TIBIAL SPINE AVULSION FRACTURES IN ADULTS TREATED WITH ACL RECONSTRUCTION

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Abstract

Introduction: Tibial spine fractures are avulsion fractures of the anterior cruciate ligament (ACL). They are more frequent in children than in adults. Arthroscopic xation methods for such fractures are technically demanding, and their outcomes are compromised due arthrobrosis leading to knee stiffness, residual ACL laxity causing anterior instability, mal-union, non-union and protruding hardware, all of which may require subsequent surgery. This is a retrospective study reporting medium-term results of Material And Methods: a series of displaced tibial spine avulsion fractures in adults treated with arthroscopic ACL reconstruction using a quadrupled Semitendinosus-Gracilis graft. From January 2019 to June 2021, 9 patients treated using this technique with a minimum follow-up of 2 years were included in this study. There were 7 new fractures and 2 cases were of non-union of tibial spine avulsion fracture previously treated non-operatively. Clinically, all patients had anterior laxity of the knee pre-operatively. Results: At 6 months all patients had regained full range of movement of the knee, complete functional recovery and ability to return to work. At the last follow-up at 2 years or beyond, in all patients anterior drawer test, Lachman test and pivot shift test were negative, and all patients had returned to their pre-injury activity levels. Outcomes as per Modied Lysholm score and also, as per Tapper and Hoover grading were excellent in 5 cases and good in 4 cases. No patient required any form of reoperation. Arthroscopic ACL reconstruction using a Conclusion: quadrupled Semitendinosus-Gracilis graft is a satisfactory method of primary treatment for displaced tibial spine avulsion fractures in adults, and also for non-union of these fractures. Patients thus treated do not have residual ACL laxity or instability, they do not have knee stiffness, and they do not need any subsequent surgery.