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Tibial Spine Avulsion Fractures: Arthroscopic Reduction and Internal Fixation

March 15, 2015

Contributors: Eric Jason Strauss, MD, FAAOS; Michael Ryan, MD; William Ryan, BS; Maxwell Weinberg, MD; Dylan Lowe, MD; Laith M Jazrawi, MD, FAAOS; Laith M Jazrawi, MD, FAAOS

BACKGROUND: Tibial spine fractures are a rare injury that is most commonly seen in children and adolescents aged 8-14. Its location at the insertion site of the anterior cruciate ligament (ACL) puts it at risk during pivoting and twisting injuries that typically damage the ACL in adults. Accurate diagnosis and prompt treatment are essential to restore stability and function to the knee. The Meyers and McKeever classification system, in addition to the patient's age and activity level, can guide which fractures require operative treatment. Reduction and fixation can be accomplished by either an open or arthroscopic approach using sutures or screws. Special considerations are necessary for skeletally immature patients as placing screws across an open physis can arrest growth. The purpose of this video is to present multiple cases of a tibial spine avulsion fracture repaired with a novel cross fiber tape fixation pattern.

METHODS: This video presents the relevant concepts and surgical technique of multiple cases of arthroscopic reduction and fixation of tibial spine fractures. Relevant patient history, injury presentation and workup, indications for surgery, imaging, postoperative rehabilitation, and clinical outcomes are presented. The important features of the technique are highlighted and the rationale behind the approach is reviewed.

RESULTS: This video presents multiple cases of arthroscopic reduction and internal fixation of a tibial spine avulsion fracture using a novel cross fiber tape fixation pattern. In these cases, fluoroscopic imaging confirmed reduction of the fracture, indicating a successful procedure. Current orthopaedic literature supports our results.

CONCLUSION: Arthroscopic reduction and internal fixation of tibial spine avulsion fractures allows successful fracture fixation, while permitting complete inspection of the joint for ligamentous injury. Clinical outcomes from the orthopaedic literature regarding this arthroscopic technique demonstrate excellent outcomes with less morbidity, faster rehabilitation, and decreased pain.

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