Clinical outcome of arthroscopic fixation of anterior tibial eminence avulsion fractures in skeletally mature patients: a comparison of suture and screw fixation technique

Abstract

Background: Extreme tensile force to the anterior cruciate ligament results in an avulsion of the tibial eminence and it was believed to be more common in skeletally immature adolescent than adult. The purpose of this study is to compare the clinical results of both screw and suture fixation for surgical treatment of anterior tibial eminence fractures in skeletally mature patients.

Methods: A retrospective review was conducted on patients from 2002 to 2009 who sustained fractures of the anterior tibial eminence and were treated with arthroscopic-assisted fixation using either cannulated screws (25 patients) or Ethibond sutures (23 patients). Follow-up assessment included function evaluation, ligament laxity, and range of motion.

Results: Seventy-five percent of the anterior tibial eminence fractures resulted from traffic-related injuries in this study. Median operating time was 75 minutes in screw fixation group and 92 minutes in suture fixation group (p = 0.006). The objective International Knee Documentation Committee (IKDC) results for patients were 23 A, 2 B, and no C or D in screw fixation group and 16 A, 4 B, 3 C, and no D (p = 0.040) in suture fixation group. The KT-1000 side-to-side difference was greater than 5 mm in two patients (8%) in the screw fixation group and in three patients (13%) in the suture fixation group (p = 0.058). Among patients in screw fixation group, two (8%) patients had grade 1 pivot shift and 2 (8%) patients had grade 2 pivot shift. Among patients in suture fixation group, five (22%) patients had grade 1 pivot shift, three (13%) patients had grade 2 pivot shift, and 1 (9%) patient had grade 3 pivot shift (p = 0.037).

Conclusions: Significant better IKDC objective evaluation, lower glide pivot shift phenomenon, and shorter operating time requirement in screw fixation group with respect to suture fixation group were shown in our study although the other functional knee scores (Lysholm score, Tegner activity level, and the IKDC subjective score) and KT-1000 manual side-to-side difference only revealed a trend with better clinical results in screw fixation group than in suture fixation group rather than significant difference.