Tibial eminentia avulsion fracture in children - a systematic review of the current literature

INTRODUCTION: Tibial eminentia avulsion fracture is the paediatric equivalent to a midsubstance anterior cruciate ligament injury. It is most common between the ages of 8 and 19 years of age. The incidence is three per 100,000 per year. We explored the clinical evaluation and classification of the fracture, indications for and methods of surgery and the possible sequelae.

METHODS: We performed a systematic search in the PubMed database and retrieved 127 articles. A total of 16 articles met the defined inclusion criteria and were reviewed. Only studies on adolescents were included.

RESULTS: No prospective studies were found. The Meyers & McKeever and Zaricznyj classifications were commonly used, also when evaluating fractures for surgery. X-ray in three views is often sufficient to establish a diagnosis, but computed topographies can be necessary to further evaluate the type of fracture. There is disagreement as to whether a type II-fracture needs surgery. The method of fixation varies greatly between different kinds of suture techniques and screw fixations, but arthroscopic surgery is preferred in the most recent literature. Whether to cross the physis when fixating the fracture is also a matter of dis-agreement, but there is a lack of literature on the subject. All authors describe low rates of subjective sequelae.

CONCLUSION: Arthroscopic surgery is less invasive and allows for earlier mobilisation than other techniques. Pull-out suture seems to be a recommendable technique. There is a lack of literature on transphyseal fixation and a need for prospective studies evaluating the many different surgical techniques described and the indications for surgery.