Higher Preoperative Magnetic Resonance Imaging Use in Asia-Pacific Compared With North America for Pediatric Tibial Eminence Fractures: A Systematic Review.

Abstract

Purpose: To evaluate differences in the incidence, diagnosis, and management of pediatric tibial eminence fractures between the Asia-Pacific region and North America.

Methods: A systematic review and subjective synthesis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, MEDLINE, and Cochrane databases were searched from inception to May 1, 2025, using the keywords "tibial eminence" or "tibial spine" or "anterior cruciate ligament" and "fracture or avulsion." All original human surgical studies on pediatric tibial eminence fractures published in the Asia-Pacific region and North America were included, and data on the incidence, diagnosis, and treatment of pediatric tibial eminence fractures were collected.

Results: A total of 24 studies (9 from Asia-Pacific and 15 from North America) were selected with a total of 1973 patients. Subset analysis (of 6 Asia-Pacific and 3 North American studies) showed a trend toward higher rates of preoperative magnetic resonance imaging use among Asia-Pacific (96.3%-100%) compared with North American patients (36.2%-46.0%). There were also trends toward higher rates of arthroscopic reduction (compared with open reduction) and suture-based fixation (compared with screw fixation and other modalities) observed in Asia-Pacific patients compared with North American patients.

Conclusions: Asia-Pacific surgeons reported substantially higher preoperative magnetic resonance imaging use compared with North American surgeons, alongside potential trends toward greater use of arthroscopic reduction and suture-based fixation.

Level of evidence: Level IV, systematic review of Level III and IV studies.