Long-term Outcomes of Tibial Spine Avulsion Fractures After Open Reduction With Osteosuturing Versus Arthroscopic Screw Fixation: A Multicenter Comparative Study.

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Abstract

Conflict of interest statement: The authors have declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. 16. J Orthop Surg Res. 2026 Mar 18. doi: 10.1186/s13018-026-06797-1. Online ahead of print. Management of type II tibial spine fractures in children and adolescents: a systematic review. Sapienza M(1), Torrisi P(2), Mirto F(2), Amico M(2), Russo A(3)(4), Costa GG(3)(4), Raciti F(2), Testa G(2), Pavone V(2). Author information: (1)Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico-San Marco, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy. marcosapienza09@yahoo.it. (2)Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico-San Marco, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy. (3)Faculty of Medicine and Surgery, Kore University of Enna, 94100, Enna, Italy. (4)Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale Di Enna, 94100, Enna, Italy. BACKGROUND: Tibial spine avulsion fractures (TSFs) are the pediatric equivalent of anterior cruciate ligament (ACL) injuries. The optimal management of type II fractures remains debated, and both conservative and surgical strategies have been described. This systematic review compares outcomes of nonsurgical and surgical treatments in type II TSFs and evaluates different surgical fixation techniques. METHODS: A PRISMA-guided search identified studies reporting clinical and radiographic outcomes of pediatric TSFs. Data were pooled for patient demographics, treatment, complications, and functional results. Comparative analyses were performed for conservative versus surgical management in type II fractures and for suture versus screw fixation across all surgical cases. RESULTS: Thirty-eight studies (1,070 patients) were included. In type II fractures (371 knees), surgical treatment achieved lower rates of clinical instability (0.7% vs. 13.2%, p