Functional outcomes, arthrofibrosis and residual laxity following arthroscopic and open reduction and internal fixation of tibial spine fractures: A systematic review and meta-analysis.

Abstract

Tibial spine fractures are frequent injuries in the paediatric population and often require surgical fixation. Arthroscopic reduction and internal fixation (ARIF) and open reduction and internal fixation (ORIF) are the most widely adopted techniques. To compare ARIF and ORIF in terms of arthrofibrosis, functional outcomes, and residual instability in Meyers-McKeever grade ≥II tibial spine fractures. A systematic review and meta-analysis was conducted according to PRISMA guidelines. Forty-nine studies published between 2004 and 2025 were included. Extracted variables included Lysholm and International Knee Documentation Committee (IKDC) scores, arthrofibrosis rates, and postoperative anterior tibial translation. A total of 2017 patients were analysed, of whom 1785 (88%) underwent ARIF and 232 (12%) ORIF. The weighted mean age was 19.4 and 17.8 years in ARIF and ORIF group, respectively. Across 1561 patients, the weighted mean follow up was 27.6 months (95% confidence interval (CI) 26.8-28.5). ARIF yielded excellent functional scores, with pooled mean IKDC of 92.07 (95% CI 88.48-95.67) and Lysholm of 94.54 (95% CI 93.36-95.71). ORIF demonstrated similar outcomes, with IKDC 92.42 (95% CI 84.95-99.88) and Lysholm 96.68 (95% CI 93.40-99.96). Comparative studies reported no significant difference in arthrofibrosis risk (OR 0.98; 95% CI 0.41-2.37; P = 0.97). The incidence of arthrofibrosis was 7.4% (95% CI 6.2-8.7) for ARIF and 10.3% (95% CI 6.1-13.8) for ORIF. Residual anterior tibial translation > 3 mm occurred in 3.7% (95% CI 2.7-4.8) of ARIF and 2.8% (95% CI 0.0-5.8) of ORIF procedures. ARIF and ORIF provide comparable outcomes, with no evidence of superiority for either technique.