Tibial intercondylar eminence fractures

Abstract

Tibial intercondylar eminence fractures occur in all age groups, but they are seen more commonly in children. They are equivalent to to an avulsion injury of the anterior cruciate ligament, which helps to stabilize the knee joint from within. The relative weakness of this ligament's junction with the bone in the young athlete, in comparison to the strength of the ligament itself, leaves this area at particular risk for injury. In adults, where the insertion of the anterior cruciate ligament has ossified, eminence fractures are frequently the result of high-energy trauma and represent a more serious injury. A careful history and physical exam must be performed to rule out associated injuries, especially ligamentous instability. All nondisplaced or minimally displaced fractures are treated by casting in extension. Complete avulsion fractures should be treated with examination under anesthesia followed by arthroscopy to evaluate the fracture and associated injuries. If possible, arthroscopic fixation should be performed. If arthroscopic repair is not possible, an open reduction through a median parapatellar approach can be performed. Fixation with either arthroscopic or open approaches may be with suture, screws, or bioabsorbable tacks. Immobilization must be individualized depending on the stability of the fixation, but in general we recommend four weeks of immobilization in a cylinder cast with the knee in extension followed by 4 weeks in a brace. Physical theraphy is started at 4 weeks. With early identification and appropriate intervention, most patients can expect excellent long-term results.