Physeal Sparing Arthroscopic Fixation of Displaced Tibial Eminence Fractures: A Novel Surgical Technique and Case Series

Background:
Tibial spine avulsion fractures are more frequent in skeletally immature patients than in adults. ACL avulsion facture vary in the size of fragment, depth of fracture into the tibial plateau, degree of displacement and the amount of comminution. The common treatment for displaced fractures is surgical fixation. Most fixation techniques risk physeal damage and future growth disturbance. We present an arothroscopic physeal-sparing technique for fixation of tibial eminence fractures using suture anchors placed on the anterior aspect of the proximal tibia. Under direct arthroscopic vision the fracture was anatomically reduced and a provisional fixation with the use of a smooth thin K-wire is accomplished. A loop is used in order to pass a loop wire around the base of the ACL, thus enabling passage of two wire sutures. The sutures are pulled through the anteromedial portal and passed through a swivelock anchor. The tunnel for the anchor is prepared in a horizontal direction, proximal and parallel to the growth plate, thereby avoiding damage to the physes. The same steps are repeated for the two remaining suture limbs placed using the anterolateral portal forming an X shape.

Methods:
10 patients with tibial eminence fractures were operated upon using the described technique. Follow up included knee stability examination including Lachman, Pivot Shift and drawer tests, as well as knee x rays to evaluate reduction and union and Lysholm and IKDC scores.

Results:
All patients had an anatomic reduction and bony union. The mean Lysholm score and International Knee Documentation Committee subject and objective scores were normal in all patients without extension or flexion limitations. The results of the anterior drawer, Lachman, and pivot-shift tests were negative.

Conclusion:
The new technique described appears safe and effective and results in good objective and subjective outcomes without risking damage to the growth plate.