Arthrofibrosis after Surgical Fixation of Tibial Eminence Fractures in Children and Adolescents

Abstract

Background Tibial eminence fractures are rare injuries in children and adolescents. Displaced fractures require reduction and fixation. Operative stabilization can be accomplished with either open or arthroscopic reduction and fixation. Whereas loss of extension has been reported, there are no reports in the literature that quantify loss of motion or provide guidance for treatment. Purpose To report a series of patients who developed knee stiffness after operative treatment for displaced tibial eminence fractures. Study Design Case series; Level of evidence, 4. Methods Review of medical records and imaging studies of pediatric patients with displaced tibial eminence fractures who developed arthrofibrosis after surgical intervention. Results Thirty-two patients were identified. Twenty-four required reoperation for loss of flexion (n = 9), loss of extension (n = 4), or both (n = 11). Manipulation under anesthesia resulted in distal femoral fractures and subsequent growth arrest in 3 patients. Twenty-nine patients were able to achieve near full knee motion at final follow-up. Conclusions Children with tibial spine fractures are at risk for arthrofibrosis. Stabilization of the fracture is important to allow early postoperative rehabilitation. Should stiffness occur, manipulation of the knee should be performed only in conjunction with lysis of adhesions.