Arthroscopic treatment of tibial intercondylar eminence avulsion fracture in pediatric patients without epiphyseal interference

Objective To evaluate the clinical efficacy of arthroscopic treatment of tibial inter-condylar eminence avulsion fracture in pediatric patients without epiphyseal interference. Methods From February 2010 to February 2014, 18 children patients with avulsion fracture of tibial eminence were admitted. They were 12 boys and 6 girls, from 7 to 14 years of age (average, 10.4 years) . Four cases were complicated with meniscus injury and 2 with medial collateral ligament injury. The mean time from injury to surgery was 4.5 days (range, from 2 to 7 days) . According to Meyers-McKeever classification, 13 children were type Ⅱ and 5 type Ⅲ. They were treated with Ultrabraid sutures arthroscopically. After reposition, the bone fragments were fixated to the distal epiphysis of tibial tubercle through the inferior of transverse ligament of knee to avoid epiphyseal injury. Anterior drawer test, Lanchman test, pivot shift test and Lysholm knee scoring were conducted at all clinical follow-up visits to assess functional recovery. Results All children were followed up from 10 to 24 months (average, 15 months) . The X-ray examination demonstrated bone union in all cases. At the end of follow-up, all children achieved satisfactory recovery of range of motion without complications like joint stiffness, joint relaxation, dysfunction or epiphyseal injury. The anterior drawer test, Lanchman test and pivot shift test were all negative at the last follow-up. The mean Lysholm knee scores improved significantly from preoperative 45.6±7.4 to 92.4±5.8 at the final follow-up (t=-25.403, P<0.01). Conclusions Bone reposition under arthroscopy with suture fixation is reliable and minimally invasive in the treatment of avulsion fractures of tibial intercondylar eminence in pediatric patients. Key words: Arthroscopy; Anterior cruciate ligament; Tibial fractures; Pediatrics