Arthroscopic reduction and suture fixation of displaced tibial intercondylar eminence fractures in adults.
BACKGROUND
Tibial intercondylar eminence fractures are uncommon. In a review of the literature, most authors agreed that conservative treatment was suggested for non-displaced fractures. Displaced fractures were considered an indication for surgery.


METHODS
Between April 2000 and November 2001, five adult displaced tibial eminence fractures were treated by arthroscopic reduction and non-absorbable suture fixation. Postoperatively, the knee was immobilized in a hinged knee brace locked in full extension with non-weight bearing for 4 weeks. Range of motion and quadriceps-strengthening exercises were started 4 weeks later. Partial weight-bearing was allowed in the following 4 weeks.


RESULTS
The average follow-up was 24.6 months (range 18-36 months). Subjectively, there was no instability or residual pain in the knee. The patients were able to resume their normal activities. Objectively, the average Lysholm Score was 95.6 (range 93-98). The average knee range of motion was 2 degrees to 135 degrees (range 0 degree-140 degrees). All patients had a negative Lachman's test and no pivot shift phenomenon. All fractures showed good union according to radiological evaluation.


CONCLUSIONS
Arthroscopy-assisted screw fixation is more stable, and it allows early exercise. However, the fragment must be large enough to be fixed with a screw. Comminuted or small fragments present limitations for screw fixation techniques. We used the non-absorbable intraligmentous suture to pull down the fragment regardless of small size or comminuted status. The technique is simple and provided secure fixation without damage to the ACL insertion. A second operation is not required to remove the hardware.
Yang
Shan-Wei
SW
Department of Orthopaedic Surgery, Veterans General Hospital-Kaohsiung, 813 Kaohsiung, Taiwan, ROC.
Lu
Yih-Chau
YC
Teng
Hsiu-Peng
HP
Wong
Chi-Yin
CY
D000328:Adult; D001182:Arthroscopy; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D007103:Immobilization; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular / Q000502:physiology; D013536:Suture Techniques; D013978:Tibial Fractures / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome