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Tibial Eminence Fracture

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Topic updated on 12/30/15 9:57pm
Introduction
  • A fracture of the bony attachment of the ACL on the tibia
  • Epidemiology
    • rare injuries
    • most common in ages 8-14
  • Mechanism
    • traumatic
      • rapid deceleration or hyperextension of the knee
      • same mechanism that would cause ACL tear in adult
  • Associated conditions
    • occur in 40% of eminence fractures
      • meniscal injury 
      • collateral ligament injury
      • capsular damage
      • osteochondral fracture
Anatomy
  • Osteology
    • tibial eminence
      • non-articular portion of the tibia between the medial and lateral tibial plateau
  • Ligaments
    • anterior cruciate ligament
      • inserts 10-14 mm behind anterior border of tibia and extends to medial and lateral tibial eminence
Classification
 
Meyers and McKeever Classification
Type I Nondisplaced
Type II Minimally displaced with intact posterior hinge

Type III Completely displaced
 
Presentation
  • Symptoms
    • pain in knee
  • Physical exam
    • inspection
      • immediate knee effusion
    • ROM
      • often limited secondary to pain
      • once pain is controlled, lack of motion may indicate
        • meniscal pathology
        • displaced/entrapped fracture fragment
      • positive anterior drawer
Imaging
  • Radiographs
    • recommended views
      • standard knee radiographs
  • CT
    • useful for pre-operative planning
  • MRI
    • better at determining associated ligamentous/meniscal damage than CT or radiographs
Treatment
  • Nonoperative  
    • closed reduction, evacuation of hemarthrosis, immobilization in 0-20 degrees of extension
      • indications
        • non-displaced type I and reducible type II fractures
  • Operative
    • ORIF vs. all-arthroscopic fixation
      • indications
        • Type III or Type II fractures that can't be reduced
Sugical Techniques
  • Arthroscopic fixation 
    • approach
      • standard arthroscopic portals
    • technique
      • debride fracture
      • disengage entrapped meniscus or intermeniscal ligament
        • medial meniscus entrapment most common
      • reduce fracture
      • fracture fixation
        • suture fixation
          • pros
            • avoids physis
          • cons
            • technically demanding
        • screw fixation
          • pros
            • less demanding than suture fixation
            • possibly earlier mobilization
          • cons
            • hardware irritation
            • impingement from improperly placed screw
            • physeal damage
    • post-operative care
      • early range of motion
      • length of limited weight bearing is controversial
Complications
  • Arthrofibrosis 
    • more common with surgical reconstruction
  • Growth arrest
  • ACL laxity
    • incidence
      • 10% of knees managed surgically
      • 20% of knees managed non-operatively
    • often not clinically significant

 

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Qbank (5 Questions)

TAG
(OBQ11.237) A 19-year-old patient is undergoing an arthroscopic treatment of a right knee with suture fixation via transosseous tunnels shown in the video in Figure V. What is the most likely postoperative complication? Topic Review Topic
FIGURES: V          

1. Infection
2. Arthrofibrosis
3. Spontaneous osteonecrosis of the knee (SONK)
4. Hardware prominence in the intercondylar notch necessitating removal of implants
5. Increased posterior tibial excursion

PREFERRED RESPONSE ▶
TAG
(OBQ06.56) The AP radiograph in Figure A demonstrates an injury in a 13-year-old soccer player. What is the equivalent injury in a skeletally mature patient? Topic Review Topic
FIGURES: A          

1. Patella tendon rupture
2. Posterior cruciate ligament tear
3. Anterior cruciate ligament tear
4. Lateral meniscus tear
5. Posteromedial capsular avulsion

PREFERRED RESPONSE ▶
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Cases

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Videos

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video
Demonstrates tibial eminence fracture suture fixation.
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