Suture Fixation Versus Screw Fixation in Pediatric Tibial Eminence Fractures: A Systematic Review and Meta-Analysis of Clinical Outcomes and Reoperation Rates

Suture fixation (SF) has gained prominence as a physeal-sparing alternative to screw fixation (SCF) in the operative management of pediatric tibial eminence fractures, aiming to reduce hardware-related complications while maintaining joint stability. This meta-analysis evaluated clinical and functional outcomes comparing SF with SCF in skeletally immature patients. A systematic review of comparative studies was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Outcomes assessed included clinically relevant postoperative measures used to evaluate overall treatment success. Fixed-effect models were used to generate pooled effect estimates. Heterogeneity was quantified using the I² statistic, and publication bias was examined with funnel plots and Egger's test. Four studies encompassing 224 pediatric patients were included. SF resulted in a significantly lower reoperation frequency (OR = 0.22, 95% CI: 0.12-0.42, p < 0.00001, I² = 42%) and markedly reduced hardware removal (OR = 0.08, p < 0.00001, I² = 0%). Return to sport rates were superior in the SF group (OR = 2.71, p = 0.02, I² = 0%). No significant differences were observed between SF and SCF for postoperative instability (OR = 0.72, p = 0.50, I² = 0%), arthrofibrosis requiring surgery (OR = 0.80, p = 0.60, I² = 0%), or full range of motion recovery (OR = 1.36, p = 0.34, I² = 0%). Publication bias was not detected. Compared with SCF, SF provides substantially lower rates of reoperation and hardware removal while maintaining equivalent stability, stiffness outcomes, and functional recovery. SF should be strongly considered the preferred technique in appropriately selected pediatric patients.