Mid-term Outcomes of Arthroscopic Suture Fixation Technique in Tibial Spine Fractures in the Pediatric Population

Background: Segond fractures (avulsion fractures of the proximal lateral tibia) are considered to be pathognomonic for anterior cruciate ligament (ACL) tears in adult patients. Purpose: To describe the largest case series of pediatric Segond fractures and associated intra-articular injuries of the knee to determine if these fractures are pathognomonic for ACL tears in young patients. Methods: IRB-approved retrospective study of patients under 20 years who presented with Segond fracture to a tertiary children’s hospital between 2009-2019. Demographics, clinical data, imaging features, associated injuries, and treatment information were collected. Results: 55 patients (46 males, 9 females) with mean age 15.2 years (11.8-19.1) with Segond fractures of the proximal tibia on radiology imaging were identified (Fig.1.2). Diagnosis of associated injuries was established based on clinical examination, radiology report and findings during arthroscopy. Average Segond fracture size was 2.7 x 9.5mm as measured on standard knee radiographs. Magnetic resonance imaging (MRI) was obtained in 49/55(89%) patients. Associated injuries included anterior cruciate ligament (ACL) tears (39 patients, 70.9%), tibial eminence fractures (9, 16.4%), and all other injuries (7, 12.7%) (Table 1.1). Among Segond fractures found with ACL tears, 12 (30.8%) were contact injuries, 30 (76.9%) were sports injuries. In associated tibial spine fractures, 7 (78%) injuries were contact in nature and were sports related. When age was compared between the patient group with ACL tears (mean 15.7 years) to the ones with tibial spine fractures ( mean 13.9 years), there was a statistically significant difference(p=0.007). 12/55 (21.8%) had associated articular cartilaginous injuries, 3 of which required surgical intervention. 37/55 (67.3%) patients had meniscal injury. 3 (5.5%) patients suffered multi-ligament injuries. Overall, 87.2% of the patients required surgical management for associated intra-articular injuries of the knee. Conclusion: The Segond (tibial avulsion) fracture is associated with intra-articular injuries the pediatric population, most commonly ACL tears and meniscus tears. However, the largest case series in the pediatric population suggests that they are not pathognomonic for ACL tears as a notable proportion of patients, especially the ones who are younger in age, have tibial eminence fractures or no ACL tears. [Table: see text][Figure: see text]

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COMPARING RATES OF TIBIAL SPINE FRACTURES TO ACL TEARS: A 7-YEAR TREND

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00173 ◽

2020 ◽

Vol 8 (4_suppl3) ◽

pp. 2325967120S0017

Author(s):

Julien T Aoyama ◽

Scott M LaValva ◽

Joshua T Bram ◽

Thomas Reese ◽

Theodore J Ganley

Keyword(s):

Pediatric Population ◽

Cruciate Ligament ◽

Patient Characteristics ◽

Graphical Analysis ◽

Incidence Rates ◽

Spine Fractures ◽

Acl Injuries ◽

Tibial Spine ◽

Acl Tear ◽

Icd 10

Background: Sometimes referred to as the “pediatric” ACL injury, tibial spine fractures, although less commonly seen, are believed to share the same injury mechanism as anterior cruciate ligament (ACL) tears. And while incidence rates of pediatric ACL tears have been known to be increasing in recent years, to our knowledge, trends in incidence rates of tibial spine fractures (TSFs) in the pediatric population have not yet been reported in the literature. With sport specialization in children becoming a more commonly discussed topic, our goal was to report on the incidence rates of TSFs over a 7-year span at a single-center, and to compare rates of injury in these two conditions by sport and other patient characteristics. Hypothesis/Purpose: TSF and ACL injuries are both on the rise but draw from different populations. Methods: Retrospective comparison study of all patients presenting between 1/1/2010 and 1/1/17 with a TSF or an ACL tear at a single pediatric hospital. Medical records were queried for TSFs and ACL tears using ICD-10 and ICD-9 codes. Incidence rates over time were compared against one another. Incidence rates were further stratified based on sex, race, age, BMI, and sport/mechanism of injury, and bivariate analyses were performed to find significant differences between groups. Results: 43 patients with a TSF and 947 patients with an ACL tear were identified. Graphical analysis showed an upward trend in the yearly incidence of both injuries, particularly in the last two years. TSF age ranged from 3 to 17 years with an average of 12.5 ± 2.8 years. ACL tear age ranged from 6 to 24 years with an average of 15.2 ± 2.3 years. Comparisons of sport, age, sex, and BMI were all found to have significant differences (p < .001 for all) between the two injuries. Race was not found to be significantly different between the two injuries. Conclusion: Our data supports the hypothesis that, similar to ACL tears, incidence rates of TSFs have been increasing in recent years. Injury during sport was found to be significantly different between the two injuries, with football being the most common sport for TSFs and soccer being the most common sport for ACL tears. ACL tears also draw from a slightly older age population (15.2 ± 2.3 years) than TSFs (12.5 ± 2.8 years), and TSFs are more commonly seen in males and those with lower BMI when compared to ACL tears.

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