Download PDF
J Knee Surg 2015; 28(03): 255-262
DOI: 10.1055/s-0034-1388657
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Treatment of Tibial Eminence Fractures: A Systematic Review

Ljiljana Bogunovic
1   Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, Missouri
,
Majd Tarabichi
1   Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, Missouri
,
David Harris
1   Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, Missouri
,
Rick Wright
1   Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, Missouri
› Author Affiliations
Further Information

Publication History

24 April 2014

13 July 2014

Publication Date:
27 August 2014 (online)

   Permissions and Reprints

Abstract

Fractures of the tibial eminence are rare, accounting for less than 1% of the injuries involving the anterior cruciate ligament (ACL). Most agree that nondisplaced fractures can be managed nonoperatively, but debate exists over the ideal treatment of displaced fractures. This systematic review evaluates the outcome of nonoperatively and operatively managed displaced tibial eminence fractures. The PubMed, Embase, and Cochrane databases were queried. Inclusion criteria included reported outcomes of displaced tibial eminence fractures, minimum 2-year follow-up, and English language. Outcomes reported were pooled and included the following: clinical instability (Lachman/anterior drawer, pivot shift, and KT 1000), patient-reported pain and/or instability, return to sport, Lysholm, Tegner, and the need for ACL reconstruction. Comparison was made in the outcomes of nonoperatively and operatively treated fractures and between suture and screw fixation techniques. Overall 16 studies met the inclusion criteria. The pooled mean age was 23 years and mean follow-up was 35 months. Clinical instability was seen in 70% of nonoperatively treated patients and 14% of operatively treated patients (p < 0.0001). Patient-reported instability was higher in nonoperatively treated patients (54 vs. 1.2%, p < 0.0001), as was the rate of ACL reconstruction (10 vs. 1.0%, p = 0.036). In comparing suture fixation to screw fixation, patient-reported instability and the rate of ACL reconstruction were equivalent. Patients treated with screw fixation had a higher incidence of clinically measured instability (Lachman and KT arthrometer) and an increased rate of hardware removal (3.9 vs. 64.9%, p < 0.05). Surgically managed patients report less instability, are higher functioning, and require fewer ACL reconstructions when compared with nonoperatively treated patients. Suture fixation was associated with improvements in clinical measures of stability and decreased need for hardware removal; however, patient perception of stability and need for ACL reconstruction was no different between the two treatment methods.

Keywords

tibial eminence fracture - tibial eminence avulsion - ACL avulsion - intercondylar eminence fracture - intercondylar eminence avulsion
 

  • References

  • 1 Lubowitz JH, Elson WS, Guttmann D. Part II: arthroscopic treatment of tibial plateau fractures: intercondylar eminence avulsion fractures. Arthroscopy 2005; 21 (1) 86-92
    CrossrefPubMedSearch in Google Scholar
  • 2 Reynders P, Reynders K, Broos P. Pediatric and adolescent tibial eminence fractures: arthroscopic cannulated screw fixation. J Trauma 2002; 53 (1) 49-54
    CrossrefPubMedSearch in Google Scholar
  • 3 Zhao J, Huangfu X. Arthroscopic treatment of nonunited anterior cruciate ligament tibial avulsion fracture with figure-of-8 suture fixation technique. Arthroscopy 2007; 23 (4) 405-410
    CrossrefPubMedSearch in Google Scholar
  • 4 Kocher MS, Micheli LJ, Gerbino P, Hresko MT. Tibial eminence fractures in children: prevalence of meniscal entrapment. Am J Sports Med 2003; 31 (3) 404-407
    PubMedSearch in Google Scholar
  • 5 Monto RR, Cameron-Donaldson ML, Close MA, Ho CP, Hawkins RJ. Magnetic resonance imaging in the evaluation of tibial eminence fractures in adults. J Knee Surg 2006; 19 (3) 187-190
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am 1970; 52 (8) 1677-1684
    CrossrefPubMedSearch in Google Scholar
  • 7 Zaricznyj B. Avulsion fracture of the tibial eminence: treatment by open reduction and pinning. J Bone Joint Surg Am 1977; 59 (8) 1111-1114
    CrossrefPubMedSearch in Google Scholar
  • 8 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
    CrossrefPubMedSearch in Google Scholar
  • 9 Huang TW, Hsu KY, Cheng CY , et al. Arthroscopic suture fixation of tibial eminence avulsion fractures. Arthroscopy 2008; 24 (11) 1232-1238
    CrossrefPubMedSearch in Google Scholar
  • 10 Hirschmann MT, Mayer RR, Kentsch A, Friederich NF. Physeal sparing arthroscopic fixation of displaced tibial eminence fractures: a new surgical technique. Knee Surg Sports Traumatol Arthrosc 2009; 17 (7) 741-747
    CrossrefPubMedSearch in Google Scholar
  • 11 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
    CrossrefPubMedSearch in Google Scholar
  • 12 Senekovic V, Veselko M. Anterograde arthroscopic fixation of avulsion fractures of the tibial eminence with a cannulated screw: five-year results. Arthroscopy 2003; 19 (1) 54-61
    PubMedSearch in Google Scholar
  • 13 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
    CrossrefPubMedSearch in Google Scholar
  • 14 Mahar AT, Duncan D, Oka R, Lowry A, Gillingham B, Chambers H. Biomechanical comparison of four different fixation techniques for pediatric tibial eminence avulsion fractures. J Pediatr Orthop 2008; 28 (2) 159-162
    Search in Google Scholar
  • 15 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
    CrossrefPubMedSearch in Google Scholar
  • 16 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
    CrossrefPubMedSearch in Google Scholar
  • 17 Tsukada H, Ishibashi Y, Tsuda E, Hiraga Y, Toh S. A biomechanical comparison of repair techniques for anterior cruciate ligament tibial avulsion fracture under cyclic loading. Arthroscopy 2005; 21 (10) 1197-1201
    CrossrefPubMedSearch in Google Scholar
  • 18 Seon JK, Park SJ, Lee KB , et al. A clinical comparison of screw and suture fixation of anterior cruciate ligament tibial avulsion fractures. Am J Sports Med 2009; 37 (12) 2334-2339
    Search in Google Scholar
  • 19 Pan RY, Yang JJ, Chang JH, Shen HC, Lin LC, Lian YT. Clinical outcome of arthroscopic fixation of anterior tibial eminence avulsion fractures in skeletally mature patients: a comparison of suture and screw fixation technique. J Trauma Acute Care Surg 2012; 72 (2) E88-E93
    PubMedSearch in Google Scholar
  • 20 Moher D, Liberati A, Tetzlaff J, Altman DG ; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009; 62 (10) 1006-1012
    CrossrefPubMedSearch in Google Scholar
  • 21 Atay OA, Doral MN, Tetik O, Leblebicioğlu G. Conservative treatment of eminentia intercondylaris fractures of the tibia in children. Turk J Pediatr 2002; 44 (2) 142-145
    PubMedSearch in Google Scholar
  • 22 McLennan JG. Lessons learned after second-look arthroscopy in type III fractures of the tibial spine. J Pediatr Orthop 1995; 15 (1) 59-62
    CrossrefPubMedSearch in Google Scholar
  • 23 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
    Search in Google Scholar
  • 24 Jang KM, Bae JH, Kim JG, Wang JH. 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
    CrossrefPubMedSearch in Google Scholar
  • 25 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
    CrossrefPubMedSearch in Google Scholar
  • 26 Mah JY, Adili A, Otsuka NY, Ogilvie R. Follow-up study of arthroscopic reduction and fixation of type III tibial-eminence fractures. J Pediatr Orthop 1998; 18 (4) 475-477
    PubMedSearch in Google Scholar
  • 27 Sang W, Zhu L, Ma J, Lu H, Yu Y. A comparative study of two methods for treating type III tibial eminence avulsion fracture in adults. Knee Surg Sports Traumatol Arthrosc 2012; 20 (8) 1560-1564
    CrossrefPubMedSearch in Google Scholar
  • 28 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
    CrossrefPubMedSearch in Google Scholar
  • 29 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
    PubMedSearch in Google Scholar