title: Outcomes after arthroscopic excision of the bony prominence in the treatment of tibial spine avulsion fractures.
abstract: OBJECTIVE
  The purpose of this study was to determine the outcomes after arthroscopic excision of the bony prominence after a tibial spine avulsion fracture.
  
  
  METHODS
  This study included 7 subjects (5 female and 2 male subjects; mean age, 21.4 years). All subjects underwent preoperative rehabilitation focused on range of motion (ROM) and swelling control. Postoperative rehabilitation focused on regaining symmetric knee hyperextension and flexion. Objective examinations and subjective surveys were obtained at least 1 year after surgery.
  
  
  RESULTS
  All subjects achieved normal knee extension; 6 patients achieved normal knee flexion, whereas 1 patient had nearly normal flexion. Physical examination showed a negative Lachman test with a firm end point in all patients, and the mean side-to-side difference for the KT-1000 manual maximum test (MEDmetric, San Diego, CA) was 1.3 mm. No subjects required subsequent anterior cruciate ligament reconstruction. All subjects returned to their previous level of activity without instability symptoms. At a mean of 5.7 years after surgery, the mean International Knee Documentation Committee subjective survey score was 90.6 points overall, with 4.7 out of 5 possible points for the instability question. At latest follow-up, the mean ROM was from 6° of hyperextension to 147° of flexion in the involved knee, compared with 6° of hyperextension to 148° of flexion for the noninvolved knee.
  
  
  CONCLUSIONS
  The results of arthroscopic excision of the bony fragment after type II, III, or III+ tibial spine avulsion fracture are positive, with good stability, symmetric ROM, and high subjective scores. Most importantly, this procedure allows patients to regain full, symmetric hyperextension of the knee, avoiding the complications associated with extension loss.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Shelbourne Knee Center, Indianapolis, IN 46202, USA.
authors.forename: K Donald
authors.initials: KD
authors.lastname: Shelbourne
authors.forename: Scott E
authors.initials: SE
authors.lastname: Urch
authors.forename: Heather
authors.initials: H
authors.lastname: Freeman
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D001863:Bone Screws; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D007718:Knee Injuries / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016119:Posterior Cruciate Ligament / Q000293:injuries / Q000601:surgery*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013536:Suture Techniques; D013977:Tibia / Q000601:surgery*; D013978:Tibial Fractures / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult