Meyers-McKeever type 4 tibial spine avulsion – Arthroscopic reduction and fixation using tibial tunnels: A helpful technique to treat a challenging fracture

Abstract text (incl. references and figure legends)

Case History: Tibial spine fractures are intra-articular fractures involving the anterior cruciate ligament (ACL) bony insertion. They occur in the paediatric population, usually 8-14 years old, typically during sports activity. Modified Meyers and McKeever Classification is often used to categorize severity and define treatment. This clinical case shows a 13-year-old male, who sustained right knee hyperextension trauma, resulting in a type 4 tibial spine avulsion. Clinical Findings: Immediate inability for weightbearing and knee effusion occurred after trauma. Marked swelling and effusion were observed, and mobilization elicited disabling pain. Joint aspiration confirmed hemarthrosis. X rays showed a tibial spine fracture. CT scan revealed a displaced, comminuted and rotated fragment – hence, a type 4 Meyers and McKeever fracture. Results: Knee arthroscopy was performed, which showed partial intermeniscal ligament injury but excluded meniscal injury. The fracture site was debrided, arthroscopic reduction was performed and provisional fixation achieved with a K wire. Pull-out technique was chosen for definitive fixation: sutures were passed through the ACL" distal fibres, then two tibial tunnels were drilled – from which the sutures were passed and tied. Reduction of smaller comminuted fragments was achieved due to their common ACL ligament insertion. Therapy and Progressions: After surgery, the patient was immobilized with an extension brace for 1 week. He then went through physical therapy protocol for typical ACL surgery with gradual recovery until full return to sports at 6 months, with full range-of-motion and no pain. Comments: Surgical treatment is usually reserved for non-reduceable, displaced fractures. Arthroscopic treatment has risen in popularity due to being less invasive, providing diagnosis of associated intra-articular injuries, and various treatment options. Using the ACL as means of fracture fixation is a valid tool to treat type 4 fractures.

Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.)

No.