A Suture Fixation Technique for Tibial Spine Avulsion Injuries

Introduction: Tibial spine fractures typically occur in skeletally immature patients between 8 and 14 years of age. Surgical treatment is generally pursued for displaced fractures that cannot be reduced with closed manipulation. Recent biomechanical evidence favors suture fixation over screw fixation. Current suture-only techniques largely revolve around double-crossed suture configuration and lack a description regarding a form of secondary fixation. The purpose of this manuscript is to describe 2 additions to the existing suture-only techniques for pediatric tibial spine avulsion injuries. Materials and Methods (Surgical Technique): Our technique involves a U-pattern and an X-pattern suture configuration for the primary fixation. Secondary fixation is achieved with an extra-articular knotless anchor. Results: This technical write-up describes a suture fixation technique for pediatric tibial spine injuries. Discussion: There has been a shift in the literature toward suture fixation over screw fixation in cartilaginous and comminuted tibial spine avulsion injuries. In this article, we describe an arthroscopic suture fixation technique. The proposed benefits include better anatomic reduction of the fracture and improved force dissipation. Suture fixation is not without complications, namely residual laxity, which can be minimized through the use of a self-tension/continuous compression suture.