Arthroscopic treatment of displaced tibial eminence fractures using a suspensory fixation

Abstract

Background: Avulsion fractures of the tibial intercondylar eminence are fairly common injuries requiring surgery for the optimal functional outcome. The purpose of this study was to assess the clinical and radiological outcomes of an arthroscopic treatment of displaced tibial intercondylar eminence fractures using a suspensory device.

Material and methods: Five patients with type 2 and 3 displaced tibial intercondylar eminence fractures who received an arthroscopically assisted fixation using a double button device were enrolled from 2011 to 2012. Clinical assessment included the patient demographics, cause of injury, the delay before surgery, time for surgery, time to return to work and sport, the International Knee Documentation Committee (IKDC) and Lysholm knee scores. Stability was measured with the KT-2000 arthrometer with a force of 134 N. A side to side difference on the KT-2000 examination superior to 3 mm was considered as a significant and abnormal increase in the anterior translation. Radiological examination consisted of anteroposterior and lateral radiographs, as well as computed tomography (CT) scan of the affected knee. Clinical and radiological followup was done at 1, 2, 3, 6, and 12 months postoperatively and at final followup. CT-scan was performed before surgery and at 3 months followup.

Results: The median age of patients was 31 years. Mean followup was 27 ± 5.1 months. The average delay before surgery was 3 days. At final followup, the mean IKDC and Lysholm knee scores were, 93.9 and 94.5 respectively. All patients had a complete functional recovery and were able to return to work and to resume their sport activities. No secondary surgeries were required to remove hardware. No complication was noted. Bony union was achieved in all patients.

Conclusion: The arthroscopic treatment of displaced tibial intercondylar eminence fractures using a suspensory system provided a satisfactory clinical and radiological outcome at a followup of 2 years.

Keywords: Anterior cruciate ligament; arthroscopic fixation; arthroscopy; avulsion fracture; intercondylar eminence; knee joint; suture technique; tibia.

Figure 1

Computed tomography scan of knee joint showing displaced tibial eminence fracture

Figure 2

A line diagram showing surgical technique (summarized)

Figure 3

Arthroscopic view showing examination of the anterior cruciate ligament avulsion and soft tissue debridement in order to expose the fracture site

Figure 4

Arthroscopic view showing reduction of the fracture

Figure 5

Arthroscopic view showing drilling of a Kirschner-wire through the guide from the external cortex of the tibia to the reduced tibial eminence through the inferior anterior cruciate ligament fiber

Figure 6

Arthroscopic view showing that a tunnel was then created with a cannulated drill

Figure 7

Arthroscopic view showing that the suspensory system was inserted through the tunnel using a guide wire, then was flipped over the surface of the tibial eminence

Figure 8

Computed tomography scan of knee joint showing bony union at 3 months