Bilateral Tibial Tubercle Avulsion Fractures in Children – Clinical Results of a Rare Fracture

Abstract Background Tibial tubercle avulsion fractures are rare, they represent less than 1% of all physeal fractures. Compared to monolateral tibial tubercle avulsion fractures, bilateral occurrence is even rarer. The purpose of this study is to report about the so far largest group of bilateral avulsion fractures and to compare them to unilateral fractures as well as to current literature. Method All patients who suffered from bilateral tibial tubercle fractures between January 2009 and March 2019 were included. All medical records and radiographs were reviewed and a clinical follow-up was performed. The examined criteria were age, gender, mechanism of injury, classification, risk factors, complications, management and outcomes. Clinical outcome was measured using the well established Tegner activity scale and Lysholm-Gillquist score. The same criteria were analyzed in a literature review of bilateral tibial tubercle fractures to compare our results to available literature. Results We found four children with bilateral tibial tubercle avulsion fractures. All patients were male with a mean age of 14.5 ± 0.7 years (13 – 15). Mean follow-up examination was 13.6 ± 6.5 months (8 – 29) after surgery. The avulsions occurred during jumping activities in all cases. All children could no longer stand or move because of sudden pain in the knee. We found type IV fractures in three cases, type III fractures in four cases and one type V fracture according to the Ogden classification. All children were treated by open or closed reduction and stabilization with screws or K-wires. Follow-up showed complete fracture healing without complications in all patients. There were no changes in Tegner activity scale and Lysholm-Gillquist Score and knee function comparable to prior to the accident was achieved in all cases. Conclusion Good clinical results without restrictions regarding function of the knee joint can be achieved by direct operative treatment of bilateral tibial avulsion fractures. A reduction in sporting activity has not to be expected. There were no differences between bilateral or unilateral tibial tubercle avulsion fractures.

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TIBIAL TUBERCLE FRACTURES IN CHILDREN AND ADOLESCENTS

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00186 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0018

Author(s):

Daniel B. Haber ◽

Frances Tepolt ◽

Michael McClincy ◽

Leslie Kalish ◽

Mininder S. Kocher

Keyword(s):

Children And Adolescents ◽

Compartment Syndrome ◽

Patient Characteristics ◽

Tibial Tubercle ◽

Type I ◽

Return To Sports ◽

Type Iv ◽

Small Series ◽

Fractures In Children

Background: Tibial tubercle fractures are uncommon sports related injuries. Only small series are reported in the literature. The purpose of this study is to report patient characteristics, fracture types, treatment methods, and clinical outcomes of children and adolescents treated for tibial tubercle fractures. Methods: Patients age 18 and under treated for tibial tubercle fractures at a single institution from 1995 to 2015 were identified and their medical records were retrospectively reviewed. Clinical and radiographic outcomes were reported for patients with minimum follow up of 6 months. Results: Two-hundred thirty-six tibial tubercle fractures were identified in 228 patients, 198 (86%) of whom were males. Mean age was 14.3 years (range 7.7-17.6). Mean body mass index (BMI) was 25.0 (range 16.1-38.9). Osgood-Schlatter disease was identified in 72 (31%) cases and was most commonly associated with type I fractures (p<0.001). Two-hundred and three fractures (86%) occurred while participating in athletics, most commonly basketball (87, 43%). Thirty percent of fractures occurred while landing, 26% resulted from a direct blow to the leg, and 22% occurred while jumping. Type III fractures were most common (96, 41%) followed by type I fractures (67, 29%). Initial treatment was surgical for 157 (67%) fractures. Type I fractures were most commonly treated non-operatively (91%) and types II-V fractures were most commonly treated surgically (89%, p<0.001). Operative fractures were associated with higher BMI z-scores (mean 1.16, p=0.05) than those treated non-operatively. Compartment syndrome was identified in 4 (2%) patients, 3 of which were had type IV fractures. Eighty-eight percent of patients returned to sports. Among those treated operatively, 55% had hardware removed and 7% developed post-operative infection. At last follow up, 45% of surgical patients reported pain on palpation at the tibial tubercle and 26% reported pain with squatting. Conclusions: Tibial tubercle fractures are sports related injuries and occur most commonly in adolescent males. They are associated with Osgood-Schlatter disease, a higher than average BMI, and a small but relevant risk of compartment syndrome, particularly in type IV fractures. Whether treated surgically or non-surgically, most patients return to sports despite a high incidence of post-treatment pain at the tibial tubercle.

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Clinical Analysis of Classification for Tibial Plateau Fractures and Popliteal Artery Injury

10.21203/rs.3.rs-33674/v2 ◽

2020 ◽

Author(s):

Yilun Yao ◽

Xiaoshu Wu ◽

Lei Wu ◽

Lei Yang ◽

Chunzhi Jiang ◽

...

Keyword(s):

Tibial Plateau ◽

Clinical Analysis ◽

Tibial Plateau Fractures ◽

Artery Injury ◽

Type Iv ◽

Schatzker Type ◽

Schatzker Classification ◽

Tibial Head ◽

Type V

Abstract Background To explore the association between the classification for tibial plateau fractures (TPF) and the popliteal artery injury (PAI).Methods 22 TPF patients accompanied by PAI who were treated from May 2012 to July 2019 were retrospectively analyzed. There were 19 males and 3 females with an average age of 49.43 years. The Schatzker classification and three-column classification were performed for TPF. The severity of extremity injury was evaluated using the mangled extremity severity score (MESS). Except 3 patients treated with amputation, the remaining patients underwent surgical repair of popliteal artery and fracture external fixation. The outcome was evaluated using the Rasmussen score for tibial head fractures.Results There were 10 cases of Schatzker type IV fractures, 1 case of type V fractures and 11 cases of type VI fractures. Based on the three-column classification, the posterior column was involved in 22 cases, 2 columns in 15 cases and 3 columns in 6 cases. The MESS was 6-10 points, with an average of 7.59 points. Except 1 case directly receiving amputation, 3 cases of segment P1 injury was observed via preoperative DSA + intraoperative exploration, while segment P2 in 6 cases and segment P3 in 12 cases. Popliteal artery was found completely ruptured in 11 cases, partially ruptured in 1 case, and severely contused with thrombosis in 10 cases. The Rasmussen score was given to 19 patients at the last follow-up, except for the cases undergoing amputation. The outcome was satisfied in 14 cases, unsatisfied in 5 cases.Conclusion: In patients with complex TPF, the risk of PAI becomes higher with the increase of Schatzker classification level. Knee CT scan is helpful in determining the severity of fractures and evaluating PAI. Based on the three-column classification, PAI should be suspected when the fractures involve the medial and posterior column.PAI is mainly in the segment P3, and artery rupture or severe contusion with extensive thrombosis may occur.

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Does Meniscectomy Have Any Advantage Over Conservative Treatment of Degenerative Medial Meniscus Posterior Root Tear?

10.21203/rs.3.rs-257585/v1 ◽

2021 ◽

Author(s):

Nam-Hun Lee ◽

Hyoung-Yeon Seo ◽

Myung-Jin Sung ◽

Bo-Ram Na ◽

Eun-Kyoo Song ◽

...

Keyword(s):

Conservative Treatment ◽

Clinical Outcomes ◽

Symptomatic Relief ◽

Slope Angle ◽

Joint Space ◽

Conservative Group ◽

Arthroscopic Meniscectomy ◽

Activity Scale ◽

Tegner Activity Scale

Abstract Background: This study aimed to compare the clinical and radiological outcomes of arthroscopic meniscectomy and conservative treatment for degenerative MMPRT.Methods: From January 2007 to December 2014, 146 patients (Meniscectomy group, 90; Conservative group, 56) were evaluated. Clinical outcomes were assessed using the Visual Analog Scale, International Knee Documentation Committee subjective scoring scale, Tegner activity scale, and Lysholm knee scoring scale at the final follow-up. Radiologic outcomes evaluated the progression of osteoarthritis according to the K-L classification. We compared the hip-knee-ankle angle, medial proximal tibial angle, tibial posterior slope angle, and width of medial joint space. After an average follow-up of 6.3 years, the survivorship was analyzed using the Kaplan–Meier method. Results: Although all clinical outcomes had significantly improved in both groups after treatment, the VAS score (p=0.07), IKDC subjective score (p=0.18), Tegner activity scale score (p=0.08), and Lysholm knee score (p=0.53) showed no significant differences between the two groups at the final follow-up. The progression of OA according to the K-L classification, HKAA and width of medial joint space was significantly advanced in the meniscectomy group (p=0.03, 0.04, 0.03, respectively). The 10-year survival rates in the meniscectomy and conservative groups were 87% and 88%, respectively. Conclusions: This study demonstrated that both conservative treatment and meniscectomy provided symptomatic relief. However, it was confirmed that OA progression was more severe in the meniscectomy. We conclude that arthroscopic meniscectomy had no advantage over conservative treatment in terms of clinical outcomes and OA progression.

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Tibial Tubercle Fractures in Children and Adolescents

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00134 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0013

Author(s):

Daniel B. Haber ◽

Frances Tepolt ◽

Michael P. McClincy ◽

Leslie Kalish ◽

Mininder S. Kocher

Keyword(s):

Children And Adolescents ◽

Compartment Syndrome ◽

Clinical Outcomes ◽

Return To Sport ◽

Adolescent Male ◽

Tibial Tubercle ◽

Valuable Insight ◽

Type I ◽

Fractures In Children

Objectives: To report patient characteristics, fracture types, treatment methods, and clinical outcomes of children and adolescents treated for tibial tubercle fractures. Methods: Patients age 19 and under treated for tibial tubercle fractures at a single institution from 1995 to 2015 were identified and their medical records were retrospectively reviewed. Clinical and radiographic outcomes were reported for patients with a minimum follow up of 6 months. Associations were tested using Fisher’s exact test. Results: Two-hundred thirty seven tibial tubercle fractures were identified in 229 patients; 198 (86%) male. There were 139 (59%) left sided injuries. Mean age was 14.3 years (range 4.9 - 19.8). Mean body mass index (BMI) was 25. Osgood-Schlatters was identified in 72 (30%) cases and was most commonly associated with Ogden type I fractures (p<0.001). Two-hundred and four (86%) fractures occurred while participating in athletics, most commonly basketball (87, 43%). Of the 228 cases for which mechanism of injury was identified, 69 (30%) occurred while landing, 60 (26%) resulted from a direct blow to the knee, and 51 (22%) occurred while jumping. Ogden III fractures were most common (96, 41%) followed by Ogden I fractures (67, 28%). Initial treatment was surgical for 158 (67%) fractures, of which 58 (37%) underwent reoperation, 53 (34%) for hardware removal. Ogden I fractures were most commonly treated non-operatively (91%) and Ogden II-V fractures were most commonly treated operatively (89%, p<0.001). Elevated BMI was associated with Ogden II-V fractures (p=0.003) and injuries requiring operative treatment (p<0.001). Compartment syndrome was identified in 4 (2%) injuries and required emergent fasciotomy. Prophylactic anterior and/or lateral fasciotomy was performed in 35 (15%) operatively treated injuries. Of the 117 (49%) patients for whom minimum 6-month follow up was documented, 103 (88%) returned to sports; among those treated operatively (87), 2 (2%) developed symptomatic limb length discrepancy, 1 (1%) developed tibial recurvatum, and 6 (7%) developed post-operative infection. At last follow up, 39 (45%) of surgical patients reported pain at the tibial tubercle, 23 (26%) reported pain with squatting, and 13 (15%) had patellar tendonitis. Thirty-seven (43%) complained of hardware prominence. Conclusion: Tibial tubercle fractures occur most commonly in adolescent male athletes and are associated with basketball, elevated BMI, Osgood-Schlatters, and a risk of compartment syndrome. Following treatment, most patients return to sport. As the largest single series of tibial tubercle fractures reported, this study provides valuable insight into injury epidemiology, relationship with Osgood Schlatters, and clinical outcomes.

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Osseocartilaginous Rib Graft L-Strut for Nasal Framework Reconstruction

Aesthetic Surgery Journal ◽

10.1093/asj/sjz189 ◽

2019 ◽

Author(s):

Peter J Ciolek ◽

Andrea L Hanick ◽

Michael Roskies ◽

Michael A Fritz

Keyword(s):

Primary Outcome ◽

Tertiary Care ◽

Traumatic Injury ◽

Care Hospital ◽

Level Of Evidence ◽

Type Iv ◽

Type V ◽

Contractile Forces ◽

Nasal Defects

Abstract Background In the setting of major nasal framework reconstruction, it is critical to create a stable, warp-resistant L-strut to resist the contractile forces of healing to achieve a durable outcome. Objectives The authors sought to demonstrate the effectiveness of the osseocartilaginous rib graft for nasal framework reconstruction. Methods Retrospective analysis was performed of all patients who underwent osseocartilaginous rib graft for L-strut reconstruction from 2007 to 2017 at a tertiary care hospital. Only patients with severe framework-only defects (Type IV, Daniel Classification) or total/subtotal nasal defects (Type V, Daniel Classification) were included. Primary outcome measures were: (1) maintenance of projection; (2) graft warping; and (3) graft resorption. Results Twenty-six patients aged an average of 54.6 years underwent nasal framework reconstruction with an osseocartilaginous rib graft L-strut. Eighteen patients had framework-only deformities (Daniel Type IV) and 8 had total or subtotal nasal deformities (Daniel Type V). Twelve patients underwent reconstruction for autoimmune mediated deformity, 10 for malignancy, 3 for traumatic injury, and 1 for an iatrogenic deformity. Average follow-up was 21 months. There was no observed warping of the L-strut construct, and all but 2 patients demonstrated total maintenance of projection. Resorption of the caudal cartilage graft was identified as the etiology of partial loss of projection in 2 patients. Conclusions The osseocartilaginous rib graft L-strut provides a stable, warp-resistant construct for patients lacking major dorsal and caudal support, which may be applied to reconstruction of defects due to malignancy, autoimmune, traumatic, or iatrogenic etiologies. Level of Evidence: 4

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Efficacy of Autologous Platelet-Rich Plasma Injections for Grade 3 Symptomatic Degenerative Meniscal Lesions: A 1-Year Follow-up Prospective Study

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211011074 ◽

2021 ◽

pp. 194173812110110

Author(s):

Mattia Alessio-Mazzola ◽

Lamberto Felli ◽

Roberto Trentini ◽

Matteo Formica ◽

Andrea Giorgio Capello ◽

...

Keyword(s):

Platelet Rich Plasma ◽

Symptomatic Relief ◽

Case Series ◽

Degenerative Joint Disease ◽

Joint Disease ◽

Level Of Evidence ◽

Meniscal Lesions ◽

Activity Scale ◽

Tegner Activity Scale

Background: Platelet-rich plasma (PRP) injections have been proposed as a biologic option to provide symptomatic relief and delay surgery in patients with degenerative joint disease of osteoarthritis (OA). The efficacy of autologous PRP on symptomatic degenerative meniscal lesions (DMLs) has never been investigated. Hypothesis: We hypothesized that patients with symptomatic DMLs without OA undergoing autologous PRP injections experience a significant clinical improvement at 12 months. Study Design: Prospective case series. Level of Evidence: Level 4. Methods: A total of 69 patients with symptomatic DMLs without radiographic evidence of knee OA (Kellgren-Lawrence radiographic grading scale 0-1) received 4 autologous PRP injections once a week. Patients were prospectively evaluated before the injection and then at 1, 3, 6, and 12 months. Evaluation was based on Lysholm knee scoring scale (primary outcome), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Tegner activity scale, and visual analogue scale scores. Results: Patients treated with PRP injections demonstrated an improving knee function and symptoms over the duration of the study. A significant improvement from baseline to 12 months was observed in all the outcome measures, and no patients experienced failure or required surgery during the follow-up. Patients younger than 50 years reported lower subjective level of pain and higher Tegner activity scale at baseline and had significantly better Lysholm knee scoring scale ( P = 0.03) and WOMAC ( P = 0.03) scores at 6 months, as well as better range of motion at 3, 6, and 12 months ( P < 0.001). Thirty-three (47.8%) patients were very satisfied, 26 (37.7%) satisfied, 8 (11.6%) partially satisfied, and 2 (2.9 %) not satisfied, with 62 (89.8%) patients willing to repeat the same treatment. No patient was lost to follow-up and no patient experienced adverse reaction, infection, failure, recurrence or underwent further surgery. Conclusion: PRP injections provide short-term benefits in symptomatic DMLs. Although promising results were evident at 12 months, this is a preliminary study and no definitive recommendation can be made based, for example, on longer follow-up. Clinical Relevance: This research supports the use of autologous PRP injections for symptomatic DMLs.

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Joint effusion, anteroposterior stability, muscle strength and degree of patellofemoral osteoarthritis significantly impact outcome following revision ACL reconstruction

Journal of Experimental Orthopaedics ◽

10.1186/s40634-021-00370-x ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Kathleen Andrä ◽

Enes Kayaalp ◽

Robert Prill ◽

Lars Irlenbusch ◽

Eckehard Liesaus ◽

...

Keyword(s):

Clinical Outcome ◽

Joint Effusion ◽

Controlled Study ◽

Anterior Tibial Translation ◽

Cartilage Lesions ◽

Activity Scale ◽

The Impact ◽

Tibial Translation ◽

Tegner Activity Scale

Abstract Purpose: Effusion, impaired muscle function and knee instability are considered as some of the most important factors effecting outcome following anterior cruciate ligament reconstruction (ACL-R) but the impact on revision ACL-R remains unclear. It was hypothesized that these factors will significantly worsen clinical outcome following revision ACL-R. Methods Seventy knees (13 female and 57 male) were followed retrospectively after revision ACL-R at a mean follow-up of 47.8 ± 20.7 months. Clinical examination was based on the International Knee Documentation Evaluation Form-2000 (IKDC), Tegner activity scale. Instrumented measurement of anterior tibial translation was performed using the Rolimeter® (DJO Global, Freiburg, Germany). Bilateral circumference of the thigh was measured 10 and 20 cm proximal to the medial joint space. Cartilage was assessed according to Outerbridge classification during both primary and revision ACL-R. Results Tegner activity scale decreased significantly from 7.8 ± 1.4 points at primary ACL-R to 7 ± 1.8 points at revision ACL-R, and 5.8 ± 1.7 points at the time of follow up (p < 0.001). Joint effusion (r = − 0.47, p < 0.01) and side to side differences in single leg hop test (r = − 0.48, p < 0.1) significantly correlated with inferior outcome. Cartilage lesions were found in 67% of the patients at the time of revision ACL-R compared to 38% at the time of primary ACL-R. According to the IKDC classification A was graded in three patients (4.3%), B in 35 (50%), C in 29 (41.4%) and D in three (4.3%). Joint effusion was measured in 35% of patients at the time of follow-up. Degeneration at the patellofemoral compartment of > grad 2 was responsible for IKDC grade C and D (p = 0.035). Instrumented anteroposterior site-to-site difference of ≥3 mm showed significant impact on clinical outcome (p < 0.019). Conclusion The study has shown that chronic effusion, quadriceps dysfunction, cartilage lesions especially at the patellofemoral compartment and side to side difference in anteroposterior stability significantly influences patient outcome after revision ACL-R. These factors require special attention when predicting patient’s outcome. Level of evidence Level-IV, case-controlled study.

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