ABSTRACT
Resumen: Las fracturas avulsión de la espina tibial anterior (también conocidas como fracturas de la eminencia tibial) son arrancamientos óseos del LCA (ligamento cruzado anterior) en su inserción en la eminencia intercondílea. Este tipo de lesión suele darse en pacientes de entre ocho y 12 años de edad, debido a que en el niño la resistencia del LCA es superior a la del hueso y el cartílago de crecimiento y a que éste está fuertemente unido a la epífisis. Se clasifican en tres tipos según Meyers y McKeever en función del grado de desplazamiento del fragmento. Dicha clasificación resulta fundamental para la decisión terapéutica. El tratamiento artroscópico es el estándar de oro para el tratamiento de fracturas desplazadas, ya que se debe tener en cuenta la frecuente asociación con otras patologías intraarticulares (como la interposición del cuerno anterior del menisco medial o del ligamento intermeniscal anterior). Complementariamente a la artroscopía, las miniartrotomías serán necesarias para la fijación con tornillos en los casos en los que la fractura sea irreductible por vía artroscópica. Son escasos los artículos publicados en la bibliografía sobre avulsiones crónicas en pacientes pediátricos. El tratamiento para estos casos es similar al de las fracturas agudas, otorgando mayor importancia al desbridamiento del tejido fibroso entre el fragmento óseo y el lecho y al tratamiento de patología intraarticular asociada. Se ha evidenciado en estos pacientes mayores dificultades para lograr la extensión completa de rodilla tras la cirugía pese a conseguirse una buena reducción. A pesar de ello, los resultados son satisfactorios a largo plazo. En este artículo se presenta el caso de un niño de siete años con una avulsión de la espina tibial anterior de larga evolución, así como el tratamiento realizado y el resultado funcional obtenido.
Abstract: Tibial spine avulsion fractures (also called tibial eminence fractures) are bony avulsions of the anterior cruciate ligament (ACL) from its insertion in the intercondylar eminence. It is most commonly seen in children aged eight to 12 years, because LCA is more resistent than bone and physis. Furthermore, the union between epiphisys and LCA is very strong due to the collagen fibers. Meyers and McKeever classification defines three types: type I: non displaced; type II: partially dislaced; and type III: completely displaced. This classification is very important for the treatment. Arthroscopic treatment is the gold standard for displaced fractures. The association with other intraarticular injuries is frequent, and the anterior horn of the medial meniscus or the transverse meniscal ligament is frequently trapped within the fracture site. A miniarthrotomy may still be necessary in fractures that are irreducible by arthroscopic means. It's difficult to find chronic fractures in children in the literature. The treatment is similar to acute cases, but includes debridement of the scar tissue and reparation of intraarticular injuries. Loss of extension is the main problem we find in this patients, although acceptable results may be achieved. In this article we present a seven years old boy with a chronic tibial spine avulsion, the treatment and the outcome.
Subject(s)
Humans , Male , Child , Arthroscopy , Tibial Fractures/surgery , Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament , Knee JointABSTRACT
Background: Avulsion fractures of tibial spine can be called as a variant of anterior cruciate ligament injuries and are described in both adults and children. Surgical Technique: The pull through suture technique offers a simple option of arthroscopic management of such injuries with minimal chances of loss of terminal extension due to bulky intra articular hardware as may be seen with screws. Methods: Between November 2013 and April 2016, the arthroscopic Pull Through Suture Method was used for 10 tibial spine avulsion fractures. All the patients were followed for a minimum of 6 weeks months post-operatively. Results: None of the patients had a positive anterior drawer test, Lachman test and pivot shift test at final follow-up. There was no patient with loss of terminal extension. Conclusion: The Pull Through Suture Method is a simple technique for management of tibial spine avulsion fractures.
ABSTRACT
Describimos una técnica quirúrgica sin nudos (Knotless) con arpones Bioswivelock con sutura FiberTape (Arthrex inc. Naples Florida) con técnica cruzada; denominándola técnica CrossFix para reducción y osteosíntesis artroscópica de las fracturas avulsión de espina tibial anterior, logrando reducción anatómica estable, mínimamente invasiva sin la necesidad de realizar la extracción del implante al final del tratamiento. Nuestra técnica es aplicable tanto en pacientes con inmadurez esquelética como en adultos ya que no daña la fisis o cartílago de crecimiento y no requiere una segunda intervención para el retiro del implante; combinando las ventajas de la fijación con suturas de alta resistencia FiberTape, con la tecnología de los implantes sin nudos.
We describe a new surgical technique without knots (knotless technique) with Bioswivelock anchor and FiberTape suture (Arthrex inc. Naples Florida) with crossing technique, calling it CrossFix technique for arthroscopic reduction and internal fixation of avulsion fractures of the anterior tibial tubercle, achieving anatomic reduction, stable, minimally invasively without the need for removal of the implant at the end of treatment. Our technique is applicable to both patients adult and skeletal immaturity as not damage the cartilage growth plate or fisis and does not require a second surgery to remove the implant, combining the advantages of fixation with high strength sutures like the FiberTape, with an implant technology without knots like Bioswivelock.
Subject(s)
Suture Anchors , Knee Joint/surgery , Arthroscopy/methods , Fracture Fixation, Internal/methods , Tibial Fractures/surgery , Knee Injuries/surgery , Suture TechniquesABSTRACT
10.3969/j.issn.2095-4344.2013.26.004
ABSTRACT
PURPOSE: The aim of this study is to determine the relationship between the arthritic changes and a deficiency of the anterior cruciate ligament (ACL) in osteoarthritic knees. MATERIALS AND METHODS: Between May 2003 and January 2008, 815 cases of total knee arthroplasty that were due to degenerative osteoarthritis of the knee were enrolled in this study. Flexion contracture, the tibia-femoral angle, translocation of the tibial spine and erosion on the posteromedial tibial plateau were assessed and we tried to determine the relationship between these findings and an ACL-deficiency. RESULTS: The mean flexion contracture in the knees with a deficient ACL was 10.7degrees and this was 8.8degrees in the knees with an intact ACL, and this difference was statistically significant (p=0.001). The tibia-femoral angle of the patients with an ACL-deficiency was 7.97degrees varus on average, and that for patients with an intact ACL was 4.38degrees varus, and the difference was found to be highly dependent upon the ACL's integrity (p=0.000). 77.6% of the knees with varus deformity exceeding 15degrees showed an abnormal ACL. Translocation of the tibial spine doesn't predict ACL integrity. Bone erosion on the posteromedial tibial plateau was significantly frequent in patients with ACL-deficient knees (p=0.000). For the knees with erosion on the posteromedial tibial plateau, 85% of these knees showed an ACL deficiency. CONCLUSION: Varus deformity exceeding 15degrees and erosion on the posteromedial tibial plateau can reflect ACL deficiency.
Subject(s)
Humans , Anterior Cruciate Ligament , Arthroplasty , Congenital Abnormalities , Contracture , Knee , Osteoarthritis , SpineABSTRACT
The management of fractures of the intercondylar eminence of the tibia is uncomplicated when the fracture has minimal displacement(type I) or when only anterior one-third or half of the eminence is elevated(type II)(Meyers and Mckeever 1959, 1970). The treatment of complete separation(type III) has been controversial. Many authors however recommended conservative treatment even for the completely separated fracture if the fracture fragment is not rotated. Two cases of non-union of the tibial spine fracture we experienced were; one in type IIl, and the other type II. They were treated conservatively by cast immobilization. One patient had severe anterolateral rotatory.instability and had lateral meniscal tear, and the other had transverse ligament impingement at the fracture gap which interfered the reduction of the fragment and also bony union. Through the clinical experience and the two listed non-union cases, we drafted a therapeutic plan for the avulsed tibial spine fractures. The authors recommend open reduction and internal fixation of the avulsion fracture of the tibial spine in following circumstance; 1) all of the type K complete separation injuries 2) tibial spine fracture with positive Lachman test and soft end point 3) fracture with associated ligament injury. We applied the above surgical indications for 13 cases. The authors reviewed 25 cases of the anterior tibial spine fracture patients treated at the Department of Orthopaedic Surgery, Catholic Unviersity Medical College during the period from October 1982 to August 1986 and the following results were obtained. 1. The cases were classified into 3 different categories according to the Meyers and Mckeever classification; Type I(7 cases, 29%), Type II(10 cases, 40%), Type III(8 cases, 31%). 2. Associated ligament injuries on the same knee were rupture of LCL for 7 cases(28%) and MCL for 6 cases(24%). 3. Twelve out of thirteen open reduction and internal fixation cases had excellentresult in minimum 6 months follow-up period.