young child. Curr Opin Pediatr, 2015, 27(1):82-91.
18.	Mahar AT, Duncan D, Oka R, et al. Biomechanical comparison of four different fixation techniques for pediatric tibial eminence avulsion fractures. J Pediatr Orthop, 2008, 28(2):159-162.
19.	Wiegand N, Naumov I, Vámhidy L, et al. Arthroscopic treatment of tibial spine fracture in children with a cannulated Herbert screw. Knee, 2014, 21(2):481-485.
20.	In Y, Kim JM, Woo YK, et al. Arthroscopic fixation of anterior cruciate ligament tibial avulsion fractures using bioabsorbable suture anchors. Knee Surg Sports Traumatol Arthrosc, 2008, 16(3):286-289.

1. Kluemper CT, Snyder GM, Coats AC, et al. Arthroscopic suture fixation of tibial eminence fractures. Orthopedics, 2013, 36 (11):e1401-1406.
2. Louis ML, Guillaume JM, Launay F, et al. Surgical management of type Ⅱ tibial intercondylar eminence fractures in children. J Pediatr Orthop B, 2008, 17(5):231-235.
3. 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.
4. Koukoulias NE, Germanou E, Lola D, et al. Clinical outcome of arthroscopic suture fixation for tibial eminence fractures in adults. Arthroscopy, 2012, 28(10):1472-1480.
5. Ahn JH, Lee YS, Lee DH, et al. Arthroscopic physeal sparing all inside repair of the tibial avulsion fracture in the anterior cruciate ligament:technical note. Arch Orthop Trauma Surg, 2008, 128(11):1309-1312.
6. Lafrance RM, Giordano B, Goldblatt J, et al. Pediatric tibial eminence fractures:evaluation and management. J Am Acad Orthop Surg, 2010, 18 (7):395-405.
7. Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg (Am), 1970, 52 (8):1677-1684.
8. Su WR, Wang PH, Wang HN, et al. A simple, modified arthroscopic suture fixation of avulsion fracture of the tibial intercondylar eminence in children. J Pediatr Orthop B, 2011, 20 (1):17-21.
9. Bohu Y, Klouche S, Lefevre N, et al. Translation, cross-cultural adaptation and validation of the French version of the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale. Knee Surg Sports Traumatol Arthrosc, 2015, 23(4):1192-1196.
10. Swart E, Redler L, Fabricant PD, et al. Prevention and screening programs for anterior cruciate ligament injuries in young athletes:a cost-effectiveness analysis. J Bone Joint Surg (Am), 2014, 96(9):705-711.
11. Kohl S, Stutz C, Decker S, et al. Mid-term results of transphyseal anterior cruciate ligament reconstruction in children and adolescents. Knee, 2014, 21(1):80-85.
12. Cassard X, Cavaignac E, Maubisson L, et al. Anterior cruciate ligament reconstruction in children with a quadrupled semitendinosus graft:preliminary results with minimum 2 years of follow-up. J Pediatr Orthop, 2014, 34(1):70-77.
13. Herman S, Lefevre N, Bohu Y. Anterior cruciate ligament tears in children. Journal de Traumatologie du Sport, 2015, 32(2):46-55.
14. Coyle C, Jagernauth S, Ramachandran M. Tibial eminence fractures in the paediatric population:a systematic review. J Child Orthop, 2014, 8 (2):149-159.
15. Herman MJ, Martinek MA, Abzug JM. Complications of tibial eminence and diaphyseal fractures in children:prevention and treatment. J Am Acad Orthop Surg, 2014, 22 (11):730-741.
16. Jang KM, Bae JH, Kim JG, et al. Novel arthroscopic fixation method for anterior cruciate ligament tibial avulsion fracture with accompanying detachment of the anterior horn of the lateral meniscus:three-point suture fixation. Injury, 2013, 44 (8):1028-1032.
17. Gausden EB, Calcei JG, Fabricant PD, et al. Surgical options for anterior cruciate ligament reconstruction in the young child. Curr Opin Pediatr, 2015, 27(1):82-91.
18. Mahar AT, Duncan D, Oka R, et al. Biomechanical comparison of four different fixation techniques for pediatric tibial eminence avulsion fractures. J Pediatr Orthop, 2008, 28(2):159-162.
19. Wiegand N, Naumov I, Vámhidy L, et al. Arthroscopic treatment of tibial spine fracture in children with a cannulated Herbert screw. Knee, 2014, 21(2):481-485.
20. In Y, Kim JM, Woo YK, et al. Arthroscopic fixation of anterior cruciate ligament tibial avulsion fractures using bioabsorbable suture anchors. Knee Surg Sports Traumatol Arthrosc, 2008, 16(3):286-289.

Chinese Journal of Reparative and Reconstructive Surgery

ARTHROSCOPIC TREATMENT OF ANTERIOR CRUCIATE LIGAMENT TIBIAL EMINENCE AVULSION FRACTURE IN ADOLESCENTS WITH EPIPHYSEAL UNCLOSURE

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