High rates of return to impact sports may be achieved after tibial eminence fractures treated with ARIF

Patricia M. Lutz et al conducted a study to investigate functional and clinical outcomes, and physical activity after arthroscopic suture fixation of tibial eminence fractures with regard to postoperative stability, range of motion (ROM), complications, and return to sports. They found that - excellent reliable ligamentous stability and high rates of return to high impact sports can be expected after arthroscopic reduction and internal fixation (ARIF) using a suture fixation technique for type II–IV tibial eminence fractures.

The article has been published in 'Archives of Orthopaedic and Trauma Surgery'.

Surgical technique - Routine diagnostic arthroscopy was performed through a high anterolateral portal. In case of any concomitant meniscus lesions, it was addressed prior to ARIF if indicated. Subsequently, the instable fractured tibial eminence fragment was exposed and carefully debrided. The transverse ligament was visualized and the tibial fracture site was debrided. Then a curved 90° Suture Lasso was passed through the distal ACL from posteromedial in an anterolateral direction through an anteromedial portal. A FiberWire Number 2 was shuttled through the ACL.

A second suture was shuttled through the anterior part of ACL. Two transtibial K-wires were then placed mid into the instable eminence fragment to securely fix the fragment, and were then subsequently overdrilled. Then, the suture was shuttled through the drill holes and by pulling on the free ends of the FiberWire sutures, the fractured eminence fragment was then securely repositioned into the fracture site. Catching of the transverse ligament was avoided. For tibial fixation, an extracortical suture plate was used. To confirm the correct position of the suture and complete reduction of the fragment, standardized AP and lateral radiographs were carried out intra-operatively.

Patients undergoing ARIF of tibial eminence fractures using a suture fixation technique were included in the study. Outcome was evaluated retrospectively after a minimum follow-up of 24 months using KT-1000 arthrometer measurements, clinical examination, outcome scores (Lysholm score, Tegner Activity Scale), and a questionnaire about sport activities.

Key findings of the study were:

• A total of 23 patients (44% male, 57% female) with a mean age of 25±15 years were included in the study.

• Mean follow-up was 57±25 months.

• KT-1000 arthrometer measurements of anterior tibial translation revealed a mean side-to-side difference of 0.9±1.0 mm.

• Clinical examination showed 100% normal or nearly normal anterior translation of the tibia.

• Two patients (9%) received an ACL reconstruction due to traumatic ACL re-instability and were, therefore, considered as failures.

• An extension deficit concerning hyperextension occurred in 29% of patients postoperatively.

• Further postoperative complications occurred in 14% of patients and included postoperative stiffness with ROM limitations and secondary dislocation of a fragment.

• Mean postoperative Lysholm score was 89±14.

• Comparing pre- and postoperative values, no significant change of the Tegner Activity Scale was observed.

• All patients (failures excluded) returned to high impact sports activities after ARIF.

The authors concluded that – "Excellent Reliable ligamentous stability and high rates of return to high impact sports can be expected after ARIF using a suture fixation technique for type II–IV tibial eminence fractures. Complications, such as limitations in ROM, commonly occur in up to 30% after ARIF. Therefore, regular follow-up examinations remain important in this usually young patient cohort."

Level of Evidence - Level IV

Further reading:

Reliable ligamentous stability and high return to sport rates after arthroscopic reduction and internal fixation of tibial eminence fractures

Patricia M. Lutz, Stephanie Geyer et al

Archives of Orthopaedic and Trauma Surgery (2022) 142:3623–3631

https://doi.org/10.1007/s00402-021-03961-6