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CC-BY 4.0 · Surg J (N Y) 2016; 02(04): e151-e155
DOI: 10.1055/s-0036-1597663
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Effect of Bony Parameters on the Pediatric Knee: Normal versus Anterior Cruciate Ligament Injury versus Tibial Spine Avulsion Fracture

Kenneth A. Shaw
1   Department of Orthopaedic Surgery, Dwight David Eisenhower Army Medical Center, Fort Gordon, Georgia
,
Brian S. Dunoski
2   Department of Pediatric Radiology, Children's Mercy Hospital, Kansas City, Missouri
,
Neil Mardis
2   Department of Pediatric Radiology, Children's Mercy Hospital, Kansas City, Missouri
,
Donna Pacicca
3   Department of Pediatric Orthopaedic Surgery, Children's Mercy Hospital, Kansas City, Missouri
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Publikationsverlauf

26. April 2016

18. November 2016

Publikationsdatum:
22. Dezember 2016 (online)

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Abstract

Purpose Anterior cruciate ligament (ACL) injuries can present as a ligamentous disruption or avulsion fracture of the tibial spine in pediatric patients. Differences in knee morphometric parameters have been investigated between pediatric cohorts with ACL disruptions and tibial spine avulsion fractures. However, no study to date has compared morphometric parameters in patients with tibial spine avulsion fracture against a control population.

Methods A retrospective review of pediatric patients undergoing knee magnetic resonance imaging (MRI) studies was performed, identifying 15 patients with tibial spine avulsion fracture between January 1, 2009, and January 1, 2013. Inclusionary criteria consisted of patients who sustained an acute tibial spine avulsion fracture and had MRI examination. The MRI studies were analyzed by a pediatric musculoskeletal radiologist, who measured identified bony parameters, and results were compared with an age-matched control group and a skeletally immature cohort with ligamentous disruption of the ACL. Data were analyzed using unpaired t test and logistic regression.

Results Cohorts included 15 patients with a tibial spine avulsion fracture, 39 with an ACL disruption, and 28 in the age-matched control group. The tibial spine group demonstrated no significant differences in bony parameters when compared with the control group, but had significantly wider tibial eminence widths in comparison to the ACL group (2.92 cm [0.4] versus 2.71 cm [0.27]; p = 0.040). Additionally, this finding was predictive of tibial spine avulsion injury when assessed by logistic regression.

Conclusions Pediatric patients who sustain a tibial spine avulsion fracture exhibit significantly wider tibial eminences when compared with the cohort with ACL injuries. This indicates a possible biomechanical explanation for differences in ACL injury patterns that should be examined in future, prospective analyses.

Keywords

pediatric - knee anatomy - anterior cruciate ligament - tibial spine avulsion fracture
 

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