Comparative analysis of arthroscopic techniques for fixation of tibial intercondylar eminence avulsion fractures in children

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Abstract

BACKGROUND: Avulsion fracture of the tibial intercondylar eminence is a rare injury, which commonly occurs in adolescents aged 8–14 years, and may result in disability caused by improper bone union. Several surgical techniques for the treatment of patients with such fractures have been developed, involving various methods of fixation for the avulsed fragment of the tibial intercondylar eminence.

AIM: To evaluate the effectiveness of the novel technique for the treatment of type III tibial intercondylar eminence avulsion fractures according to the Meyers–McKeever–Zariczny classification in children with open growth plates and compare its outcomes to those of arthroscopically assisted reduction and fixation of the avulsed fragment using a Herbert screw.

METHODS: Functional outcomes in 45 children aged 14–17 years with tibial intercondylar eminence fractures were analyzed at 3, 6, and 12 months after surgery. Group A included 22 children who underwent arthroscopic fixation with a Herbert screw. Group B comprised 23 children who underwent arthroscopic fixation using a self-tightening suture loop following the novel method.

RESULTS: Group B demonstrated better anteroposterior and rotational stability of the knee than group A. Postoperative functional assessment scores (IKDC 2000, Lysholm Knee Scoring Scale, and Tegner Activity Scale) were significantly better in group B than in group A (p = 0.00006). In group A, postoperative complications were observed in 18.1% of cases (p ≤ 0.05), including screw fracture (4.5%) and aseptic synovitis due to a foreign body reaction (13.6%). No postoperative complications were noted in group B (p < 0.05).

CONCLUSION: The proposed technique for treating tibial intercondylar eminence avulsion fractures in children with open growth plates is more reliable and safer compared with Herbert screw fixation and may be recommended for clinical practice.

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About the authors

Marsel R. Salikhov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: virus-007-85@mail.ru
ORCID iD: 0000-0002-5706-481X
SPIN-code: 2009-4349

MD, PhD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Vladislav V. Avramenko

Saint Petersburg State Pediatric Medical University

Email: avramenko.spb@mail.ru
ORCID iD: 0000-0003-0339-6066
SPIN-code: 4632-9953

MD

Russian Federation, Saint Petersburg

Gleb E. Batalov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: Batalovgl@yandex.ru
ORCID iD: 0009-0006-5266-8530

MD

Russian Federation, Saint Petersburg

Vadim V. Kemkin

Saint Petersburg State Pediatric Medical University

Author for correspondence.
Email: vkemkin@mail.ru
ORCID iD: 0009-0002-7101-906X

MD

Russian Federation, Saint Petersburg

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Supplementary files

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2. Fig. 1. Computed tomography scan of a patient with a right tibial intercondylar eminence fracture: (a) coronal view; (b) sagittal view.

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3. Fig. 2. Tibial guide placement during anterior cruciate ligament reconstruction. БК, femur; ББК, tibia; 1, anterior cruciate ligament; 2, working tip of the guide placed at the center of the tibial eminence fragment; 3, tibial guide from a standard ACL reconstruction set, positioned at a 55° angle relative to the tibial plateau.

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4. Fig. 3. Passage of the 2.5-mm guidewire. The distal guidewire tip exited in the anterior intercondylar area of the tibia: БК, femur; ББК, tibia; 1, anterior cruciate ligament; 2, distal tip of the guidewire emerging in the anterior intercondylar area of the tibia via the center of the tibial eminence fragment; 3, tibial guide from a standard ACL reconstruction set positioned at a 55° angle relative to the tibial plateau; 4, guidewire.

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5. Fig. 4. Arthroscopic passage of the free ends of the self-tightened suture loop through the guidewire eyelet. БК, femur; ББК, tibia; 1, intra-articular plate attached to the self-tightened suture loop; 2, free ends of the suture loop inserted through the guidewire; 3, guidewire with a preloaded shuttle suture.

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6. Fig. 5. Image of the implant (self-tightening suture loop with a plate) placed over the tibial intercondylar eminence fragment: 1, free ends of the self-tightening suture loop; 2, intra-articular plate fixed on the self-tightening suture loop; 3, self-tightening suture loop.

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7. Fig. 6. Insertion of the self-tightening suture loop through the tibial tunnel. БК, femur; ББК, tibia; 1, an intra-articular plate positioned over the tibial eminence fragment; 2, self-tightening suture loop emerging from the tibial tunnel.

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8. Fig. 7. A second plate affixed externally as a component of the suture loop system. БК, femur; ББК, tibia; 1, intra-articular plate positioned over the tibial eminence fragment; 2, extra-articular plate attached to the suture loop.

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9. Fig. 8. Image of the implant (self-tightening suture loop between two plates). 1, self-tightening suture loop; 2, intra-articular plate affixed to the self-tightening suture loop; 3, extra-articular plate.

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10. Fig. 9. Final fixation employing the self-tightening suture loop and two extra-articular plates. БК, femur; ББК, tibia; 1, intra-articular plate placed over the tibial eminence fragment; 2, extra-articular plate; 3, free ends for tightening the suture loop.

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11. Fig. 10. Reduced and fixed tibial eminence fracture as seen on arthroscopy. 1, fixed TIE fragment; 2, intra-articular plate; 3, anterior cruciate ligament.

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