Arthroscopic fixation of avulsion fractures of the tibial eminence: technique and outcome

PURPOSE: The purpose of this study was to review an arthroscopic technique using screw or suture fixation for repair of types II and III fractures of the tibial eminence and review patient outcomes. TYPE OF STUDY: Retrospective review. METHODS: We conducted a review of 17 patients with Meyers and McKeever type II or III fractures of the tibial eminence treated with arthroscopic suture or screw fixation. We reviewed records and administered a questionnaire that included the International Knee Documentation Committee (IKDC) form, Tegner Activity scale, and Lysholm Knee Score. RESULTS: Five men and 12 women comprised the study group. Average age was 26.6 years (range, 7.5 to 60.1 years). Mean follow-up time was 32.6 months (range, 14 to 51 months). The study included 8 type II and 9 type III fractures. At follow-up evaluation, the mean Tegner score was 6.35 and mean Lysholm score was 94.2. In general, the best outcomes were seen in younger patients. For continuous age, significant differences were found for the IKDC functional scores, symptom scores, and IKDC final scores. For categorical age, younger patients had significantly better scores for the IKDC function and final scores. No significant differences were seen in outcomes with regard to fixation type. In 10 cases the intermeniscal ligament was interposed between the avulsed fracture and the tibia and was retracted or resected to allow fracture reduction. No significant differences were seen in the outcomes of these patients. CONCLUSIONS: We found that displaced tibial eminence fractures could be successfully treated in both younger and older patients using arthroscopic suture or screw fixation, with most patients returning to their previous activity levels. The interposed intermeniscal ligament must be retracted or resected to allow for anatomic fracture reduction. LEVEL OF EVIDENCE: Level III, Case Series.