Defining the boundaries of surgery in pediatric ACL avulsion fractures: A Case Report in a 5-Year-Old Child.

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Abstract

19. J Pers Med. 2021 May 19;11(5):434. doi: 10.3390/jpm11050434. Arthroscopic Repair in Tibial Spine Avulsion Fractures Using Polyethylene Terephthalate Suture: Good to Excellent Results in Pediatric Patients. Russu OM(1)(2), Pop TS(1)(2), Ciorcila E(1)(2), Gergely I(1)(2), Zuh SG(1)(2), Trâmbițaș C(1)(3), Borodi PG(2), Incze-Bartha Z(1)(3), Feier AM(1)(2), Georgeanu VA(4). Author information: (1)Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania. (2)Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania. (3)Department of Anatomy and Embryology, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania. (4)Clinic of Orthopaedic and Trauma Surgery, "St. Pantelimon" Hospital, 021659 Bucharest, Romania. BACKGROUND: The objective of the arthroscopic treatment in tibial spine avulsion fractures (TSAF) is to achieve firm reduction and strong internal fixation while still having the patient undergo a minimally invasive procedure. MATERIAL AND METHODS: The study was performed on 12 young patients with avulsion fracture of the anterior tibial spine. All 12 patients had type 3 Modified Meyers and McKeever fractures. The injury mechanism was direct anterior to posterior trauma in full leg length hyperextension with sport trauma reported in all cases. The physical examination revealed decreased range of motion, extension deficit, and pain during walking. Radiology, MRI, and CT pathologic findings described complete fracture of the anterior tibial spine with no clear signs of callus formation at the time of examination. All patients underwent arthroscopic suture surgical treatment. The Tegner, the Lysholm, and the International Knee Documentation Committee (IKDC) scores were used to evaluate subjective outcomes at three and six months after the surgery. Radiographs were used to assess callus formation and healing status of the fracture. RESULTS: The mean IKDC score was 33.4 ± 23.3 (p = 0.032) preoperatively and 84.2 ± 14.3 at final follow-up (p = 0.0032, CI = 95%). The mean Tegner score improved from 3.8 ± 1.1 pre-operatively to 6.7 ± 2.2 at six months follow-up (p = 0.0231, CI = 95%). The Lysholm score differed significantly at baseline compared to final follow-up (53.7 ± 17.3 vs. 87.7 ± 9.9; p = 0.0066, CI = 95%). In all cases (n = 12), the radiographs taken after six months revealed the healing of the fracture in the anatomic position without secondary displacement. No functional knee instability was detected at the end of the study. CONCLUSIONS: The study provides preliminary promising results regarding fracture healing, knee stability, and functional subjective scores. Patient selection was a major factor of success prediction for this technique. DOI: 10.3390/jpm11050434 PMCID: PMC8160716