Tibial eminence fractures in children:  earlier posttreatment mobilization results in improved outcomes.
BACKGROUND
Arthrofibrosis and decreased range of motion (ROM) are well-described sequelae of tibial eminence fractures. We sought to evaluate the effects of timing of ROM rehabilitation and postsurgical immobilization on clinical outcomes in children with fractures of the tibial eminence.


METHODS
We retrospectively reviewed the records of all children diagnosed with closed tibial eminence fractures between 2000 and 2010. Patients were treated by experienced surgeons with uniform requirements for return to full activity.


RESULTS
Fourteen females and 26 males (40 knees) of mean age 12 years (range, 5 to 17 y) started ROM therapy for a mean of 23 days after treatment (range, 4 to 47 d). Seven patients required additional surgeries for arthrofibrosis at a mean of 3 months after initial fracture treatment (range, 1.5 to 5.5 mo). Compared with patients who started ROM rehabilitation within 4 weeks of treatment, those who started later than 4 weeks required more days to return to full activity (215 vs. 103 d; P=0.011) and were 12 times more likely to develop arthrofibrosis (P=0.029). Even when accounting for other factors in multivariate regression, earlier initiation of ROM therapy was associated with earlier return to full activity (P<0.001). Surgical patients who were immobilized postoperatively required more days to return to full activity (217.5 vs. 103 d; P=0.015) and had a higher rate of arthrofibrosis (36% vs. 0%; P=0.043) than those who were not. Age, sex, fracture classification, and operative versus nonoperative treatment did not have a statistically significant effect on our multivariate model.


CONCLUSIONS
After definitive treatment, early implementation of ROM rehabilitation results in a more rapid return to full activity. ROM therapy within 4 weeks of treatment results in sooner return to full activity and decreases the likelihood of eventual arthrofibrosis. In surgical patients, postoperative immobilization results in a longer delay until return to full activity and a higher rate of arthrofibrosis.


METHODS
Therapeutic study, level III.
Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Neeraj M
NM
Patel
Min Jung
MJ
Park
Norma Rendon
NR
Sampson
Theodore J
TJ
Ganley
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004434:Early Ambulation; D005260:Female; D006801:Humans; D007103:Immobilization / Q000009:adverse effects*; D008297:Male; D015999:Multivariate Analysis; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D016896:Treatment Outcome