Purpose
To determine the clinical and radiological outcomes of patients who underwent arthroscopic
reduction and internal fixation of a tibial eminence avulsion fracture with Kirshner
wires (K-wires) at a mean of 8 years following surgery.
Methods
This was a retrospective study with prospectively collected data. Inclusion criteria
consisted of patients who underwent arthroscopic reduction and internal fixation of
tibial eminence fracture with K-wires between 1989 and 2015 at a minimum of 18 months
follow-up. Assessment included the International Knee Documentation Committee Ligament
Evaluation, Lysholm Knee Score, and clinical outcomes. Magnetic resonance imaging
(MRI) was performed to evaluate the anterior cruciate ligament (ACL) and evidence
of osteoarthritis.
Results
A total of 48 participants met the inclusion criteria, and 32 were reviewed at a mean
of 8 years (range, 18-260 months) after surgery. The mean age at the time of surgery
was 24.5 years (10-55 years). Subsequent ACL injury occurred in 5 participants (10.4%)
on the index knee and in 1 participant also on the contralateral knee; 86% had a normal
examination, and no patients had >5-mm side-to-side difference on instrumented testing.
The mean International Knee Documentation Committee subjective score at 8 years was
86 (range, 40-100). On MRI scan assessment for osteoarthritic changes at final follow-up,
82% of participants had no evidence of chondral wear on the medial compartment and
73% had no changes in the lateral compartment according to Magnetic Resonance Image
Osteoarthritis Knee Score classification. On MRI scan qualitative assessment of ACL
and tibial eminence, 7 participants (32%) were found to have high signal at the fracture
site. The mean medial tibial eminence height was 9.2 mm (range, 6.3 mm to 1.31 cm)
and the lateral tibial eminence height was an average of 6.7 mm (range, 0.38-0.97 mm).
Significant kneeling pain was reported by 8 participants (25%).
Conclusions
This study indicates that internal fixation with K-wires is an acceptable approach
to reduce tibial eminence avulsion fractures, providing excellent clinical and radiological
outcomes at a minimum of 18 months of follow-up.
Level of Evidence
Level IV, therapeutic case series.
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Article Info
Publication History
Published online: April 09, 2019
Accepted:
November 26,
2018
Received:
July 12,
2018
Footnotes
See commentary on page 1545
The authors report the following potential conflicts of interest or sources of funding: J.R. receives support from 360 Knee Systems , Global Orthopaedics , and Smith and Nephew . L.P. receives support from Smith & Nephew, Australian Biotechnologies , Australian Orthopaedic Association , and Signature Orthopaedics . Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2019 Published by Elsevier on behalf of the Arthroscopy Association of North America
