Comparative analysis of arthroscopic techniques for fixation of tibial intercondylar eminence avulsion fractures in children

BACKGROUND: Avulsion fracture of the tibial intercondylar eminence is a rare injury, which commonly occurs in adolescents aged 8–14 years, and may result in disability caused by improper bone union. Several surgical techniques for the treatment of patients with such fractures have been developed, involving various methods of fixation for the avulsed fragment of the tibial intercondylar eminence. AIM: To evaluate the effectiveness of the novel technique for the treatment of type III tibial intercondylar eminence avulsion fractures according to the Meyers–McKeever–Zariczny classification in children with open growth plates and compare its outcomes to those of arthroscopically assisted reduction and fixation of the avulsed fragment using a Herbert screw. METHODS: Functional outcomes in 45 children aged 14–17 years with tibial intercondylar eminence fractures were analyzed at 3, 6, and 12 months after surgery. Group A included 22 children who underwent arthroscopic fixation with a Herbert screw. Group B comprised 23 children who underwent arthroscopic fixation using a self-tightening suture loop following the novel method. RESULTS: Group B demonstrated better anteroposterior and rotational stability of the knee than group A. Postoperative functional assessment scores (IKDC 2000, Lysholm Knee Scoring Scale, and Tegner Activity Scale) were significantly better in group B than in group A (p = 0.00006). In group A, postoperative complications were observed in 18.1% of cases (p ≤ 0.05), including screw fracture (4.5%) and aseptic synovitis due to a foreign body reaction (13.6%). No postoperative complications were noted in group B (p 0.05). CONCLUSION: The proposed technique for treating tibial intercondylar eminence avulsion fractures in children with open growth plates is more reliable and safer compared with Herbert screw fixation and may be recommended for clinical practice.