Arthroscopic Technique Using Crossed K-wires for Avulsion Fractures of Intercondylar Eminence in Children
Abstract
PURPOSE OF THE STUDY Avulsion fractures of the intercondylar eminence (ICE) of the tibia have become increasingly frequent in older school age. Due to recent advances in arthroscopic techniques, it is now possible to treat them by minimally invasive methods.
This retrospective study presents evaluation of clinical outcomes of an arthroscopic technique using crossed K-wires. MATERIAL Thirty-five patients with ICE avulsion fracture, 17 girls and 18 boys at an average age of 13 years (7-18), were included in this study.
All were indicated for surgical treatment on the basis of radiographic evidence of McKeever type II and III fractures. METHODS The technique of arthroscopic reduction and fixation with crossed K-wires was used.
The clinical evaluation of knee stability (anterior drawer test and Lachmann s-test) was made by one clinician. The modified Tegner-Lysholm score was assessed.
RESULTS Of the 35 patients, 26 (74%) had minimal knee instability (anterior drawer up to 5 mm), two patients were primarily converted to open reduction with good results, and three (8.5%) experienced temporary knee instability (anterior drawer of 5-10 mm) that resolved spontaneously within 24 months of surgery. Four patients (11.5%) had symptoms of persistent residual instability (anterior drawer more than 10 mm) and were indicated for anterior cruciate ligament reconstruction at a later stage.
The average Tegner-Lysholm scores were 86.3/100 and 98.6/100 at 6 and 24 months, respectively. DISCUSSION At the present time at our department, McKeever type II and III avulsion fractures of the intercondylar eminence are indicated for minimally invasive surgical treatment.
By exact reduction it is possible to decrease the risk of post-operative knee instability. The current trend is the use of arthroscopy-assisted minimally invasive techniques such as the method of K-wire fixation described here.
CONCLUSIONS Arthroscopic surgery for ICE avulsion fractures shows good results, is associated with low post-operative risks, is minimally invasive and easy to reproduce. It can be recommended as the method of choice for treating ICE avulsion injury in children.