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Meta-Analysis
. 2024 Apr;52(5):1357-1366.
doi: 10.1177/03635465231175674. Epub 2023 Jun 16.

Tibial Spine Fractures in the Child and Adolescent Athlete: A Systematic Review and Meta-analysis

Tibial Spine Research Interest Group  1 ; Kevin J Orellana  2 , Nathan V Houlihan  2 , Michael V Carter  2 , Soroush Baghdadi  2 , Keith Baldwin  2 , Alexandra C Stevens  2 , Aristides I Cruz Jr  3 , Henry B Ellis Jr  4 , Daniel W Green  5 , Indranil Kushare  6 , Benjamin Johnson  4 , Alicia Kerrigan  7 , Julia C Kirby  8 , James P MacDonald  9 , Scott D McKay  6 , Todd A Milbrandt  10 , R Justin Mistovich  11 , Shital Parikh  12 , Neeraj Patel  13 , Gregory Schmale  14 , Jessica L Traver  15 , Yi-Meng Yen  16 , Theodore J Ganley  2
Affiliations
Meta-Analysis

Tibial Spine Fractures in the Child and Adolescent Athlete: A Systematic Review and Meta-analysis

Tibial Spine Research Interest Group et al. Am J Sports Med. 2024 Apr.

Abstract

Background: Tibial spine fractures (TSFs) are uncommon injuries that may result in substantial morbidity in children. A variety of open and arthroscopic techniques are used to treat these fractures, but no single standardized operative method has been identified.

Purpose: To systematically review the literature on pediatric TSFs to determine the current treatment approaches, outcomes, and complications.

Study design: Meta-analysis; Level of evidence, 4.

Methods: A systematic review of the literature was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines using PubMed, Embase, and Cochrane databases. Studies evaluating treatment and outcomes of patients <18 years old were included. Patient demographic characteristics, fracture characteristics, treatments, and outcomes were abstracted. Descriptive statistics were used to summarize categorical and quantitative variables, and a meta-analytic technique was used to compare observational studies with sufficient data.

Results: A total of 47 studies were included, totaling 1922 TSFs in patients (66.4% male) with a mean age of 12 years (range, 3-18 years). The operative approach was open reduction and internal fixation in 291 cases and arthroscopic reduction and internal fixation in 1236 cases; screw fixation was used in 411 cases and suture fixation, in 586 cases. A total of 13 nonunions were reported, occurring most frequently in Meyers and McKeever type III fractures (n = 6) and in fractures that were treated nonoperatively (n = 10). Arthrofibrosis rates were reported in 33 studies (n = 1700), and arthrofibrosis was present in 190 patients (11.2%). Range of motion loss occurred significantly more frequently in patients with type III and IV fractures (P < .001), and secondary anterior cruciate ligament (ACL) injury occurred most frequently in patients with type I and II fractures (P = .008). No statistically significant differences were found with regard to rates of nonunion, arthrofibrosis, range of motion loss, laxity, or secondary ACL injury between fixation methods (screw vs suture).

Conclusion: Despite variation in TSF treatment, good overall outcomes have been reported with low complication rates in both open and arthroscopic treatment and with both screw and suture fixation. Arthrofibrosis remains a concern after surgical treatment for TSF, but no significant difference in incidence was found between the analysis groups. Larger studies are necessary to compare outcomes and form a consensus on how to treat and manage patients with TSFs.

Keywords: ACL; general sports trauma; knee ligaments; pediatric sports medicine.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: K.B. has received compensation from Synthes GmbH for serving as faculty or speaker. H.B.E. has received hospitality payments from Stryker Corp; educational support from Smith & Nephew, Arthrex, and Pylant Medical; and speaking fees from Orthopediatrics and Smith & Nephew. D.W.G. has received compensation from Synthes GmbH for serving as faculty or speaker, royalties from Arthrex and Pega Medical, and consulting fees from Arthrex. I.K. has received educational support from Medinc of Texas and hospitality fees from Depuy Synthes. J.K. has received educational support from Pylant Medical. S.D.M. has received support for education from Medinc of Texas. T.A.M. has received consulting fees from OrthoPediatrics, Medtronic USA, Nsite, and Zimmer Biomet Holdings and owns stock with Viking scientific. R.J.M. has received travel expenses from Medical Device Business Services and Globus Medical, consulting fees from OrthoPediatrics, and consulting fees and compensation for serving as faculty or speaker from Philips Electronics North America. S.P. has received educational support from CDC Medical. N.P. has received compensation from Arthrex for serving as faculty or speaker and educational support from Medwest Associates. G.S. has received educational support from Summit Surgical Corporation and research support for an unrelated study from Arthrex. J.L.T. has received educational support from Smith & Nephew, Kairos Surgical, and Gemini Mountain Medical. Y-M.Y. has received consulting fees from Smith & Nephew. T.J.G. has received research support from Allosource and Vericel and support for education from Arthrex and is an associate editor of AJSM. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

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