Anterior Displacement of Tibial Spine Fractures: Does Anatomic Reduction Matter?

Autor:	McGurty SA; Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA., Ganley TJ; Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA., Kushare I; Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA., Leska TM; Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA., Aoyama JT; Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA., Ellis HB; Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA., Johnson B; Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA., Baghdadi S; Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA., Cruz AI Jr; Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA., Fabricant PD; Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA., Green DW; Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA., Lee RJ; Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA., McKay SD; Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA., Milbrandt TA; Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA., Patel NM; Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA., Rhodes JT; Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA., Sachleben B; Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA., Traver JL; Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA., Mistovich RJ; Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA., Schmale GA; Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA., Cook DL; Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA., Yen YM; Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA.
Jazyk:	angličtina
Zdroj:	Orthopaedic journal of sports medicine [Orthop J Sports Med] 2023 Aug 22; Vol. 11 (8), pp. 23259671231192978. Date of Electronic Publication: 2023 Aug 22 (Print Publication: 2023).
DOI:	10.1177/23259671231192978
Abstrakt:	Background: Operative treatment of displaced tibial spine fractures consists of fixation and reduction of the fragment in addition to restoring tension of the anterior cruciate ligament. Purpose: To determine whether residual displacement of the anterior portion of a tibial spine fragment affects the range of motion (ROM) or laxity in operatively and nonoperatively treated patients. Study Design: Cohort study; Level of evidence, 3. Methods: Data were gathered from 328 patients younger than 18 years who were treated for tibial spine fractures between 2000 and 2019 at 10 institutions. ROM and anterior lip displacement (ALD) measurements were summarized and compared from pretreatment to final follow-up. ALD measurements were categorized as excellent (0 to <1 mm), good (1 to <3 mm), fair (3 to 5 mm), or poor (>5 mm). Posttreatment residual laxity and arthrofibrosis were assessed. Results: Overall, 88% of patients (290/328) underwent operative treatment. The median follow-up was 8.1 months (range, 3-152 months) for the operative group and 6.7 months (range, 3-72 months) for the nonoperative group. The median ALD measurement of the cohort was 6 mm pretreatment, decreasing to 0 mm after treatment ( P < .001). At final follow-up, 62% of all patients (203/328) had excellent ALD measurements, compared with 5% (12/264) before treatment. Subjective laxity was seen in 11% of the nonoperative group (4/37) and 5% of the operative group (15/285; P = .25). Across the cohort, there was no association between final knee ROM and final ALD category. While there were more patients with arthrofibrosis in the operative group (7%) compared with the nonoperative group (3%) ( P = .49), this was not different across the ALD displacement categories. Conclusion: Residual ALD was not associated with posttreatment subjective residual laxity, extension loss, or flexion loss. The results suggest that anatomic reduction of a tibial spine fracture may not be mandatory if knee stability and functional ROM are achieved. (© The Author(s) 2023.)
Databáze:	MEDLINE
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