Arthroscopic reduction and double-tunnel button fixation of fractures of the tibial intercondylar eminence in children / 中华创伤骨科杂志

Objective:To investigate the efficacy of arthroscopic reduction and double-tunnel button fixation in the treatment of fractures of the tibial intercondylar eminence in children.Methods:From January 2019 to June 2022, 8 children with fracture of the tibial intercondylar eminence were treated at Orthopedics Department, Shenzhen Children's Hospital with arthroscopic reduction and double-tunnel button fixation. They were 6 boys and 2 girls, with an age of (8.4±1.9) years. Injured sites: 4 left knees and 4 right knees. Their operation time, intraoperative blood loss, knee flexion and extension, and complications were recorded. Their Lysholm scores were compared between preoperation and the last follow-up.Results:The operation time was (161.9±57.9)min. All patients were followed up for (12.1±5.7) months. The intraoperative blood loss was 3.5 (1.0,4.3)mL. Their knee flexion was 145.0°±5.0° and extension 0.9°±1.2° after operation. All their incisions healed at one stage, with no postoperative infection or other complications. Their preoperative Lysholm score [(20.3±15.8) points (from 2 to 54 points)] increased significantly to (99.3±1.0) points (from 98 to 100 points) after operation ( P<0.05). Conclusions:Arthroscopic reduction and double-tunnel button fixation is effective for fractures of the tibial intercondylar eminence in children, leading to limited complications, limited bleeding and a low infection rate.

Comparison of notch width indexes between tibial intercondylar eminence avulsion fracture and anterior cruciate ligament injury / 中华创伤骨科杂志

Objective To find out if there is any difference in intercondylar fossa width and notch width index (NWI) between tibial intercondylar eminence avulsion fracture and anterior cruciate ligament (ACL) injury.Methods A retrospective study was conducted of the patients who had sought medical attention at Department of Sports Medicine and Adult Reconstructive Surgery,Drum Tower Hospital from June 2014 to May 2018.There were 10 patients with tibial intercondylar eminence avulsion fracture (4 males and 6 females with an average age of 32.7 ± 9.2 years),13 patients with ACL injury (8 males and 5 females with an average age of 31.8 ± 10.9 years) and 22 patients with simple meniscus injury as controls (13 males and 9 females with an average age of 30.9 ± 10.6 years).They all had MRI examination of the knee before surgery.The width of intercondylar fossa and the width and height of bilateral femoral condyles were measured on high resolution images of MRI axial view.NWI was calculated.The 3 groups were compared in intercondylar fossa width and NWI.Results The 3 groups of patients were comparable because there were no significant differences in gender,age,height,weight or BMI between them (P ＞ 0.05).The intercondylar fossa width in the ACL injury group (17.4 ± 3.5 mm) was significantly smaller than that in the avulsion fracture group (20.8 ± 1.1 mm) or in the control group (20.2 ±2.6 mm) (P ＜ 0.05),but no significant difference was detected between the avulsion fracture group and the control group (P ＞ 0.05).NWI in the avulsion fracture group (0.301 ±0.011) was similar to that in the control group (0.280 ±0.039) (P ＞ 0.05) but significantly higher than that in the ACL injury group (0.25 ± 0.05) (P ＜ 0.05).NWI in the ACL injury group was significantly lower than that in the control group (P ＜ 0.05).Conclusions Intercondylar notch stenosis may be a risk factor for ACL injury but may not be associated with tibial intercondylar eminence avulsion fracture.The difference in pathogenesis between tibial intercondylar eminence avulsion fracture and ACL injury may be associated with their difference in NWI.

Curative effect of adolescent tibial intercondylar eminence fracture:fixed with suture anchor or hollow screw or wire / 实用医学杂志

Objective To compare the curative effect of fixation of adolescent tibial intercondylar emi-nence fracture among suture anchor,hollow screw and wire. Methods Forty-six adolescent cases of the tibial intercondylar eminence fracture treated with surgical treatment were selected from January 2010 to June 2016 and divided into three groups refer to intra-operative fixation suture anchor group(Group A),hollow screw group (Group B)and wire group(Group C).Duration of treatment,total operation time,hospital stay and surgery times were recorded. All patient condition was assessed with the Lysholm,Tegner,IKDC and VAS score. Results All patients received an average of 13(11~14)months follow-up visit. No blood-vessel,nerve and osteoepiphysis injured,infection and fracture displacement occurred.Before receiving treatment,difference in Lysholm,Tegner, IKDC and VAS score of group A,B and C showed no statistical difference.When it comes to hospitalization condi-tion,data were as follows.Group A/B/C:operation time(80.67 ± 16.68/114.00 ± 20.28/111.88 ± 20.07)min, hospital stay(8.40 ± 1.12/ 15.47 ± 1.25/ 15.19 ± 1.17)d,surgery times(1/2/2)times. Moreover,compared with those before operation and after operation in both of groups,the Lysholm,Tegner,IKDC and VAS score were improved(P < 0.05). Besides,the Lysholm,Tegner,IKDC and VAS score of group A,B and C did not have statistically significant difference yet after post treatment(P>0.05).Conclusions The curative effect of fixation of adolescent tibial intercondylar eminence fracture among suture anchor,hollow screw and wire was similar. By contrast,the fixation of fracture by use of suture anchor can decrease operation time and hospital stay to some extent. It had advantage of need not to have a second operation to remove the internal fixation and can be used in preference.

Fractura de la eminencia intercondílea / Intercondylar Eminence Fracture

La eminencia intercondílea o espina tibial, está entre las carillas articulares interna y externa de la superficie superior del extremo proximal de la tibia. Las fracturas a este nivel aparecen con mayor frecuencia en niños de 8 a 13 años y por lo común no se las detecta en menores de 7 años, son esencialmente avulsiones de los ligamentos cruzados con un fragmento de hueso unido. Se presentó una paciente de 13 años de edad que sufrió un accidente del tránsito, en el cual recibe trauma de rodilla izquierda, diagnosticándole una fractura de la eminencia intercondilea. Se le realizó reducción y osteosíntesis con micro tornillo AO a través de una vía de acceso anteromedial. La evolución fue satisfactoria, alcanzando una adecuada fijación de la fractura, así como, una recuperación funcional total. Este tipo de fractura requiere un diagnóstico preciso, puede ser tratada conservadoramente, pero con el tratamiento quirúrgico se obtienen excelentes resultados.

The intercondylar eminence or tibia spine is between the inner and outer of the upper surface of the proximal end of the tibia. Fractures at this level appear more frequently in children aged 8-13 years, and usually they are not detected under seven years old. These fractures are essentially avulsions of the crossed ligaments with joint bone fragment. A 13- year-old patient was presented, who suffered a traffic accident, and as a result of this she got a left knee trauma. A fracture of the intercondylar eminence was diagnosed. The patient underwent reduction and internal fixation with AO micro screw through an anteromedial access. The evolution was satisfactory, achieving adequate fracture fixation, as well as full functional recovery. This is a type of fracture that requires an accurate diagnosis and can be treated conservatively, but with surgery excellent results can be achieved.

The Position of Proximal Reference Point of Tibia Plateau for Correct Tibial Osteotomy in Total Knee Replacement: Prospective Randomized and 6 Years Follow-up Study

PURPOSE: When there is a varus deformity in proximal tibia, the extension of a tibial shaft axis tends to pass through the lateral intercondylar eminence. A prospective randomized study was conducted to find out whether the lateral eminence of tibia could serve as a reference point for proximal tibial osteotomy during total knee arthroplasty and results from 6-years follow up period were reported. MATERIALS AND METHODS: Forty-six patients (50 knees) who received total knee replacement arthroplasty from April to December 2004, were randomly divided into two groups. For a proximal tibial osteotomy, the proximal tibial reference point was located at the center of intercondylar eminence for group I and at the lateral eminence for group II and subsequently, the results were evaluated. Radiologic indices were the angles between the axis of the prosthesis and the mechanical/shaft axes of tibia and angle of the prosthesis in sagittal plane. Clinical indices were pain and function score of American knee society, functional score of Hospital for Special Surgery and range of knee joint motion. RESULTS: The angles between the axis of the prostheses and the mechanical/shaft axes of tibia were varus 1.64degrees/2.12degrees in group I and valgus 0.57degrees/0.38degrees in group II (p=0.589/p=0.558). There were 6 cases of outliers (27.2%) in group 1 and 3 cases (15.0%) in group 2. There was a significant difference in the pain score between group I (82.9) and II (91.4) (p=0.032), respectively. CONCLUSIONS: By moving the reference point of proximal tibial osteotomy laterally, lower incidence of outlier and residual varus deformity could be achieved.

The Position of Proximal Reference Point of Tibial Plateau to Prevent Varus Tibial Cutting in Total Knee Replacement : Prospective Randomized Study

PURPOSE: When there is a varus deformity in proximal tibia, the extension of a tibial shaft axis usually passes through the lateral intercondylar eminence. We performed prospective randomized study to find out whether the lateral eminence of tibia could be used as a reference point for proximal tibial cutting during total knee arthroplasty. MATERIALS AND METHODS: We randomly divided fifty patients who received TKR from April to December 2004 into two groups. For a proximal tibial cutting, we located the proximal tibial reference point at the center of intercondylar eminences for group I and at the lateral eminence for group II. Along with the clinical assessment, we measured the angles between the axis of the prostheses and both the mechanical and shaft axis of tibiae. RESULTS: There were no differences in clinical results between two groups. The angles between the axis of the prostheses and the mechanical / shaft axis of tibiae were varus 2.14 / 2.22 degrees in group 1 and valgus 0.20 / 0.14 degrees in group 2(p=0.02, 0.01). CONCLUSION: With moving the reference point laterally, we could prevent the varus tibial osteotomy and achieve more reliable alignment of the tibial component.

Arthroscopic treatment of the avulsion fracture of anterior cruciate ligament from the tibial spine using steel-wire fixation / 中国矫形外科杂志

[Objective]To explore the operating methods and key points of bysteel-wire guiding fixative steel-wire repearing tibial intercondylar eminence avulsion fractures under arthroscope.[Method]From February 2006 to August 2006,14 patients with tibial intercondylar eminence avulsion fractures were treated in bysteel-wire guiding fixative steel-wire method.Among them,there are 9 males and 5 females with an average age of 32.6 years,aged from 5 to 40 years.Injury cause:7 of road accident,5 of falling down while moving and 2 of falling from height.The results of preoperative x-Ray and Artoscan of all patients suggested the avulsion fracture of anterior cruciate ligament from the tibial spine.In the operation,firstly,fixative steel-wire cross the avulsion fracture tendon-bone joint zone.Then,make each side of avulsion fracture a bone tunnel on the tibial plateau.Finally,guide fixative steel-wire out of these two bone tunnels and then fix this steel-wire with the help of guiding steel-wires.After operation,fix the knee joint with plaster slab bended at 20? in three or four weeks.Remove the plaster slab and do functional exercise after 4 weeks.And move with walking stick 8 weeks later.[Result]All 14 patients were available at follow up with mean duration of 10.5 months.The X-Ray suggested bone healed at about 5.5 months after operation.We got the excellent in 8 cases,good in 4 and fair in 2 according to the advanced Lyshdm's classification at the last follow up.The excellent and good rate was 85.1%.[Conclusion]The technique needn't traditional cut,and has many advantages,such as micro injury,rapid recovery and few complications.And it is good to master the main points of this technique for applying it.

The Change of Proximal Reference of Tibial Plateau in Total Knee Replacement: The Cadaveric Study

PURPOSE: We frequently observed varus cutting of tibia in total knee arthroplasty. And we found that the extension of the tibial shaft axis often reach the lateral intercondylar eminence. So right tibias were osteotomized as usual manner and left tibias were osteotomized as the proximal reference point of cutting at the lateral intercondylar eminence, then we compared the differences. MATERIALS AND METHODS: By using 6 cadavers, right tibias were osteotomized as usual manner and left tibias were osteotomized as the proximal reference point of cutting at the lateral intercondylar eminence. Tibial prosthesis were implanted after measuring the thickness of cut tibial condyles. The radiological examinations were accomplished pre- and postoperatively. With postoperative X-ray films, we measured the angles between the perpendicular line to the prosthesis and shaft axis/mechanical axis. RESULTS: The mediolateral differences of cut tibial condyles were not statistically different between right and left tibias. The right angles between the perpendicular line to the prosthesis and shaft axis/mechanical axis were measured average varus 1.00 and 1.08 degree and left angles average varus 0.25 and 0.17 degree, so no statistical differences were observed(p=0.066, 0.066). CONCLUSIONS: Although no statistical differences, we could get more stable alignment by valgus osteotomy and somewhat low incidences of varus cutting were observed. In the future more studies would be required by using varus deformed tibias.

Arthroscopic Treatment of Tibia Intercondylar Eminence Comminuted Fracture Used Number 5-nonabsobable Suture Material

PURPOSE: To evaluate effect of modified arthroscopic pull-out suture technique which used number 5-nonabsorbable suture material for tibia intercondylar eminence comminuted fractures. MATERIALS AND METHODS: There were 21 cases of tibia intercondylar emimence fracture which arthroscopic treated at our hospital between 1999 and 2004. However the study population only included 12 cases in which a number 5-nonabsorbable suture material (Ethibond No. 5) was used for tibia intercondylar eminence comminuted fractures and minimum 1-year follow-up has gone. The average follow-up period was 18.5 months (range, 12 to 42 months). Lachman test and KT-2000 athrometer test were evaluated at the pre-and post-operation. Clinical results of all patients were evaluated with the Meyers and Mckeever 's criteria. RESULTS: In all 12 cases, the normal range of motion and sports activities were recovered at the final follow-up. When tested for anterior instability with KT-2000 arthrometer, there were no different between normal knee and operated knee. Clinical results by Meyers and Mckeever's criteria were excellent in 10 patients and good in 2 patients. CONCLUSION: We obtained early mobilization and stable fixation in modified arthroscopic pullout suture technique for tibia intercondylar eminence comminuted fractures. Patients can early return to his job. This technique seems to be one of the effective operative techniques for treatment of tibia intercondylar eminence comminuted fractures.

Arthroscopic Reduction and Pull-out Suture Fixation for the Intercondylar Eminence Fracture of the Tibia

PURPOSE: Meyers-McKeever and Zaricznyj proposed a classification for intercondylar eminence fractures of the tibia. Type III and IV classifications are generally accepted as surgical indications for the fractures. The purpose of the present study was to evaluate the effectiveness of arthroscopic reduction and multiple pull-out suture fixation for displaced intercondylar eminence fractures of the tibia. MATERIALS AND METHODS: Twenty two cases were examined, with a average age of 14(5~23) years, and the average follow-up was 34 months(24 months~6 years). Patients were evaluated according to the Meyers and McKeever criteria, and were scored at 6 weeks, 4 months, 8 months, each year and at the last follow-up. Patients underwent the following evaluations: radiological, range of motion, Lachman test, pivotshift test and the KT 2000 arthrometer. RESULTS: The average union time was postoperative week 9.3(6~12 weeks). According to the Meyers and McKeever criteria, the cases showed the following outcomes at the final follow-up: 19(86.4%) excellent, 2(9.1%) good and 1(4.5%) poor. CONCLUSION: Using the short- and mid-term arthroscopic reduction and multiple pull-out suture fixation procedure for displaced intercondylar eminence fractures of the tibia resulted in 95.5%(19) of cases showing good or excellent outcomes, indicating this procedure is effective.

Arthroscopic Treatment of Displaced tibial Intercondylar Eminence Fractures: A Comparison of K-wires vs. Screw Fixation / 대한정형외과학회잡지

OBJECTIVES: To assess and compare the degree of reduction and clinical results following arthroscopic cannulated screw and K-wire fixation for type III displaced tibial intercondylar eminence fractures. METHODS: From 1991 to 1997, 20 patients with type III of intercondylar eminence fractures were arthroscopically treated (K-wire in 12 and screw in 8) and followed up 31 mo. in average. Degrees of reduction, extension loss and residual joint laxity were checked. And statistical analysis was done (Mann Whitney U-test) . Functional results were recorded by Meyers & McKeever's criteria. RESULTS: Degrees of reduction showed +2.1mm in K-wire group, and -1.3mm in screw group (avg., p<0.05) . Anterior displacements were 2.2mm and 1.7mm in stress x-rays and 3.5mm and 1.2mm in KT-1000 arthrometer, respectively (avg.,p<0.05) . Average loss of extension was 7 in K-wire group and 3 in screw group. There were excellent 9, good 3 in K-wire group and excellent 7, good 1 in screw group. CONCLUSION: Because of arthroscopic screw fixation able to compress and sink the fragment, it may showed less extension loss and residual laxity than K-wire fixtion. It is recommendable for the first choice to the treatment of type III tibial intercondylar eminence fractures with relatively large fragment.

A biomechanical Comparison of Different Fixation Techniques on Intercondylar Eminence Fractures of Tibia

Methods of internal fixation for displaced intercondylar eminence fractures of tibia are percutaneous pinning, pull-out knot with wire or nylon and screw fixation. We tried experimental tensile test on four different fixation methods with 60 fresh pig knees. The results were as follows. 1. In our experimental study, the maximum tensile strength(M.T.S.) was recorded average 73.49N in the group of percutaneous pinning, 133.01N in Ethilon used group, 198.01N in wire used group and 275.05N in screw fixed group. 2. The group of percutaneous pinning with K-wires showed the lowest value of M.T.S., therefore, this method of fixation must be discarded. 3. The M.T.S of pull-out knot tie was about twice as high as that of percutaneous pinning. But the method of knotting should be improved because of the failure around the knot. 4. The group of screw fixation showed the highest value of M.T.S., but this method of fixation has some problems, like as arthrotomy or difficulty of removal of hardware.

Treatment of Fracture of the Tibial Intercondylar Eminence with Arthroscopic Pull-Out Suture

The purpose of this study is to demonstrate the effectiveness of arthrocopic treatment for the avulsion fracture of intercondylar eminence of the tibia and of the technique of arthroscopically assisted reduction and fixation through pull-out suture method. Between January 1995 and May 1997, three patients were underwent arthroscopic reduction and suture fixation for type 0 of avulsion fracture of intercondylar eminence of tibia and were followed up. The result of two patients were graded as normal and one as nearly normal by the criteria of the International Knee Documentation Committee(IKDC) rating scale. The advantages of this technique include no retained hardware and ability to treat comminuted fracture(type g ). We describe technique of arthroscopic reduction and suture fixasion for displaced avulsion fractures, including those with comminution of intercondylar eminence of tibia.