|
https://upload.orthobullets.com/topic/4022/images/tibial eminence.jpg
https://upload.orthobullets.com/topic/4022/images/tibial eminence classification.jpg
https://upload.orthobullets.com/topic/4022/images/nondisplaced tibial eminence.jpg
https://upload.orthobullets.com/topic/4022/images/tibial eminence classification 2.jpg
https://upload.orthobullets.com/topic/4022/images/type 2.jpg
Introduction
  • A fracture of the bony attachment of the ACL on the tibia
  • Epidemiology
    • rare injuries
    • most common in ages 8-14
  • Mechanism
    • traumatic
      • rapid deceleration or hyperextension of the knee
      • same mechanism that would cause ACL tear in adult
  • Associated conditions
    • occur in 40% of eminence fractures
      • meniscal injury 
      • collateral ligament injury
      • capsular damage
      • osteochondral fracture
Anatomy
  • Osteology
    • tibial eminence
      • non-articular portion of the tibia between the medial and lateral tibial plateau
  • Ligaments
    • anterior cruciate ligament
      • inserts 10-14 mm behind anterior border of tibia and extends to medial and lateral tibial eminence
Classification
 
Modified Meyers and McKeever Classification
Type I Nondisplaced (<3mm)
Type II Minimally displaced with intact posterior hinge

Type III Completely displaced
Type III+ Type III fracture with rotation   
Type IV Completely displaced, rotated, comminuted  
 
Presentation
  • Symptoms
    • pain in knee
  • Physical exam
    • inspection
      • immediate knee effusion
    • ROM
      • often limited secondary to pain
      • once pain is controlled, lack of motion may indicate
        • meniscal pathology
        • displaced/entrapped fracture fragment
      • positive anterior drawer
Imaging
  • Radiographs
    • recommended views
      • standard knee radiographs
  • CT
    • useful for pre-operative planning
  • MRI
    • better at determining associated ligamentous/meniscal damage than CT or radiographs
Treatment
  • Nonoperative  
    • closed reduction, aspiration of hemarthrosis, immobilization in full extension
      • indications
        • non-displaced type I and reducible type II fractures
      • reduction maneuver = extend the knee to full extension to observe for fragment reduction
  • Operative
    • ORIF vs. all-arthroscopic fixation
      • indications
        • Type III or Type II fractures that cannot be reduced
        • block to extension
Sugical Techniques
  • Arthroscopic fixation 
    • approach
      • standard arthroscopic portals
    • technique
      • debride fracture
      • disengage entrapped meniscus or intermeniscal ligament
        • medial meniscus entrapment most common
      • reduce fracture
      • fracture fixation
        • suture fixation
          • pros
            • avoids physis
          • cons
            • technically demanding
        • screw fixation
          • pros
            • less demanding than suture fixation
            • possibly earlier mobilization
          • cons
            • hardware irritation
            • impingement from improperly placed screw
            • physeal damage
    • post-operative care
      • early range of motion
      • length of limited weight bearing is controversial
  • Open fixation
    • same principles as arthroscopic
Complications
  • Los of motion
    • very common, especially loss of extension
  • Arthrofibrosis 
    • more common with surgical reconstruction
  • Growth arrest
  • ACL laxity
    • incidence
      • 10% of knees managed surgically
      • 20% of knees managed non-operatively
    • often not clinically significant
 

Please rate topic.

Average 4.0 of 34 Ratings

Technique Guides (1)
Questions (12)
Question locked
Sorry, this question is for
Virtual Curriculum Members Only
Click here to purchase
Question locked
Sorry, this question is for
Virtual Curriculum Members Only
Click here to purchase
Question locked
Sorry, this question is for
Virtual Curriculum Members Only
Click here to purchase
Question locked
Sorry, this question is for
Virtual Curriculum Members Only
Click here to purchase
Question locked
Sorry, this question is for
Virtual Curriculum Members Only
Click here to purchase
Question locked
Sorry, this question is for
Virtual Curriculum Members Only
Click here to purchase
Question locked
Sorry, this question is for
Virtual Curriculum Members Only
Click here to purchase
Question locked
Sorry, this question is for
Virtual Curriculum Members Only
Click here to purchase

(OBQ11.237) 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? Review Topic

QID: 3660
FIGURES:
1

Infection

1%

(18/1515)

2

Arthrofibrosis

74%

(1123/1515)

3

Spontaneous osteonecrosis of the knee (SONK)

4%

(54/1515)

4

Hardware prominence in the intercondylar notch necessitating removal of implants

16%

(236/1515)

5

Increased posterior tibial excursion

5%

(75/1515)

Select Answer to see Preferred Response

PREFERRED RESPONSE 2

(OBQ06.56) 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? Review Topic

QID: 167
FIGURES:
1

Patella tendon rupture

3%

(15/483)

2

Posterior cruciate ligament tear

2%

(10/483)

3

Anterior cruciate ligament tear

91%

(440/483)

4

Lateral meniscus tear

1%

(6/483)

5

Posteromedial capsular avulsion

2%

(9/483)

Select Answer to see Preferred Response

PREFERRED RESPONSE 3
Question locked
Sorry, this question is for
Virtual Curriculum Members Only
Click here to purchase
Question locked
Sorry, this question is for
Virtual Curriculum Members Only
Click here to purchase
EVIDENCE & REFERENCES (26)
VIDEOS (2)
CASES (1)
GROUPS (1)
Topic COMMENTS (16)
Private Note