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A 19-year-old patient is undergoing an arthroscopic treatment of a right knee with suture fixation via transosseous tunnels shown in the video in Figure V. What is the most likely postoperative complication?
Spontaneous osteonecrosis of the knee (SONK)
Hardware prominence in the intercondylar notch necessitating removal of implants
Increased posterior tibial excursion
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Intercondylar eminence fractures that occur in adolescent or adult patients need to be counseled as to the risk of development of stiffness and arthrofibrotic scar tissue. This often presents with the inability to achieve full knee extension.
Lubowitz et al present a Level 5 review article emphasizing that early range-of-motion exercises are critical to prevent loss of extension in patients that have been operatively treated for intercondylar eminence fractures.
Montgomery et al present Level 4 evidence of 17 adults treated arthroscopically with suture fixation for displaced anterior cruciate ligament avulsion fractures. They found that 9 (53%) had severe difficulty regaining motion postoperatively and about 25% of the patients required a manipulation under anesthesia for arthrofibrotic scar tissue.
Illustration V demonstrates a tibial intercondylar eminence fracture treated with suture fixation via transosseous tunnels.
Lubowitz JH, Elson WS, Guttmann D
Arthroscopy. 2005 Jan;21(1):86-92. PMID: 15650672 (Link to Abstract)
Montgomery KD, Cavanaugh J, Cohen S, Wickiewicz TL, Warren RF, Blevens F
Arthroscopy. 2002 Feb;18(2):171-6. PMID: 11830811 (Link to Abstract)
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The AP radiograph in Figure A demonstrates an injury in a 13-year-old soccer player. What is the equivalent injury in a skeletally mature patient?
Patella tendon rupture
Posterior cruciate ligament tear
Anterior cruciate ligament tear
Lateral meniscus tear
Posteromedial capsular avulsion
The radiograph demonstrates a displaced fracture of the tibial spine. The ACL inserts on the tibial eminence and the lateral aspect of the medial tibial spine. Mid-substance ACL tears are seen in both children and adults, but tibial spine fractures are seen primarily in the skeletally immature. The analogous injury in the adult knee would be an ACL tear, and if associated with a fracture, that would be a lateral capsule avulsion (Segond fracture). The Segond fracture results from excessive internal rotation and varus stress of the knee.
The Campos paper discusses that the iliotibial band and anterior oblique ligaments are thought to be involved in generation of the Segond fracture. Injuries associated with Segond fractures include ACL (75-100%) and meniscal (66-75%) tears.
Kocher et al found that narrower notch width index predisposes patients to ACL tear more than tibial spine fracture.
Campos JC, Chung CB, Lektrakul N, Pedowitz R, Trudell D, Yu J, Resnick D.
Radiology. 2001 May;219(2):381-6. PMID: 11323461 (Link to Abstract)
Kocher MS, Mandiga R, Klingele K, Bley L, Micheli LJ
J Pediatr Orthop. 2004 Mar-Apr;24(2):185-8. PMID: 15076605 (Link to Abstract)
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HPI - motor vehicle accident ,acute onset of swollen painful knee inability to weight bear
what is the best method of fixation for tibial spine .patellar tuberosity.torn MCL
Dr. Jazrawi and Dr. Strauss discuss their technique for tibial spine avulsion fr...
Demonstrates tibial eminence fracture suture fixation.