Arthroscopic-Assisted Fixation of Tibial Spine Fractures

Tibial spine fractures (TSF) are an avulsion injury of the anterior cruciate ligament (ACL) at the insertion on the tibial plateau. These injuries predominantly affect the pediatric population and are important to treat appropriately as they act similarly to complete ACL injuries. The decision to pursue surgical management is dictated mostly by fracture displacement, but also by various factors such as concomitant injuries, age and level of activity. Multiple fixation strategies are available, ranging from transosseous suture and suture anchors to the use of screws, staples, or absorbable nails.

This technique paper describes the author's preferred technique involving an arthroscopic assisted reduction of the tibial spine fracture and transosseous suture fixation. High tensile nonabsorbable sutures are passed through the base of the ACL which are then passed through two 2.4 mm transosseous tunnels tied over a bone bridge on the anterior medial tibia.

An arthroscopic approach has been reported to have similar positive outcomes when compared to open reductions. Furthermore, the transosseous suture construct has been described to be advantageous biomechanically and to yield satisfactory results when compared to alternative fixation options.