The knee is examined for any entrapped meniscus or intermeniscal ligament and any interposing soft tissue is pulled back so that the avulsion fracture can be reduced with an arthroscopic probe applying firm and gentle pressure.įixation can be done using either the cannulated screws or non-absorbable suture fixation technique. Then the fragments are identified and all soft tissues around them are debrided for complete visualization of the joint. The hematoma is evacuated at first using motorized suction shaver. Arthroscope is inserted through an anterolateral portal (on side) whereas the probe and other instruments are passed through an anteromedial portal (in the center). In minimally invasive arthroscopic procedure, tiny incisions are made on the front side of the joint. The injured knee is placed on a leg holder over the radiolucent operating table as postoperative plain X-rays will be taken after the procedure to verify whether reduction and fixation is satisfactory. With the use of arthroscopy in treatment, it is possible to visually evaluate the reduction of the tibial spine fracture and check for articular or mid substance cruciate injury. Treatment options for tibial spine avulsions include extension casting for type I fracture, extension casting or open reduction and internal fixation (ORIF) if required for type II fractures and ORIF for type III injuries. Type III: Completely displaced fracture.Type II: Fracture is rotated but the rear end or posterior part of the avulsion is still in place.Type I: Nondisplaced or minimally displaced spine avulsion.Tibial spine avulsions are classified into three types as follows: This injury represents the childhood equivalent of the anterior cruciate ligament (ACL) rupture and may occur because of abnormal outward bending or twist, injuries caused by sudden halt of moving joints, excessive flexion (bending inwards) and internal rotation as happens in skiing and in motor vehicle accidents. Tibial eminence spine avulsion fracture is avulsion (tear away) of the tibial eminence (an extension on the bone for attachment of muscles) which most commonly involves the anterior cruciate ligament (ACL) insertion site.
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