Arthroscopic fixation of anterior tibial spine fractures with bioabsorbable nails in skeletally immature patients.

Abstract

A number of arthroscopic techniques have been introduced in the treatment of displaced anterior tibial spine fractures. Several of the procedures are technically demanding or include a second removal operation of metallic implants. The purpose of this study is to describe and evaluate an arthroscopic technique using bioabsorbable nails in displaced anterior tibial spine fractures. Case series; Level of evidence, 4. Sixteen consecutive patients, aged 7 to 15 years, with anterior tibial spine fractures type II and III according to Meyers and McKeever, were treated with arthroscopic fixation of the fragment using bioabsorbable nails. After 2 to 5 years, 13 of the patients were evaluated with regard to anterior knee laxity, range of motion, hop tests, Lysholm knee scoring scale, and activity level. Postoperative surgical complications were registered in the whole group of patients. One of the 13 patients had an increased anterior knee laxity of 3 mm. Extension deficits of 5 degrees were seen in 4 patients and flexion deficits of 5 degrees to 10 degrees in 3 patients. One patient had an outcome of <90% of the uninjured side in the hop tests. Eleven patients were excellent, 1 was good, and 1 was poor according to the Lysholm knee scoring scale. There was no influence on activity level. There were no inflammatory reactions and all fractures healed without complications. In 1 case, the arthroscopy was converted into an open procedure because of technical problems, still using the bioabsorbable nails. The outcome is comparable with other procedures. A second operation for removal of metallic implants is avoided.