# A Novel Physeal-Sparing Fixation Technique for Tibial Eminence Fractures in Paediatric Patients

## TL;DR

A new surgical technique was developed to safely fix tibial eminence fractures in children without damaging their growth plates, showing promising short-term results.

## Contribution

A novel physeal-sparing fixation technique for tibial eminence fractures in children that avoids growth plate injury.

## Key findings

- All 12 patients achieved satisfactory fracture reduction and healing within six weeks.
- No patients experienced postoperative complications or growth-plate damage.
- All patients returned to their preinjury activity level within six months.

## Abstract

Introduction

Tibial eminence fractures are common knee injuries in paediatric patients. They are an uncommon cause of knee injury that is associated with effusion, and most frequently present in the paediatric population. These injuries affect knee stability. Surgical management is challenging and associated with risks and complications due to the direct relation to the proximal tibial growth plate. We developed a new physeal-sparing technique to fix these fractures while avoiding any violation of the proximal tibial growth plate.

Materials and methods

This new technique involves transfixing the avulsed tibial eminence using multiple non-absorbable high-tension sutures passed through the anterior cruciate ligament (ACL) in a crossed fashion, then creating subcapsular tracts deep to the anterior capsule, passing the sutures through these tracts, and securing them to the anterior tibial surface distal to the growth plate using anchors. Post-operative adjustable knee brace was applied, and patients were allowed to fully weight bear with crutches, and a full range of motion was allowed. All patients were referred to rehabilitation for cryotherapy, quadriceps muscle strengthening, and passive and active range-of-motion exercises postoperatively for six weeks; thereafter, resisted closed-chain exercises were commenced for three months before return to sports. All patients were followed for two years using clinical assessment, serial radiographs, and Lysholm scores.

Results

Twelve patients who were acutely referred to our clinic underwent this new tibial eminence fixation technique between 2020 and 2023. All patients had type III or IV tibial eminence fractures according to the modified Meyers and McKeever classification. At presentation, all had swollen knees with limited range of motion and demonstrated positive Lachman and anterior drawer tests when examined under anaesthesia. Arthroscopy confirmed the diagnosis, and all fractures were fixed using No. 2 FiberWire sutures (Arthrex, Naples, FL, USA) in a crossed fashion, secured to the tibia distal to the physis with two 4.5-mm SwiveLock anchors (Arthrex). Reduction was performed before fixation, and satisfactory reduction was achieved in all cases. Postoperatively, all patients had intact neurovascular examinations and were able to start quadriceps strengthening and range-of-motion exercises in the first week. None developed early or late postoperative complications, and all showed signs of healing on radiographs by six weeks, allowing initiation of resisted exercises. All patients returned to their preinjury level by six months, and none showed clinical or radiographic evidence of growth-plate injury or arrest.

Conclusions

This novel physeal-sparing tibial eminence fixation technique has shown that it is a safe fixation method with no short-term complications and has achieved healing in all patients who had the procedure. Further long-term studies and clinical trials are required to compare the results with other fixation methods that are currently in use.