Satisfactory clinical outcomes using a novel arthroscopic technique for fixation of tibial spine avulsion fractures: technical note

This research aims to present a novel arthroscopic fixation technique that uses double-row suture anchor for tibial spine avulsion and evaluate its short-term clinical outcomes. The surgical is described retrospective case series presented. Patients who presented with type III IV fractures according the Meyers McKeever classification received same treatment from 2013 2018 in two specialised hospitals Medellín City were included. All interventions performed by an experienced surgeon. To determine outcomes during follow-up, Lysholm score objective subjective International Knee Documentation Committee scores obtained before at least 12 months after surgery. A total of 24 patients followed, mean age 31 years; female. median time between trauma was days (IQR=7–23), follow-up period 13.5 (IQR=9.5–31.5). When comparing patients' state initially postoperative period, statistically significant differences found all analysed (p<0.05). Likewise, there no complications reinterventions satisfied procedure. Fixation using results improvement function, pain activity level. main conclusion procedure anatomical requires minimal access leads satisfactory evolution patients.Level evidence: Level V, series. patients. Current techniques•Several techniques have been described, but none has demonstrated superiority.•The disadvantages are sensations knee instability, need other remove material, alteration physis, cartilage damage inadequate tension physiotherapy. •Several New technique•A stable can be guaranteed technique.•A as well shorter time, lower risk cartilage.•Satisfactory achieved technique. •A Displaced cause instability result secondary lesions anterior cruciate ligament (ACL) due insertion into spine.1Tuca M Bernal N Luderowski E et al.Tibial fractures: update.Curr Opin Pediatr. 2019; 31: 103-11110.1097/MOP.0000000000000719http://www.ncbi.nlm.nih.gov/pubmed/30531228Crossref PubMed Scopus (10) Google Scholar These observed different populations, namely children adults. In adolescents, lesion normally caused sports rotational (like ACL injuries adults). Considering stronger than eminence, which incomplete ossification, bone occurs when subjected valgus external rotation forces. adult patients, these usually high-energy trauma, such road traffic accidents.2Strauss EJ Kaplan DJ Weinberg ME al.Arthroscopic management principles techniques.J Am Acad Orthop Surg. 2018; 26: 360-36710.5435/JAAOS-D-16-00117http://www.ncbi.nlm.nih.gov/pubmed/29688959Crossref (16) classified this pathology three types made recommendations on classification.3Chouhan DK Dhillon MS John R al.Management neglected systematic review.Injury. 2017; 48: S54-S60https://linkinghub.elsevier.com/retrieve/pii/S002013831730495310.1016/S0020-1383(17)30495-3Abstract Full Text PDF (12) Scholar, 4Osti L Buda Soldati F eminence fracture: review methods.Br Med Bull. 2016; 118: 73-90http://www.ncbi.nlm.nih.gov/pubmed/2715195210.1093/bmb/ldw018Crossref (34) fracture I, not displaced or minimally displaced, while II 30% 50% avulsed bone, thus creating deformity looks like peak lateral X-rays. fractures, completely avulsed. Subsequently, Zaricznyj5Zaricznyj B Avulsion eminence: open reduction pinning.J Bone Joint Surg Am. 1977; 59: 1111-1115http://www.ncbi.nlm.nih.gov/pubmed/591548Crossref (268) adds fourth group classification, where show displacement comminution.3Chouhan Conservative recommended I II, surgery commonly used fractures. However, current controversies over conservative since it reported reducing their improve residual instability.6Mitchell JJ Mayo MH Axibal DP al.Delayed reconstruction young previous fractures.Am J Sports Med. 44: 2047-205610.1177/0363546516644597http://www.ncbi.nlm.nih.gov/pubmed/27159316Crossref (33) 7Bogunovic Tarabichi Harris D al.Treatment review.J 2015; 28: 255-26210.1055/s-0034-1388657Crossref (39) considered isolated lesions; however, multiple chondral, meniscal associated described. Among most frequent 22% treatment, joint stiffness, defined flexion contracture greater 5° less 110° persists 3 treatment. latter complication 12.5% treated intervention, mainly those screw fixation.8Vega JR Irribarra LA Baar AK new growth plate-sparing method.Arthroscopy. 2008; 24: 1239-1243http://www.ncbi.nlm.nih.gov/pubmed/1897105310.1016/j.arthro.2008.07.007http://www.ncbi.nlm.nih.gov/pubmed/18971053Abstract (65) 9Aderinto Walmsley P Keating JF Fractures spine: epidemiology outcome.Knee. 15: 164-167http://www.ncbi.nlm.nih.gov/pubmed/1832170910.1016/j.knee.2008.01.006http://www.ncbi.nlm.nih.gov/pubmed/18321709Abstract (54) With used, many literature.4Osti use Kirschner wires, cannulated screws, ultra-high molecular weight polyethylene through tunnels, screw-type anchors impaction-type worth mentioning.10Huang T-W Hsu K-Y Cheng C-Y fractures.Arthroscopy. 1232-1238http://www.ncbi.nlm.nih.gov/pubmed/1897105210.1016/j.arthro.2008.07.008http://www.ncbi.nlm.nih.gov/pubmed/18971052Abstract (77) There currently enough biomechanical evidence shows superiority sutures fixation.10Huang 11In Y Kim J-M Woo Y-K bioabsorbable anchors.Knee Traumatol Arthrosc. 16: 286-28910.1007/s00167-007-0466-xhttp://www.ncbi.nlm.nih.gov/pubmed/18157488Crossref (32) screws blockage extension, necessitating removal thereby causing patient.10Huang Furthermore, some recent studies also compared sutures, anchors. Anchors loaded one showed maximum failure load 213.8±48 (N), FiberWire 244.1±92.3 (N) Orthocord 286.7±29.6 (N). On hand, 125±74 It important note model rupture suture, failed pull-out.12Eggers Becker C Weimann al.Biomechanical evaluation methods 2007; 35: 404-41010.1177/0363546506294677http://www.ncbi.nlm.nih.gov/pubmed/17170161Crossref (70) 13Hapa O Barber FA Süner G comparison high-strength EndoButton, anchor.Arthroscopy. 2012; 681-687https://linkinghub.elsevier.com/retrieve/pii/S074980631101262X10.1016/j.arthro.2011.10.026http://www.ncbi.nlm.nih.gov/pubmed/22284410Abstract (46) 14Bong MR Romero Kubiak al.Suture versus comparison.Arthroscopy. 2005; 21: 1172-117610.1016/j.arthro.2005.06.019http://www.ncbi.nlm.nih.gov/pubmed/16226643Abstract (88) advantages injury possibility comminution, neurovascular implant removal. Although cases delivering excellent published,14Bong 15Zhao Huangfu X Arthroscopic nonunited figure-of-8 technique.Arthroscopy. 23: 405-410https://linkinghub.elsevier.com/retrieve/pii/S074980630601491510.1016/j.arthro.2006.12.008http://www.ncbi.nlm.nih.gov/pubmed/17418334Abstract (42) papers inserted fracture, proposed research. perspective, study classification16Meyers FM Fracture intercondylar tibia.J 1959; 41-A (13630956): 209-22210.2106/00004623-195941020-00002Crossref (316) 2013–2018 Fundación Clínica del Norte Saludcoop medical records identified reviewed data extracted (gender, age, elapsed surgery, complications, level patient satisfaction scores). (IKDC) follow-up. done GraphPad Prism V.7.0 (San Diego, California, USA) software analysis. Normality evaluated Shapiro-Wilk test. Student's t-test Wilcoxon test parametric non-parametric groups, respectively. For correlations, Pearson Spearman tests data, ordinal qualitative variables, χ2 used. values 0.05 significant. ideally first 15 trauma. During turniquet thigh positioned 90° flexion. leg holder high upper visualisation portal adjacent junction patellar tendon patella. Subsequently standard medial made. Adequate cleaning then performed, haematoma clots removed. Visual inspection discard lesions. exposed cleaned. synovia removed, adequately controlled radiofrequency device. intended respect transverse ligament; posterior side could resected sometimes. order make adequate reduction. After done, surgeon must change portal, will now portal. needle placed above horn meniscus inferior created, plastic cannula inserted. (5.5 mm diameter) carries (four strands) implanted (figure 1A), four strands recovered retriever. Then, straight passer, crosses fragment completely, One strand passed carried remaining strands. pass colour avoid cross-linking. cross-shaped configuration 1, figure 2).Figure 2Surgical three-dimensional model. (A) Anterolateral view position sutures. (B) Top (C) final sutures.View Large Image Figure ViewerDownload (PPT) reduced. Once obtained, proceeds holding dissector 1B) Seoul Medical Center (SMC) self-locking sliding knot knotted knotter. steps, another second strand. noted constantly visualised. Afterwards, perforations lateral, 4.5 drill 1C). Through each perforation, differently coloured 1D, 2C). last step provide fixation. tibia, tied screw, button (see online supplemental file-video). Twenty-four followed had years (SD=9.7) women. Of 14 (58.3%) 10 (41.6%) classification. IKDC initial 3, 4).Figure 4Subjective test, 95% confidence significance shown part (***<0.001).View table 1. No required additional surgeries period. being outcome Also, Lachman grade 2 greater, six (25%) pivot shift positive drawer only (8.3%) loss extension five grades evaluation. Despite this, range movement evidenced (table 1). Moreover, correlation (p=0.4606) (p=0.2003) scores, (p=0.8012) (p=0.7370) scores. Finally, difference men women.Table 1Objective scoreIKDC gradeBefore, n (%)After, (%)P valueA022 (91.6)<0.05B02 (8.3)C18 (75)0D6 (25)0A, normal; B, nearly C, abnormal; D, severely IKDC, Committee. Open tab A, Tibial common among youth adolescents may related rupture. Some sometimes inability fully extend joint. surgical, several routes lesion, either route.1Tuca 2Strauss indicated, preferred because soft tissue, incision smaller, better management, simultaneously faster recovery.7Bogunovic 8Vega arthroscopy, highlighted. Disadvantages include sensation perceived requirement intervention osteosynthesis articular cartilage, comminution fragments, physis stop growth.10Huang regard higher cost challenging terms non-absorbable alter physis. contrary, absorbable does generate necessary Meanwhile, wires suitable comminuted so they large fragments. insufficient early mobilisation far method performance long-term follow-up.1Tuca study, great performance, measured addition, cost-effective easy carry out require extract material.11In While literature reports about especially injuries,1Tuca our adults, accidents. concomitant 90%–100% reports.2Strauss 3Chouhan findings, 41.6% found. explained injured accidents mechanics differ noteworthy involved occurred motorcycles. moderate-term return normal activities, without functional limitations, Undoubtedly, up minimum months. limitations research, small number although significantly literature. Early repair resulted operated safely even injuries. cartilage.