RESUMEN
BACKGROUND: Tibial eminence fracture is an intra-articular fracture of bony attachment of ACL. The displaced fragment could hinder the mobility of the knee and may lead joint instabilty; therefore, requires fixation. Arthroscopic suture and screw fixation are the widely used surgical modalities for eminence fractures of the tibia. Past studies have not yet depicted the superiority of one method over the other. Through this cohort study, comparison of the clinical and functional outcomes of these two surgical methods was done. METHODS: A prospective, randomized, interventional study was conducted from December 2019 to January 2022 for comparing the clinical outcome of arthroscopic pull through suture fixation and arthroscopic antegrade cancellous screw fixation in skeletally mature individuals. Ninety patients (45 in each group) were randomly assigned and treated with the above two methods. A comprehensive clinical analysis was done after nine months of surgery for assessment of functional outcome, ligament laxity, range of motion, and complications if any. RESULTS: 65.55% of anterior tibial eminence fractures were caused by road traffic accidents followed by sports injuries (28.88%). The postoperative mean subjective IKDC score in the suture group was 91.36 and for the screw fixation group was 85.71 (p = 0.001). After nine months of surgery, the mean LKS was 91.96 in patients treated with suture fixation and 86.00 in patients treated with screw fixation (p = 0.001). Pivot shift grading was grade 3 in one patient of the suture group and in three patients of the screw group (p = 0.319). Seven patients who had screw fixation required re-surgery for removal of the implant; however, no such complication was seen in the suture fixation group. CONCLUSION: Arthroscopic pull-through suture fixation of tibial avulsion of ACL in skeletally mature patients seems to be a superior intervention over arthroscopic screw fixation with the benefits of better clinical and functional outcomes and decreased chances of re-surgery.
RESUMEN
PURPOSE: The treatment of high-energy tibial condylar fractures which are associated with severe soft tissue injuries remains contentious and challenging. In this study, we assessed the results of Joshi's external stabilization system (JESS) by using the principle of ligamentotaxis and percutaneous screw fixation for managing high-energy tibial condylar fractures associated with severe soft tissue injuries. METHODS: Between June 2008 and June 2010, 25 consecutive patients who were 17e71 years (mean, 39.7), underwent the JESS fixation for high-energy tibial condylar fractures associated with severe soft tissue injuries. Out of 25 patients, 2 were lost during follow-up and in 1 case early removal of frame was done, leaving 22 cases for final follow-up. Among them, 11 had poor skin condition with abrasions and blisters and 2 were open injuries (Gustilo-Anderson grade I&II). The injury mechanisms were motor vehicle accidents (n=19), fall from a height (n=2) and assault (n=1). The fractures were classified according to Schatzker classification system. RESULTS: There were 7 type-V, 14 type-VI and 1 type-lV Schatzker's tibial plateau fractures. The average interval between the injury and surgery was 6.8 days (range 2-13). The average hospital stay was 13 days (range, 7-22). The average interval between the surgery and full weight bearing was 13.6 weeks (range 11-20). The average range of knee flexion was 121°(range 105°-135°). The normal extension of the knee was observed in 20 patients, and an extensor lag of 5°-8° was noted in 2 patients. The complications included superficial pin tract infections (n=4) with no knee stiffness. CONCLUSION: JESS with lag screw fixation combines the benefit of traction, external fixation, and limited internal fixation, at the same time as allowing the ease of access to the soft tissue for wound checks, pin care, dressing changes, measurement of compartment pressure, and the monitoring of the neurovascular status. In a nutshell, JESS along with screw fixation offers a promising alternative treatment for high- energy tibial condylar fractures associated with severe soft tissue injuries.